PROGROUP at the ASO Conference by Mia Alexander

General Overview of the Event

In November 2024, along with other members of the PROGROUP team, I attended the ASO South-West regional network event; a full-day gathering that focused on updates, successes, and challenges in both local and broader weight management. The event highlighted the evolving landscape of obesity treatment, with a particular emphasis on the growing visibility and use of weight loss drugs, particularly GLP-1 receptor agonists (RA’s). At the time of the event, semaglutide (WeGovy) was being prescribed within UK weight management, while tirzepatide (Mounjaro) was on the horizon.

Throughout the day, speakers made comparisons of weight management strategies across different countries, providing a global perspective on the issue. Additionally, the complexity of obesity was thoroughly explored, with presentations and discussions addressing not only the physical but also the emotional, behavioural, and societal factors involved.

Spectrum and Timing of Weight Management

A variety of weight management approaches were discussed, ranging from Tier 3 to Tier 4 services. Tier 3 services are NHS specialist weight management programmes run by multidisciplinary teams including psychologists and dieticians. Some individuals who complete Tier 3 may then progress onto Tier 4 which is weight loss surgery. Professor Jon Pinkney shared an update from the PROGROUP research project, which is investigating a Tier 3 group-based behavioural intervention grounded in the social identity approach.

Meanwhile, Professor Jane Blazeby provided insights into weight loss surgery options available to UK patients, highlighting that gastric bypass procedures tend to be more effective, although slightly less safe, compared to gastric sleeve surgery. In the UK, weight loss surgery is generally offered only to patients with a high body mass index (BMI). The perceived severity of the procedure and surrounding weight stigma can also deter patients from pursuing it. Professor Richard Welbourn contrasted this with Sweden, where weight loss surgery is offered to younger patients at lower BMI thresholds. Concerns were raised about the UK’s high obesity rates and comparatively low levels of weight loss surgery. Sweden’s system was seen as having “fewer hurdles,” reducing stigma and making access easier, as patients are not required to demonstrate an extensive weight management history. This presentation triggered discussions around potential access adaptations to the UK’s system.

Updates on Weight Loss Drugs

A key focus of the event was the expanding pharmacotherapy options for obesity treatment. Professor Jon Pinkney and Irena Cruickshank shared updates based in their clinical expertise and key clinical trials. Jon emphasized the behavioural implications of GLP-1s, discussing the importance of effective behavioural change interventions and encouraging the audience to consider the best order in which to deliver weight management strategies. He also touched on the neural systems, including reward pathways, influenced by GLP-1 RA’s. Interestingly, there were observed reductions in alcohol use among some patients taking GLP-1 RA’s.
Beyond the biomedical and behavioural effects of these drugs, Jon also raised concerns about patients who may not enjoy their lives while on weight loss drugs, especially due to a lack of food enjoyment.

Irena highlighted her concerns around the real-world application of weight loss drugs in stretched weight management settings. These included lacking support provision to help patients cope with the side effects of weight loss drugs and communication issues between pharmacies and weight management services. This stressed a need for established pathways and protocols within weight management to adequately support patients taking weight loss drugs.

Online Weight Management Provision

The tension between online weight management providers and local specialist teams was also a major topic of discussion. Online services often offer much shorter wait times—weeks compared to the years some patients face when trying to access specialist weight management. As a result, some Integrated Care Boards (ICBs) have outsourced weight management services to online providers, causing frustration among local teams. The event underscored the importance of collaboration between online and local specialist services to meet the diverse needs of patients. For instance, while digital services may be a good fit for some patients due to quicker and easier access, those with more complex needs—such as those requiring Tier 4 surgical services—may be better served by local specialist weight management teams.

Challenges in Obesity Services

In the afternoon, Dr Kai Tan and Dr Hassan Kahal discussed the gap between demand and capacity in obesity services, drawing attention to ongoing funding issues. Leaders of local specialist weight management services expressed concerns about their ability to meet the needs of an increasing number of patients with limited resources. Just over 50% of ICBs commission Tier 3 services, and funding has not been adjusted to account for the growing demand for their services.

Looking Ahead

Over the past few years, the four specialist weight management services in Devon have collaborated to create standardised county-wide specification for services, which includes referral guidelines and criteria for expedited referrals, as well as supporting documents. A task-and-finish group has been set up to explore how best to triage patients and how this process could integrate with private providers. The actions of this group reflect and act upon some of the common issues highlighted by Devons weight management representatives throughout the event.

Reflection

Overall, I found the event very stimulating due the presenters’ passion for delivering the best quality care while navigating a quickly changing treatment landscape. Their sensitivity to the complex needs of their patients was also evident. Such a broad range of topics were covered in one day, with questions both answered and asked. I look forward to the next regional network event to understand how local weight management services solved the challenges presented here.