Aim
To investigate the clinical outcomes following personalised medical management in an Endocrinologist-led outpatient clinic.
Background
Obesity has been identified in over one-third of hospital inpatients at the Royal Melbourne Hospital. This audit was performed to benchmark the Royal Melbourne Hospital Bariatric Medicine Clinic (RMH BMC) which provides personalised medical management plans for weight loss.
Methods
This retrospective cohort study collected data from patient records, pathology results and patient surveys. The study included all patients who attended the clinic from February 2012 to November 2018 for at least one visit. BMC data were captured at baseline, 3, 6 and 12-month time points. The primary outcome measure was weight loss at 12 months. Secondary endpoints were waist circumference, biochemical markers and quality-of-life.
Results
The RMH BMC cohort comprised 313 patients (213 female). The cohort mean (±sd) age, weight and BMI at baseline were 46.1(±14.0)years, 129.0(±31.7)kg, and 46.5(±9.8)kgm2, respectively. Patient attrition was high, with only 113 (36%) patients attending for 12 months. After 12 months the mean weight loss was 4.1(±8.7)kg (3.3% of baseline) and their waist circumference decreased by 6.2(±11.2)cm. Sixty-eight patients (60%) lost 1kg or more, and 42 (37%) lost greater than 5% body weight. Mean quality-of-life physical domain score increased from 34 at baseline to 44 after 12 months, a significant improvement relative to the Australian population mean of 50. In contrast, biochemical markers, including HbA1c and fasting glucose, did not change significantly.
Conclusion
The RMH BMC population had high rates of loss to follow up by 12 months. Of those who attended for 12 months, approximately one third attained more than 5% weight loss, comparable to other reported medical interventions. Clinic attendance delivered substantial improvement in physical quality of life but resulted in only modest weight loss with no significant impact on biochemical markers.