Injectable anti-obesity medications in specialist weight management services: supporting people with complex needs
Overview
Organisation: Somerset NHS Foundation Trust, Musgrove Park Hospital
Organisation type: NHS Foundation Trust
The introduction of anti-obesity medications
Liraglutide was recommended by NICE in December 2020 and became available for prescription through specialist weight management services. This service was the first in the UK to begin prescribing it in early 2021. The clinical team was committed to providing this treatment to as many eligible people as possible, but they identified the need for additional staffing to support and monitor people throughout their treatment journey. At the time, there was a shortage of dietitians, which further highlighted the challenge. NICE's guidelines emphasise the importance of ongoing monitoring to assess the medication's effects, as well as reinforcing behavioural advice and ensuring adherence through regular reviews.
The team was aware that NICE was expected to recommend additional anti-obesity medications such as semaglutide. Given the complexities of dose escalation, high prescription volumes, and the need for wrap around care, the team recognised the importance of seamless coordination. Additionally, dispensing from a hospital pharmacy serving a geographical area spanning over 4,000 km2 posed unique logistical challenges. To meet these demands, they had to adapt their service model to ensure safe and effective prescribing of the medications.
The complex nature of patients
The need for additional staff was especially critical due to the complex nature of the people they served. Of around 900 referrals a year, many include people with neurodiversity, mental health problems, significant past trauma leading to post-traumatic stress disorders (PTSD), eating disorders, and more. For most of these people, bariatric surgery is not suitable. With the introduction of pharmacological treatments, the clinical team was cautious about prescribing these without having proper support in place. NICE's guidelines highlight the importance of providing equitable access to services for individuals with learning disabilities or autism, emphasising person-centred care.
In Somerset West and Taunton, it is estimated that 1 in 7 people exhibit neurodiversity, which could equate to 14% of their referrals. In 2024, they saw 20 people (3%) with learning disabilities alone. Unfortunately, data was not available for referrals related to other neurodiverse conditions.
According to NHS Digital's 2024 experimental statistics on the health and care of people with learning disabilities:
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37% of people with learning disability are classified as living with obesity. This is greater than those without learning disability (30.1%)
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the percentage of people who have a learning disability and an ADHD diagnosis has nearly doubled (from 5.5% in 2017/18 to 9.0% in 2023/24)
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the percentage of people who have a learning disability and an autism diagnosis has increased from 21.4% in 2017/18 to 33.3% in 2023/24
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the percentage of people who have a diagnosis of autism has increased from 0.5% in 2017/18 to 1.2% in 2023/24.
Genetic testing for obesity
NICE recommends setmelanotide for treating obesity in adults caused by the deficiency of certain genes (LEPR or POMC). The team noticed several people who had not previously undergone genetic testing. To investigate genetic causes of obesity, testing was arranged to allow for further personalisation of treatment and care as well as to identify potential eligibility for ongoing clinical trials.
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