Obesity-related complications, healthcare resource use and weight loss strategies in six European countries: the RESOURCE survey

Study population and demographic characteristics

In total, 25,686 people were invited to take part in the survey. Of the 1850 eligible individuals who completed the survey, 1042 participants (56.3%) were in obesity class I, 496 (26.8%) in obesity class II and 312 (16.9%) in obesity class III. The mean age was 52.9 years (SD: 13.9) and 963 participants were women (52.1%). Most participants were Caucasian (n = 1665; 90.0%) and the majority (n = 1242; 67.1%) reported obtaining treatment via their country’s national health service. Table 1 shows demographic characteristics for the whole population, by obesity class and by number of ORCs.

Table 1 Demographic characteristics for participants in the RESOURCE survey.

Demographic characteristics were generally similar across obesity classes, although there was a greater proportion of women in the higher compared with the lower obesity classes (class I: 46.5%; class II: 56.2%; class III: 63.8%). Compared with those who had fewer or no ORCs, participants with an increasing number of ORCs were likely to be older: mean age for those with no ORCs was 45.6 years (SD: 13.0), compared with 59.3 years (11.4) for those with ≥3 ORCs. Participants with more ORCs were also more likely to be men (0 ORCs: 60.5% women; 1 ORC: 54.2%; 2 ORCs: 46.4%; 3 ORCs: 45.7%). Demographic and clinical data by country are provided in Supplementary Table S3.

Distribution of ORCs

Nearly 75% of participants had at least one of the 15 ORCs assessed in this study. In total, 526 (28.4%) had 1 ORC, 362 (19.6%) had 2 ORCs and 486 (26.3%) had ≥3 ORCs; 476 participants (25.7%) reported no ORCs (Table 1). When all of the approximately 50 comorbidities listed in the survey were accounted for, 132 participants (7.1%) reported no comorbidities at all. Higher obesity classes tended to have more ORCs: 242 participants with class I obesity (23.2%) had ≥3 ORCs, compared with 130 participants with class II obesity (26.2%) and 114 with class III obesity (36.5%). Supplementary Table S3 includes data on number of ORCs by country.

The most frequent ORC was hypertension, which was reported by 39.3% of all participants (n = 727; Fig. 1a). Other frequently reported ORCs were dyslipidaemia (n = 422; 22.8%), T2D (n = 323; 17.5%) and osteoarthritis (n = 297; 16.1%). Some ORCs were reported by more participants in higher rather than lower obesity classes. Rates of obstructive sleep apnoea were >2.5 times higher for obesity class III than for class I, rates of T2D were nearly double and rates of osteoarthritis were ~1.5 times higher. Rates of hypertension, musculoskeletal pain and urinary incontinence were also notably higher for each increasing obesity class (Fig. 1a). In general, the ORCs most frequently reported by all participants were also the most frequent in participants with multiple ORCs. For example, 51.7% of participants with 2 ORCs (n = 187) and 78.4% of those with ≥3 ORCs (n = 381) had hypertension, and these proportions were 30.7% (n = 111) and 56.0% (n = 272) for dyslipidaemia (Fig. 1b). Supplementary Table S4 shows the numbers of participants reporting each ORC, by obesity class and number of ORCs.

Fig. 1: ORCs reported in the RESOURCE survey.figure 1

a obesity class and b number of ORCs. ASCVD, atherosclerotic cardiovascular disease; CKD, chronic kidney disease; GERD, gastro-oesophageal reflux disease; ORC, obesity-related complication; PCOS, polycystic ovary syndrome.

Healthcare resource use

In the preceding 12 months, 334 survey participants (18.1%) had experienced at least one inpatient admission (hospitalization), for any reason. Similar proportions of obesity classes I, II and III had experienced hospitalization (19.4%, 15.7% and 17.3%, respectively; Supplementary Table S5). In contrast, participants with more ORCs reported higher rates of hospitalization than those with fewer or no ORCs. Overall, 13.4% of participants with no ORCs had been hospitalized in the past year, compared with 15.4% of those with 1 ORC, 16.3% of those with 2 ORCs and 26.7% of those with ≥3 ORCs (Supplementary Table S5). Participants with any number of ORCs were significantly more likely to report hospitalization than those with no ORCs (Table 2); those with ≥2 ORCs were more than twice as likely to have experienced hospitalization (OR: 2.18 [95% CI: 1.57–3.06]; P < 0.001) and those with ≥3 ORCs were ~3 times more likely to have experienced hospitalization (OR: 2.98 [95% CI: 2.08–4.30]; P < 0.001). Of the survey participants who reported an inpatient admission, most reported that the admission had been preceded by a visit to the emergency department (n = 207; 62.0%).

Table 2 ORs for risk of reporting hospitalization or surgery, by number of ORCs.

For all survey participants, the mean number of nights spent in hospital for any reason in the past 12 months was 1.3 (SD: 6.9; n = 1838). There appeared to be no relationship between obesity class and mean (SD) number of nights spent in hospital (1.4 [7.8]; 0.8 [4.4]; 1.6 [7.3] for the three classes, respectively), but participants with more ORCs had spent more nights in hospital than those with fewer or none (0 ORCs: 0.6 [3.1]; 1 ORC: 0.8 [4.4]; 2 ORCs: 1.7 [11.1]; ≥3 ORCs: 2.0 [7.7]).

In the preceding 12 months, 319 participants (17.2%) had undergone any surgical procedure, and these proportions were similar across obesity classes I, II and III (17.6%, 17.5% and 15.7%, respectively; Supplementary Table S5). In the group with no ORCs, 14.1% of participants reported a surgical procedure, compared with 15.8% of those with 1 ORC, 14.6% of those with 2 ORCs and 23.9% of those with ≥3 ORCs (Supplementary Table S5). Compared with participants who had no ORCs, participants with ≥2 ORCs (OR: 1.45 [95% CI: 1.05–2.03]; P = 0.027) or ≥3 ORCs (OR: 1.87 [95% CI: 1.31–2.69]; P < 0.001) were significantly more likely to report undergoing a surgical procedure (Table 2).

Most participants had received at least one prescription treatment in the past 12 months (n = 1478; 79.9%). This was driven largely by participants with ORCs: a minority of participants with no ORCs had been prescribed a treatment in the past 12 months (43.7%), but rates were much higher for those with at least one ORC (1 ORC: 86.5%; 2 ORCs: 93.9%; ≥3 ORCs: 97.7%).

Participants were asked if they had received a treatment administered by a healthcare professional in a healthcare setting, such as treatments administered via injection or intravenous drip, radiotherapy or physiotherapy. Overall, 596 participants (32.2%) had received at least one such treatment in the past 12 months. This proportion increased slightly with obesity class (class I: 29.8%; class II: 34.5%; class III: 36.5%), but had a stronger relationship with number of ORCs (0 ORCs: 18.7%; 1 ORC: 32.1%; 2 ORCs: 34.8%; ≥3 ORCs: 43.6%).

Weight loss strategies

Overall, 1050 participants (56.8%) reported that they had received a diagnosis of overweight or obesity, or were currently receiving treatment for weight loss or management. A minority of these participants (n = 161; 15.3%) reported receiving a prescription medication for weight management, the majority of whom had received this from a general practitioner (n = 95; 59.0%) or a dietician (n = 57; 35.4%) in a primary care setting (n = 93; 57.8%) or a weight management clinic (n = 54; 33.5%).

The majority of participants (n = 1454; 78.6%) reported that they had attempted to lose weight in the past year. This proportion was similar for obesity classes I (n = 807; 77.4%), II (n = 397; 80.0%) and III (n = 250; 80.1%). Most participants had attempted only one strategy (n = 851; 58.5%). The most frequently reported weight loss strategy was a calorie-controlled or restricted diet (n = 1046; 71.9% of participants; Fig. 2 and Supplementary Table S6), and the second most frequent was an exercise programme or course, reported by a much smaller proportion of participants (n = 318; 21.9%). Overall, 81% of those who had attempted to lose weight used diet and/or exercise strategies. The distribution of weight loss strategies was similar across obesity classes. Use of pharmaceutical treatment or medication was reported most frequently in obesity class III (class I: 11.4%; class II: 11.8%; class III: 16.0%), as was use of a weight loss service (5.7%, 8.3% and 12.4%, respectively); however, overall rates of these strategies in the study population were low, at 12.3% and 7.6%, respectively.

Fig. 2: Weight loss strategies reported by survey participants.figure 2

Digital health application refers to an application specifically for weight management. Alternative treatments include dietary supplements or herbal products. Weight loss service refers to both commercial services and programmes provided by the national health service.

Weight loss

Overall, data on estimated weight changes during the past 12 months were available for 1753 participants (94.8%), and of the 1454 participants who reported attempting weight loss via one or more strategies, weight change data were available for 1383 people (95.1%). Overall, 73.4% of the latter group did not experience clinically meaningful weight loss of ≥5% (weight remained the same: n = 700 [50.6%]; weight increased: n = 316 [22.8%]). When a more stringent threshold of ≥10% weight loss was applied, 89.0% of those who attempted weight loss did not experience a clinically meaningful loss (weight remained the same: n = 1077 [77.9%]; weight increased: n = 154 [11.1%]). For a threshold of ≥15% weight loss, 95.1% did not experience a clinically meaningful loss (weight remained the same: n = 1239 [89.6%]; weight increased: n = 76 [5.5%]).

Weight loss of ≥5% was most frequently reported by participants who had undergone surgery (50.0% lost weight) or used a digital health application (32.1% lost weight; Fig. 3a). Weight loss of ≥10% was reported by 36.4% of participants who had undergone surgery, but by ≤17% of those who used other strategies (Fig. 3b). Regardless of the number of weight loss strategies attempted, most participants did not experience clinically meaningful weight loss of ≥5%. Participants who had attempted two or more different strategies were more likely to achieve weight loss of ≥5% than those who had attempted only one strategy (33.1% vs 22.4% reported weight loss), and those who attempted three or more strategies were most likely to achieve ≥10% weight loss or ≥15% weight loss (Table 3). Weight loss rates were similar across the three obesity classes: 26.7%, 26.9% and 25.3% in each class, respectively, reported ≥5% weight loss. Supplementary Table S7 shows weight loss data by country and obesity class.

Fig. 3: Estimated proportions of participants reporting use of a weight loss strategy who achieved clinically meaningful weight loss.figure 3

a ≥5% and b ≥10%. Reported weight loss strategies are not mutually exclusive.

Table 3 Percentages of participants achieving weight loss, by number of strategies attempted.

留言 (0)

沒有登入
gif