Type 2 diabetes is an independent predictor of weight loss in Tier 3 Weight Assessment and Management Services

Aliya Syahreni Prihartadi*, Giovanna Impelliziere Licastro*, Harshal Deshmukh, Sufyan Benamer, Kyaw Linn, Najeeb Shah, Thozhukat Sathyapalan, Kamrudeen Mohammed


Introduction: A specialist weight management service provides an effective treatment option for severe obesity; however, there are limited data exploring the baseline predictors of response and effect on HbA1c following engagement with the service.

Methods: We used prospective data from the regional weight management services within the Hull University Teaching Hospitals NHS Trust Tier 3 Obesity Programme. Data were available for 249 patients referred to the service. T-tests were used for univariate baseline characteristics of those with and without 5% weight loss after engagement with the service. Logistic regression analysis was used to identify independent predictors of weight loss at 12 months.

Results: A total of 309 patients were referred to the Tier 3 adult weight management service, of which 249 (80.6%) participated in the programme and had at least one follow-up. The median age of the study population was 46 years (range 36–55) and consisted of 66% females with a median baseline body mass index of 44 kg/m2 (range 42–45). The prevalence of type 2 diabetes was 31%, hypertension was 35%, gastro-oesophageal reflux disease was 34% and osteoarthritis was 29%. The median baseline weight on enrolment in the programme was 126 kg (range 115–138). During the follow-up period of 1 year, the median weight fell to 120.5 kg at 3 months, 119.6 kg at 6 months, 117.7 kg at 9 months and 117.5 kg at 12 months. The median HbA1c fell from a baseline of 60.25 mmol/mol to 54.4 mmol/mol during the follow-up period. Sixty-four patients had a baseline HbA1c of >53 mmol/mol (7% HbA1c), which fell to <53 mmol/mol in 21% of patients during the follow-up period. In the logistic regression model, higher age (OR 1.05, p=0.0001), type 2 diabetes (OR 2.54, p=0.002) and dyslipidaemia (OR 2.21, p=0.03) were independently associated with more than 5% weight loss at 12 months follow-up.

Conclusion: Engagement with Tier 3 adult weight management is associated with significant weight loss and improvement in glycaemic control in a large proportion of patients at one year. Higher age, diabetes and dyslipidaemia at baseline are independent predictors of weight loss on the Tier 3 weight management service.


Tier 3 weight management, weightwise, BMI, obesity, diabetes, HbA1c, predictors of weight loss

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Alkharaiji M, Anyanwagu U, Donnelly R, Idris I. Tier 3 specialist weight management service and pre-bariatric multicomponent weight management programmes for adults with obesity living in the UK: a systematic review. Endocrinol Diabetes Metab 2019;2(1):e00042. https://doi.org/10.1002/edm2.42

Blane DN, McLoone P, Morrison D, Macdonald S, O'Donnell CA. Patient and practice characteristics predicting attendance and completion at a specialist weight management service in the UK: a cross-sectional study. BMJ Open 2017;7(11):e018286. https://doi.org/10.1136/bmjopen-2017-018286

Brown A, Gouldstone A, Fox E, et al. Description and preliminary results from a structured specialist behavioural weight management group intervention: Specialist Lifestyle Management (SLiM) programme. BMJ Open 2015;5(4):e007217. https://doi.org/10.1136/bmjopen-2014-007217

Brown TJ, O'Malley C, Blackshaw J, et al. Exploring the evidence base for Tier 3 weight management interventions for adults: a systematic review. Clin Obes 2017;7(5):260−72. https://doi.org/10.1111/cob.12204

Caci G, Albini A, Malerba M, Noonan DM, Pochetti P, Polosa R. COVID-19 and obesity: dangerous liaisons. J Clin Med 2020;9(8). https://doi.org/10.3390/jcm9082511

Caussy C, Wallet F, Laville M, Disse E. Obesity is associated with severe forms of COVID-19. Obesity (Silver Spring) 2020;28(7):1175. https://doi.org/10.1002/oby.22842

Ross HM, Laws R, Reckless J, Lean M and Counterweight Project Team. Evaluation of the Counterweight Programme for obesity management in primary care: a starting point for continuous improvement. Br J Gen Pract 2008;58(553):548−54. https://doi.org/10.3399/bjgp08X319710

Crowe C, Gibson I, Cunningham K, et al. Effects of an eight-week supervised, structured lifestyle modification programme on anthropometric, metabolic and cardiovascular risk factors in severely obese adults. BMC Endocr Disord 2015;15:37. https://doi.org/10.1186/s12902-015-0038-x

Haslam DW, James WP. Obesity. Lancet 2005;366(9492):1197−209. https://doi.org/10.1016/S0140-6736(05)67483-1

Homer CV, Tod AM, Thompson AR, Allmark P, Goyder E. Expectations and patients' experiences of obesity prior to bariatric surgery: a qualitative study. BMJ Open 2016;6(2):e009389. https://doi.org/10.1136/bmjopen-2015-009389

Jackson SE, Beeken RJ, Wardle J. Perceived weight discrimination and changes in weight, waist circumference, and weight status. Obesity (Silver Spring) 2014;22(12):2485−8. https://doi.org/10.1002/oby.20891

Lavie CJ, Milani RV, Artham SM, Patel DA, Ventura HO. The obesity paradox, weight loss, and coronary disease. Am J Med 2009;122(12):1106−14. https://doi.org/10.1016/j.amjmed.2009.06.006

Lean ME, Leslie WS, Barnes AC, et al. Primary care-led weight management for remission of type 2 diabetes (DiRECT): an open-label, cluster-randomised trial. Lancet 2018;391(10120):541−51. https://doi.org/10.1016/S0140-6736(17)33102-1

Lean MEJ, Leslie WS, Barnes AC, et al. Durability of a primary care-led weight-management intervention for remission of type 2 diabetes: 2-year results of the DiRECT open-label, cluster-randomised trial. Lancet Diabetes Endocrinol 2019;7(5):344−55. https://doi.org/10.1016/S2213-8587(19)30068-3

Logue J, Allardice G, Gillies M, Forde L, Morrison DS. Outcomes of a specialist weight management programme in the UK National Health Service: prospective study of 1838 patients. BMJ Open 2014;4(1):e003747. https://doi.org/10.1136/bmjopen-2013-003747

MacLaughlin HL, Hall WL, Condry J, Sanders TA, Macdougall IC. Participation in a structured weight loss program and all-cause mortality and cardiovascular morbidity in obese patients with chronic kidney disease. J Ren Nutr 2015;25(6):472−9. https://doi.org/10.1053/j.jrn.2015.05.001

Matsuda M, Shimomura I. Increased oxidative stress in obesity: implications for metabolic syndrome, diabetes, hypertension, dyslipidemia, atherosclerosis, and cancer. Obes Res Clin Pract 2013;7(5):e330−341. https://doi.org/10.1016/j.orcp.2013.05.004

Nield L, Kelly S. Outcomes of a community-based weight management programme for morbidly obese populations. J Hum Nutr Diet 2016; 29(6):669−76. https://doi.org/10.1111/jhn.12392

Rowe R, Cowx M, Poole C, McEwan P, Morgan C, Walker M. The effects of orlistat in patients with diabetes: improvement in glycaemic control and weight loss. Curr Med Res Opin 2015;21(11):1885−90. https://doi.org/10.1185/030079905X74943

Russell GV, Pierce CW, Nunley L. Financial implications of obesity. Orthop Clin North Am 2011;42(1):123−7, vii. https://doi.org/10.1016/j.ocl.2010.09.003

Jackson SE, Beeken RJ, Wardel J. Predictors of weight loss in obese older adults: findings from the USA and the UK. Obes Facts 2014;7:102-10. https://doi.org/10.1159/000362196

Scheelbeek PFD, Cornelsen L, Marteau TM, Jebb SA, Smith RD. Potential impact on prevalence of obesity in the UK of a 20% price increase in high sugar snacks: modelling study. BMJ 2019;366:l4786. https://doi.org/10.1136/bmj.l4786

Wing RR, Lang W, Wadden TA, et al. Benefits of modest weight loss in improving cardiovascular risk factors in overweight and obese individuals with type 2 diabetes. Diabetes Care 2011;34(7):1481−6. https://doi.org/10.2337/dc10-2415

Wright F, Boyle S, Baxter K, et al. Understanding the relationship between weight loss, emotional well-being and health-related quality of life in patients attending a specialist obesity weight management service. J Health Psychol 2013;18(4):574−86. https://doi.org/10.1177/1359105312451865

DOI: https://doi.org/10.15277/bjd.2020.263


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