Parallel session
Chair, Helen Ashby
Hormones from the GI tract play key roles in regulation of digestion, metabolism and food intake. Key players that signal satiety include cholecystokinin, peptide YY, in the incretin hormones glucagon like peptide 1 (GLP1) and GIP, whereas ghrelin from the stomach stimulates food intake. Although abnormalities of the hormones are sometimes seen in obesity, it is unlikely they are a major cause. Analogues of GLP1 have been used for the treatment of type 2 diabetes for many years and consistently result in modest weight loss of 3-5% of body weight. At higher doses great weight loss is seen and is of clinical value in the treatment of obesity. The GLP1 receptor agonist (RA) liraglutide 3mg, given by daily subcutaneous injection, has been available for some time and results in weight loss of about 8% in clinical trials. The recent approval of semaglutide 2.4mg weekly represents a major advance in efficacy. In clinical trials, semaglutide results in weight loss of 15% or more in more than half the patients treated and is associated with improvements in glucose control in diabetes, cardiovascular risk factors, reduced cardiovascular events in high-risk patients as well as quality of life. Adverse events of nausea tend to resolve over time with gradual dose titration. Even greater weight loss, as GLP1 RAs are combined with other gut hormone analogues; tirzepatide targets both GLP1 and GIP reduces weight by 20% at the highest dose and has been shown to have benefit in sleep apnoea as well as improving glucose metabolism and cardiovascular risk factors. Others, such as the amylin analogue cagrilintide, used in combination with semaglutide, and triple agonists that target GLP1, GIP and glucagon, such as retadrutide, are also looking promising. Oral options including semaglutide and the small molecule orforglipron are likely to be approved for clinical use imminently. These rapid advances allow treatment for many people living with obesity & are now approaching the efficacy seen with surgical approaches.
Learning outcomes:
Metabolic bariatric surgery (MBS) stands as the most effective intervention for severe obesity, offering profound and sustained weight loss alongside improvements in weight-related comorbidities. Despite these benefits, all forms of MBS influence nutritional status to varying extents. Hence, without appropriate management, there is a risk of developing clinically significant nutritional deficiencies.
In recent years, randomised clinical trials have demonstrated that glucagon-like peptide-1 receptor agonist (GLP-1 RA) pharmaceutical treatments can yield placebo-adjusted weight reductions ranging from 5% to 18% for individuals with obesity or overweight. Beyond facilitating weight loss, these therapies provide additional clinical advantages, including cardiovascular, hepatic, and renal benefits that occur independently of weight reduction. Their efficacy and clinical data have generated enormous interest and utilisation of GLP-1 RA and combination treatments. Nevertheless, there remains a gap in understanding regarding the impact of these agents on nutrient intake and associated complications. Furthermore, real-world challenges, combined with limited awareness among clinicians and the general public on nutritional and lifestyle interventions, may restrict the effectiveness, clinical outcomes and cost-efficiency of GLP-1 RA therapies.
This session will explore evidence-based nutritional strategies to address key challenges around MBS procedures and GLP-1 RA based therapies for those with severe obesity.
Learning outcomes:
Post-bariatric hypoglycaemia (PBH) is a condition that commonly affects people who have undergone weight loss surgery. In this condition, people develop low blood sugar occurring about 2–4 h after meals, leading to debilitating symptoms such as hunger, sweating, anxiety, palpitations and even blackouts and fainting. PBH is becoming more common as weight loss surgery is being taken up by more people to help with their weight and to help with diabetes. The condition often develops after the patient has been discharged from follow-up after their surgery, which can lead to inconsistent diagnosis and treatment in non-specialist healthcare centres. The lack of clear information and evidence in the existing scientific literature further contributes to the variation in care. To address this problem, the Society for Endocrinology has created new guidelines to help healthcare professionals accurately diagnose and manage this condition. The guidelines were developed with input from dietitians, surgeons and doctors specialising in weight loss, and hormone specialists. Dr Hazlehurst presents these guidelines as well as new developments in this field.
Learning outcomes:
John Wilding leads clinical research into obesity, diabetes and endocrinology at the University of Liverpool, where he has worked since 1996, after training in Southampton and London.
His clinical interests focus on caring for people with diabetes and obesity and he leads specialist services for obesity at Aintree University Hospital – designated centre for Obesity Management by the UK and European Associations for the Study of Obesity.
John’s research team focusses on developing and evaluating treatments for obesity and type 2 diabetes. He has published over 400 papers, chapters and review articles, including clinical trials in diabetes and obesity, as well as studies of adipocyte biology and metabolism.
He has advised NICE and NHS England on various aspects of obesity care. He was previously Chair of UK Association for the Study of Obesity and is a past President of the World Obesity Federation.
Royce Vincent is a Consultant chemical pathologist at King’s College Hospital NHS Foundation Trust in London and an Adjunct senior lecturer within the Faculty of Medicine and Life Sciences at King's College London.Vincent is also a Strategic clinical lead for South East London Pathology services (Synnovis: a collaborative partnership between Guy’s, St Thomas’, and King’s College Hospital NHS Foundation Trusts, together with SYNLAB UK & Ireland).
His postgraduate education includes specialist training in Chemical Pathology/Metabolic Medicine as well as clinical research, undertaken at King's College Hospital and Imperial College London. Vincent was awarded a Master’s degree by University College London in 2008 and completed his research Doctorate at Imperial College London in 2012.
Vincent’s primary clinical interests encompass bariatric medicine, clinical nutrition, and endocrinology. He serves as Chief or Principal investigator in a number of landmark randomised clinical trials, particularly those focusing on major adverse cardiovascular events (MACE) and obesity, including studies such as SELECT, REDEFINE-1 and ZEUS.
Demonstrating a strong commitment to research, Vincent has secured numerous research grants, has an extensive publication record and acts as Editor for various peer-reviewed journals.
Jonathan Hazlehurst is a Clinical academic at the University of Birmingham and runs the large specialist weight management service at Birmingham Heartlands Hospital. He studied medicine and a DPhil at the University of Oxford.
His academic interests include clinical trials as well as mapping work to improve access to obesity services and a wide range of academic and commercial studies. He speaks and publishes widely in these areas.
More recently he is part of several NIHR funded studies looking at long term outcomes of thyrotoxicosis treatment, prediction models for type 2 diabetes remission following bariatric surgery and an OLS i4i grant looking at digital provision of weight management services.
Jonathan is 1st author of the national guidance on postbariatric hypoglycaemia. He works closely with his ICB to try to turn NICE guidance and technology appraisals into clinical reality for patients and understands the full challenge in this area as well as the potential opportunities and pitfalls associated with digital services.
He is a passionate advocate for patient first language and is proud to provide ongoing support for patient advocates as part of ECPO as well as training and support colleagues in obesity.
