Published Data
Clinical Complexity in Specialist NHS Obesity Services: Real-World Applicability of the EASO Pharmacological Framework
The European Association for the Study of Obesity (EASO) recently published its pharmacological management framework, shifting focus from weight loss to targeted treatment of obesity-related complications. The framework distinguishes 'fat mass disease' (mechanical complications) from 'sick fat disease' (metabolic/inflammatory complications) to guide medication selection.
Authors:
Thomas Curtis1, Laura Falvey1, Claudia Ashton1, Hywel Room2, Adrian Brown3, Siri Steinmo4, Dipesh Patel5, Jonathan Kwan6, Barbara McGowan7
Affiliations:
1Reset Health Ltd, London, UK 2Colchester Hospital, East Suffolk and North Essex NHS Trust, UK 3University College London, London, UK 4UCLH, London, UK 5Royal Free Hospital, London, UK 6Darent Valley Hospital, Kent, UK 7Guys & St Thomas Hospital, London, UK
Background:
The European Association for the Study of Obesity (EASO) recently published its pharmacological management framework, shifting focus from weight loss to targeted treatment of obesity-related complications. The framework distinguishes 'fat mass disease' (mechanical complications) from 'sick fat disease' (metabolic/inflammatory complications) to guide medication selection. This study evaluates the prevalence of clinical complexity in a real-world, specialist NHS digital obesity service (Roczen) using the EASO algorithm.
Methods:
We conducted a retrospective analysis of 105 patients enrolled in a six-month digital specialist NHS obesity programme (Roczen, SNEE ICB - ESNEFT Complex Obesity Service). Patient demographics and comorbidities were identified from electronic health records through comprehensive review of coded data and clinical notes. We calculated the mean BMI, waist circumference, and number of comorbidities. Obesity-related complications (ORCs) were categorised according to EASO criteria: mechanical or ‘fat mass’ disease (obstructive sleep apnoea, osteoarthritis) and metabolic or ‘sick fat’ disease (prediabetes, type 2 diabetes, cardiovascular disease, heart failure, MASLD). Patients were grouped as: obesity without EASO-listed ORCs, mechanical only ORCs, metabolic only ORCs or mixed phenotype ORCs (both mechanical and metabolic). The prevalence of individual complications was also reported.
Results:
The cohort was predominantly female (79.0%, n=83) with mean age 54.7±12.5 years, mean BMI 47.1±10.3 kg/m², mean waist circumference 131.6±19.7 cm, and a mean of 7.0±3.4 documented all-cause comorbidities per patient. Mixed phenotype ORCs were observed in 32.4% (n=34). Metabolic-only ORCs were present in 21.9% (n=23), mechanical-only ORCs in 31.4% (n=33), and 14.3% (n=15) presented with obesity that did not have a currently listed EASO treatment framework condition. Among metabolic complications, prediabetes affected 23.8% (n=25) of patients, MASLD 15.2% (n=16), and type 2 diabetes 14.3% (n=15). Mechanical disease included osteoarthritis (44.8%, n=47) and obstructive sleep apnoea (38.1%, n=40). Depression or anxiety was documented in 45.7% (n=48), highlighting the need for holistic management as advocated by EASO.
Conclusion:
In this specialist NHS cohort, mixed-phenotype ORCs were most common (32.4%), with mean adiposity (BMI 47.1 kg/m²) and all-cause comorbidity burden (7.0±3.4 per patient) reflecting real-world complexity. These findings support the EASO framework's complication-focused approach and highlight the need for obesity services to provide adequate clinical time for comprehensive assessment and individualised treatment selection.