Great to meet with Professor Berit Heitmann who is developing the Danish Hub-functions within the Lighthouse Consortium on Obesity Management (LightCOM) project, and is also co-leading on the intervention in Denmark, to learn about this work.
Thanks for taking the time to tell us about the LightCOM project, Berit! This work focuses on providing new options for managing obesity using two distinct approaches; one focusing on intensive weight-loss, and the other weight-neutral approach. Can you explain the inspiration behind opting for these two diverse intervention approaches?
Obesity management is complex, and there is a significant gap in our understanding of effective options. While healthier dietary habits and increased physical activity are important, they are not always enough. New medications have raised questions about whether weight loss is the optimal solution for every individual. Not everyone desires, can afford, or tolerates these treatments. Additionally, for individuals with mild and uncomplicated obesity, de-stigmatizing obesity and reshaping the narrative may offer greater benefits.
The challenge lies in balancing the emergence of highly effective pharmaceutical interventions with the need for weight-neutral approaches. Who should be offered weight-loss initiatives, including medication or surgery? Who should be offered weight-neutral approaches, which prioritize body acceptance, joyful movement, and healthy eating patterns without an aim to lose weight?
We are therefore focused on developing two distinct approaches. The first is an intensive weight loss program designed to facilitate significant and sustainable weight loss while improving both physical and mental health. This intervention offers an individualized combination of total meal replacement, behavioral support, physical activity, and possibly pharmacological treatment. This program is evaluated through RCTs comparing it to current usual care, including bariatric surgery, with outcomes encompassing not only weight loss but also overall physical and mental well-being. The second approach is a weight-neutral program, which prioritizes body acceptance, joyful movement, and healthy eating patterns without an aim to lose weight.
We believe that both approaches are important, and we are committed to developing and evaluating evidence-based interventions that meet the needs of all individuals with obesity. We are assessing this weight-neutral program to assess its feasibility.
Using a combination of dietary strategies and cutting-edge digital and health tech solutions, what novel methodologies does LightCOM plan to introduce in obesity management?”
The intensive weight loss program is delivered remotely in the UK and mainly in-person in Denmark, with some remote delivery in Denmark as well. This allows us to compare the feasibility of the two delivery methods, including acceptance, adherence, and cost-effectiveness. This information will inform the development of potentially innovative and effective digital solutions in the future. Additionally, the remote component of the program can benefit from technological innovations and expertise from both countries. Collaborating on the development of digital tools and platforms can lead to a more robust and user-friendly online experience.
Thinking about the cross-border nature of this initiative, how do you envision the synergies between leading UK institutions, cities and towns and health boards — and Denmark — enhancing the effectiveness of these programs?
In my opinion, the cross-border nature of the initiative gives us a unique opportunity to leverage synergies, combining the strengths of Denmark and the UK to create more effective and comprehensive interventions. It promotes a holistic approach that takes into account cultural, organizational, technological, research, and policy aspects to improve the overall effectiveness and impact of these programs. Understanding the different policy approaches to obesity management in Denmark and the UK can provide insights into the effect of policy on program outcomes. This knowledge can inform advocacy efforts.
Furthermore, scientific collaboration helps us gather data from larger and more diverse populations, leading to more robust and generalizable findings, which will inform evidence-based approaches to obesity management.
You’re including health economic analyses to evaluate cost-effectiveness. How important do you find this aspect of the programme in ensuring sustainable adoption by healthcare systems in Denmark and the UK?
Health economic analyses are crucial to understanding and informing policy makers about whether LightCOM and our results are realistic, implementable and sustainable. The LightCOM project originates from the Lighthouse Life Science program on Healthy Weight, where a wide range of public and private actors in the Copenhagen Capital Region have come together to develop new health solutions across life science and welfare technology aimed at preventing, identifying, and treating severe obesity. Cost-effectiveness analyses help prioritize interventions by demonstrating which treatments or programs offer the most value for resources invested. This ensures resources are allocated efficiently and equitably, maximizing the overall health benefits, as well as ensuring individual patients have access to effective and cost-efficient care. Comparing cost-effectiveness of the intervention in Denmark and UK will further provide insights into global best-practice and will help to identify areas where improvements can be made.
Should the LightCOM programmes prove effective, what strategies are in place to optimize rapid integration within existing national healthcare frameworks of both countries?
In both countries, we are assessing the effectiveness of the intensive weight loss and evaluating our mode of delivery. In Denmark, we are collaborating with three municipalities in the Greater Copenhagen Area to establish new Municipal Weight Management Hubs. These Hubs will coordinate efforts from municipal, primary, and secondary healthcare providers. We anticipate that by demonstrating the feasibility and cost-effectiveness of our approach, we can create a model that can be easily implemented in other municipalities. Obesity management is a major challenge in many countries, and there is a need for innovative and effective models. By leveraging existing infrastructure and emphasizing seamless communication between GPs, endocrinology specialists, and healthcare workers, we aim to enable municipalities to offer interventions to people living with obesity, including those with co-morbidities. Patient communication will occur through face-to-face consultations, telephone, and online meetings to optimize cost-efficiency throughout the intervention.
In the UK, we will establish a hub-based model in partnership with a private healthcare provider to deliver treatment, and recruitment will involve GPs. The UK model will be implemented nationwide from the outset, and if it proves successful, it can be easily integrated into the existing national healthcare system.
Given the backing the project has received from the Novo Nordisk Foundation and the collaborative nature of LightCOM do you see a potential ripple effect of the project in influencing global perspectives and solutions for obesity management?
I believe that if we can develop a cost-effective model that is successful in two countries, we are in a strong position to impact global obesity management options. Bringing together expertise from two countries, each with its own healthcare system and approach to obesity management, can serve as a model for other countries looking to address the global challenge of obesity.
Thanks so much Berit.
Who are the lead scientists behind LightCOM BOX?
Chief physicians, Associate Professor Carsten Dirksen (Principal Investigator for LightCOM) and Associate Professor Kirstine Bojsen-Møller from Research unit of Endocrinology, Department of Medicine, Copenhagen University Hospital – Amager and Hvidovre, Denmark. In Denmark Professor Frans Waldorff is lead of primary care and the weight neutral Interventions, the latter in close collaboration with Assistant Professor Rasmus Køster-Rasmussen. Other intervention parts in Denmark are led by Professors Berit L Heitmann (the Danish Hub functions) and Susanne Reventlow (process evaluations), all from Center for General Medicine at University of Copenhagen. A team of health economists from the Danish Centre of Health Economics Research at University of Southern Denmark led by Professor Kim Rose Olsen. In the UK, the full project is lead jointly by Professor Susan Jebb and Professor Paul Aveyard both from the Nuffield Department of Primary Care Health Sciences, University of Oxford.
Facts about the LightCOM project BOX:
Funding: supported by the Novo Nordisk Foundation grant “LightCOM (Lighthouse Consortium on Obesity Management)”/ NNF22SA0080921
You can learn more about the project here: https://www.regionh.dk/lightcom/ and https://novonordiskfonden.dk/en/projects/lighthouse-consortium-on-obesity-management-lightcom/