Obesity Abstracts

Background: Tier 3 bariatric services provide multidisciplinary support for individuals with severe obesity, focusing on medical optimization, behavioral interventions, and preparation for potential bariatric surgery. Evaluating patient outcomes, pathway retention, and service performance is essential to understand program effectiveness and inform future obesity management strategies.

Method: A retrospective analysis was conducted on all patients referred to a Tier 3 bariatric program from January 2022 to December 2023. Data collected included referral numbers, discharge outcomes, multidisciplinary team (MDT) decisions, surgical referrals, active cases, and reasons for discontinuation from the program. Success in completing the pathway was defined as either referral for bariatric surgery or discharge after achieving a weight loss of more than 5% during the program. Patients who dropped out were categorized based on non-attendance, voluntary withdrawal, or ineligibility for surgery. Active cases at the end of the year were also included to evaluate ongoing patient engagement and the overall performance of the service.

Results: A total of 229 patients were referred in 2022 and 304 in 2023. Successful completions were 55 (24.0%) in 2022 and 28 (9.2%) in 2023. Active cases numbered 5 in 2022 and 83 in 2023. When combining completed and active cases, pathway retention improved from 26.2% in 2022 to 36.5% in 2023, demonstrating increased patient engagement. Patients referred for bariatric surgery decreased from 48 in 2022 to 23 in 2023, reflecting changing patient choices and suitability criteria. Common reasons for leaving the program included non-attendance, preference for weight loss injections, pregnancy, smoking, and other medical or personal factors. Diabetes prevalence decreased from 66 patients in 2022 to 29 in 2023, with notable reductions in type 2 diabetes and pre-diabetes cases. Gender distribution remained predominantly female, and obstructive sleep apnoea prevalence declined.

Conclusion: This analysis demonstrates that while surgical referrals declined, the overall engagement and retention of patients within the Tier 3 pathway improved over the two-year period. Active pathway monitoring highlights the importance of supporting patients who are still progressing through the program. Addressing barriers such as non-attendance and treatment preference is essential to optimize service delivery. These findings support continued evaluation of Tier 3 bariatric services to enhance patient outcomes, inform multidisciplinary practice, and contribute to the development of national obesity management strategies.