The RESOURCE survey was designed to collect a broad range of healthcare information from people with obesity in six European countries. Firstly, we show that ORCs are frequently reported by people with obesity, particularly in obesity class III. Secondly, the presence of multiple ORCs is linked to a greater likelihood of hospitalization or other HCRU. Thirdly, although most people reported attempting to lose weight, the majority did not experience clinically meaningful weight loss of ≥ 5%.
In the RESOURCE survey, more than 25% of participants had ≥ 3 of the 15 ORCs considered to be strongly linked to obesity, and nearly 75% of participants had ≥ 1 ORC, the most frequently reported being hypertension, dyslipidaemia and T2D. Furthermore, the chance of having multiple ORCs was linked to obesity class, and some specific ORCs were considerably more frequent in individuals in the highest obesity class. Notably, participants in obesity class III were much more likely to report obstructive sleep apnoea or T2D than those in obesity class I. This finding aligns closely with the results of a previous UK study, in which sleep apnoea and T2D were found to be the ORCs with the greatest increase in risk associated with obesity class III, compared with normal weight . It should also be noted that, rather than experiencing a combination of less serious conditions, most participants with multiple ORCs had one or more chronic conditions requiring continuous management. Of the participants who reported ≥ 3 ORCs, nearly 80% had hypertension, more than 50% had dyslipidaemia and more than 40% had T2D. These self-reported conditions are likely to represent diagnosed conditions, and therefore it is probable that additional participants had cardiovascular risk factors or prediabetes, but have not yet been diagnosed.
ORCs are known to be linked to healthcare costs in individuals with obesity , and the results of the survey indicate that increasing number of ORCs is a greater risk factor for higher HCRU than increasing obesity class. The likelihood of reporting hospitalization or surgery was similar across obesity classes, but participants with any number of ORCs had a significantly higher chance of reporting hospitalization than participants with no ORCs, and participants with multiple ORCs had a significantly higher chance of reporting any surgical procedure. The presence of ORCs was also linked to requirement for prescription medication: 44% of participants with no ORCs but 87% of those with one ORC had received at least one prescription treatment in the past year. This close link between ORCs and HCRU shows the need for a shift in the treatment perspective for obesity, by both clinicians and healthcare systems, from focusing only on change in body weight to also assessing the benefits for overall health status to be gained via weight management. This holistic view, which takes into account the reductions in comorbidities that may be gained via weight management, is one that recognizes unmet need and attempts to address the full clinical impact of obesity.
Our findings on weight loss strategies and estimated weight changes indicate that most people with obesity in Europe attempt to lose weight, but are unsuccessful. Most participants reported attempting weight loss via diet or exercise, but fewer than 30% experienced clinically meaningful weight loss of ≥ 5% during the past 12 months. Surgical intervention was the most successful strategy; however, as suggested by the small sample size for this group (n = 22; 1.2% of all participants), weight loss surgery is not indicated for all people with obesity, and may be unsuitable or not desired by many people who are eligible, with the risks of surgery and the lifestyle changes required acting as barriers to uptake . Nearly half of participants in the survey had not received a formal diagnosis of overweight or obesity, and only 15% had been prescribed a treatment for weight management. Together, these data highlight a clear unmet need for support with weight loss, structured monitoring of weight loss strategies, and access to effective therapy. This would help to ease both the clinical and the economic impacts of obesity. In a study using UK data, weight loss of 13% was estimated to reduce the risks of multiple ORCs, including hypertension, dyslipidaemia and T2D , and our results suggest that limiting the development of these comorbidities would considerably reduce risks of hospitalization, surgery and other HCRU.
The key value of the RESOURCE survey is the breadth of data captured and the collection of evidence on weight loss strategies. The results indicate that healthcare professionals are not involved in participants’ weight management in many cases, suggesting that this information would not be available in other sources of real-world data, such as medical records. The relatively large sample size and geographic scope of this study mean that the results provide a broad overview of obesity in Western Europe. Although self-reporting of data is a necessary limitation of patient surveys, checks and quality control incorporated into the survey design were used to confirm data relevance and validity. There remains, however, the potential for inaccuracies and recall bias in the survey results. The reliance on BMI alone as a measure of obesity means that individuals with high muscle mass rather than excess fat could have been included in the study sample. More importantly, weight change was based on comparison between a historical weight estimate and current weight, which could be either a measurement or an estimate. Timings of weight change, or fluctuations over the past 12 months, were not recorded, and could not be linked to the timings or duration of weight loss attempts, meaning that weight loss strategies may have been associated with some temporary weight loss, but followed by subsequent gain. Therefore, these results cannot be used to compare the likelihood of weight loss between particular strategies, but rather to demonstrate a need for improved support and future research. Structured, longitudinal studies tracking weight loss strategies are required to quantify weight change accurately; similarly, future studies should be designed to assess the relationship between development of ORCs and subsequent HCRU in greater detail.