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A survey of adults with obesity from six Western European countries highlights the struggle people with obesity endure trying to lose weight, and sheds new light on what works and what doesn’t when it comes to losing weight.
The study by Dr Marc Evans from University Hospital, Cardiff, UK, and Dr Jonathan Pearson-Stuttard, from Lane Clark & Peacock LLP, London, UK, and colleagues including from Novo Nordisk, Denmark, a manufacturer of diabetes and obesity medications and sponsor of the study, is being presented at this year’s congress.
“Our survey results indicate that while the majority of adults with obesity are actively trying to reduce their weight, using a variety of strategies, most are unsuccessful,” says Dr Evans. “This underscores the need for increased support and solutions for weight management. And while obesity’s impact on health is well known, our finding that a sizeable proportion of adults with obesity appear at elevated risk of hospitalisation or surgery due to multiple underlying illnesses, undoubtedly adds a sense of urgency to tackling Europe’s growing obesity epidemic.”
For this study, researchers conducted the cross-sectional RESOURCE survey  to collect data on demographic characteristics, comorbidities, treatments, healthcare use, weight loss strategies and weight change in the past year from adults (aged 18 years or older) with obesity (BMI 30 kg/m² or higher) in France, Germany, Italy, Spain, Sweden and the UK. Data were collected between May and June 2021.
Respondents were asked about different methods they have used to lose weight, including commercial weight loss programmes, anti-obesity medications, calorie-controlled or restricted diets, exercise, support from weight loss services, and digital health applications.
In total, 1,850 eligible individuals (average age 53 years, 52% female) with obesity who reported using primary or secondary healthcare services in the past 12 months were included in the analyses . Women who were pregnant were excluded. Over half (56%; 1,042) of participants had a BMI of 30 to <35 kg/m² (obesity class I), more than a quarter (27%; 496) had a BMI of 35 to <40 kg/m² (obesity class II) and just under a fifth (17%; 312) had a BMI of 40 to <70 kg/m² (obesity class III).
79% report trying to lose weight in the past year
Analyses looking at weight loss strategies found that 79% of respondents reported attempting to lose weight in the past year; the proportion was similar across obesity classes (class I, 75%; class II and III, 80%).
The most common weight loss methods were calorie-controlled or restricted diets (72% of participants), exercise programs or courses (22%), and pharmaceutical treatments (12%). However, three-quarters of participants who attempted to lose weight within the past year, did not achieve a clinically meaningful weight loss defined as at least 5% of their body weight.
The degree of success varied greatly between weight loss strategies—with just under a third of respondents reporting clinically meaningful weight loss from using a weight loss service or taking a pharmaceutical treatment. However, a third of respondents also reported gaining weight (more than 5% their bodyweight) despite attempts at various weight loss strategies.
Notably, exercise and calorie-controlled or restricted diets were the least beneficial, with respect to achieving clinically meaningful weight loss with only around 20% of respondents achieving this level of weight loss using these approaches.
While weight loss surgery is currently considered the most effective approach to clinically significant weight reduction, very few respondents in the study had undergone any weight loss surgical procedures. Among respondents from the UK, calorie-controlled or restricted diets and exercise programmes or courses were the most common weight loss strategies (see table in notes to editors).
The researchers say that further research is needed to explore how successful individuals who lose weight are at maintaining this weight loss.
More than 25% of people living with obesity have three or more complications
Further analyses of the survey data indicate that adults living with obesity face a broad range of obesity-related complications (ORCs), which tend to increase as obesity progresses, and which are associated with greater use of healthcare resources.
In total, 476 (26%) reported having no ORCs, 526 (28%) reported one ORC, 362 (20%) had two ORCs, and 486 (26%) had three or more ORCs.
The analyses also found increasing disease complications as obesity progresses: 23% of respondents with class 1 obesity reported three or more ORCs, compared to 26% with class II obesity, and 37% of those with class III obesity.
The most commonly reported ORCs were high blood pressure (39%), dyslipidaemia (high levels of cholesterol and/or other fats in the blood; 23%), type 2 diabetes (18%), and osteoarthritis (16%;).
Over the previous year, similar proportions of individuals in obesity classes I, II, and III had been hospitalised (19%, 16% and 17%, respectively) or undergone a surgical procedure (18%, 18% and 16%). However, the analyses found that having at least one ORC was linked to increased healthcare resource use.
Those with multiple ORCs (3 or more) twice as likely as those with none to be hospitalised in past year (13% vs 28%). Similarly, 14% of those without ORCs had undergone any surgical procedure, compared with 24% of those with three or more ORCs.
Author contact: Dr Marc Evans, University Hospital, Llandough, Penarth, Cardiff, UK,
 Participants were recruited through an existing consumer research panel and individuals were asked to complete an online structured questionnaire independently.
 The study included 500 respondents from the UK, 100 from Sweden, 250 from France, 250 from Germany, 300 from Italy, and 450 from Spain.
The studies were sponsored by Novo Nordisk A/S, a leading global healthcare company and leading researcher into and manufacturer of diabetes and obesity medications, and employer of several of the co-authors. Medical writing support was provided by Oxford PharmaGenesis.
Conflict of interest: ME has received fees from AstraZeneca, Boehringer Ingelheim and Novo Nordisk. CLH, EdL, MF and KSM are employees of Novo Nordisk A/S. JdC and AM are employees of Adelphi, who received consulting fees from Novo Nordisk A/S to perform this analysis. JPS is partner and Head of Health Analytics at Lane Clark & Peacock LLP, Chair-elect of the Royal Society for Public Health and reports personal fees from Novo Nordisk A/S and Pfizer Ltd outside of the submitted work.