The prevalence of obesity
The prevalence of obesity has increased worldwide in the past 50 years, reaching epidemic proportions . In Denmark, obesity prevalence had risen to 18.5% of adults in 2021, while in England, 27% of adults had obesity in 2019.
As excess weight increases, there is an increase in both morbidity and mortality, including the risk of diseases such as type 2 diabetes, ischemic heart disease, stroke, sleep apnoea, polycystic ovary syndrome, osteoarthrosis, and several cancers. There are strong associations between the magnitude of weight loss and improvements in obesity-related outcomes. This has been shown in 0.5 million people from a United Kingdom primary care database, with the greatest benefits observed for other established risk factors for cardiovascular diseases, e.g. type 2 diabetes, hypertension, and dyslipidaemia.
The prevalence of obesity is also inversely associated with socioeconomic status, and the social inequality seen in people living with obesity has persisted and worsened over the past 20 years. Moreover, people living with obesity face social stigma in health care sectors and wider society, which directly contributes to the detrimental effects of obesity on mental and physical health. The World Health Organization (WHO) recognises that weight bias and obesity stigma have detrimental effects on mental and physical health.
The multifactorial and chronic nature of obesity makes obesity management a complicated task both for people living with obesity and for society.
Unmet needs for people living with obesity to improve health outcomes and quality of life
As stated in the UK Government's Life Science Vision, “Despite the increasing prevalence of obesity and other risk factors, there has been little progress in recent decades in demonstrating, at a population level, the efficacy of interventions (whether behavioural or medical) that allow individuals to, for example, sustainably reduce their BMI, and in so doing, reduce their serious, related disease."
To address this, there is a pressing need for structured, multidisciplinary solutions based on solid evidence and designed to be effectively embedded in existing healthcare systems. Solutions should be broadly accessible and tailored to individual needs, hereby allowing people living with obesity to access the solutions most appropriate for them.
Up until now, the most common form of intervention offered to people living with obesity has been based on behavioural support with advice to reduce energy intake through healthy eating and increased physical activity, which, however, at a population level it is rarely sufficient to bring noticeable clinical improvements for individual patients. Use of weight lowering medications has been limited by lack of evidence for their performance and cost-effectiveness in a clinical setting, intolerable adverse effects, or limited economic reimbursement. For people with severe and complex obesity, bariatric surgery has so far been an effective offer that consistently results in a large (≥ 15%) and persistent (>6-12 months) weight loss, but is constrained by factors such as access and risk of complications etc.
Recently, however, several trials have given rise to renewed optimism in assisting people living with obesity to obtain and maintain a sustained weight loss through intensive nonsurgical interventions. The current state-of-the-art points towards a combination of initial total dietary replacements followed by introduction of a healthy energy-reduced diet, exercise and, when relevant, newer, and very promising weight lowering medications.
How LightCOM addresses the unmet needs for people living with obesity
To address the needs for effective treatments for people living with
obesity, the LightCOM project will implement and evaluate a nonsurgical
intensive weight loss (IWL) intervention compared to usual obesity care in
three independent but closely coordinated state-of-the-art randomised controlled trials conducted within the existing
primary and secondary healthcare systems in Denmark and the United Kingdom. (Read more about IWL here)
Recognising the workforce and capacity constraints within health services in both countries, delivery of the IWL intervention will be through specialised weight management hubs. In Denmark, new municipality-based hubs will be established to secure delivery of both in-person and remote support by healthcare professionals in close collaboration with other local health services and general practitioners. In the United Kingdom, delivery will draw on the experience of delivering weight-loss programmes at scale, for example, the Pathway to Remission pilot run by NHS England that currently offers a total dietary replacement programme for patients with type 2 diabetes.
To address the
ubiquitous burden of obesity stigma and weight bias
, a novel and radically different treatment for people with obesity is a
weight-neutral approach, centring around the weight-neutral definition of
health based on the principles and frameworks of Health At Every Size (HAES®).
Here, the focus is on body acceptance, eating patterns and physical activity,
with the aim of improving health-related quality of life and tackling the
weight stigma experienced by people living with obesity. The LightCOM project
will develop a weight-neutral intervention and evaluate its feasibility in a
pilot study in Denmark, thereby contributing to
a diversified range of treatment options for people with obesity to improve
health outcomes. (Read more about the weight neutral approach here)