Oral Presentation ANZOS Annual Scientific Meeting 2021

Relationship between polypharmacy and clinical disease burden in adults with super-obesity in a tertiary weight management program; A prospective observational study (#34)

Kevin Chan 1 , Houston Xue 1 , Annette MacDonald 2 , Amy Phu 3 , Ramy Bishay 1 2 , Golo Ahlenstiel 1 3 4
  1. Western Sydney University, Campbelltown, NSW, Australia
  2. Blacktown Metabolic and Weight Loss Program, Department of Endocrinology, Blacktown Hospital, Blacktown, NSW, Australia
  3. Storr Liver Centre, Westmead Millennium Institute, University of Sydney, Sydney, NSW, Australia
  4. Department of Medicine, Blacktown Hospital, Western Sydney Local Health District, Sydney, NSW, Australia

Objectives: Obesity is typically associated with greater comorbidities and a corresponding increase in medication use.1,2 Few studies have examined the relationship between polypharmacy, therapeutic categories of medication and body mass index (BMI), Edmonton Obesity Staging System (EOSS) Stage, presence of ischaemic heart disease (IHD), type 2 diabetes mellitus (T2DM), hypertension and chronic kidney disease (CKD) stage within a complex, super-obese population.3

Design: A prospective observational cohort study (2018-2020) of complex obese patients in the Blacktown Metabolic and Weight Loss Program of BMI>35 kg/m2 with T2DM or BMI>40 kg/m2 with two obesity complications. Total number and therapeutic categories of medication were correlated with clinicopathologic parameters.

Results: A total of 270 patient records were analysed (mean(SD) BMI 51.3(11.8) kg/m2, mean(SD) age 48.9(12.4) years, 95 males (35.2%), 175 females (64.8%)). Age correlated significantly with total medication burden (p<0.001), cardiovascular medications (p<0.001), respiratory medications (p=0.031) and analgesic medications (p=0.047). The mean(SD) medications used by patients across all EOSS stages was 5.4(3.7), with patients of EOSS Stage 1, 2 and 3 using 2.5(2.3), 4.6(3.4) and 7.0(3.7) medications respectively. Significant correlations were found between EOSS and total, cardiovascular and psychotropic medications (p<0.001, p<0.001 and p=0.030 respectively), whereas BMI correlated only with respiratory medications (p=0.014). There was a significant increase in total and cardiovascular medications for patients with IHD, and in total, cardiovascular and diabetes medications for patients with T2DM (all p<0.001). Total, cardiovascular and diabetes medications correlated with HbA1c% (all p<0.001). There was a significant difference between individuals of each CKD stage and total (p<0.001), cardiovascular (p<0.001) and respiratory medications (p=0.003).

Conclusions: EOSS Stage may be a superior predictor for polypharmacy than BMI in super-obese patients. Cardiovascular medication use correlates with several clinicopathologic parameters. Further research is required across larger cohorts and to establish whether medications of specific pharmacologic classes correlate with clinicopathologic parameters.

  1. Wang YC, McPherson K, Marsh T, Gortmaker SL, Brown M. Health and economic burden of the projected obesity trends in the USA and the UK. Lancet Lond Engl. 2011 Aug 27;378(9793):815–25
  2. Narbro K, Agren G, Jonsson E, Näslund I, Sjöström L, Peltonen M, et al. Pharmaceutical costs in obese individuals: comparison with a randomly selected population sample and long-term changes after conventional and surgical treatment: the SOS intervention study. Arch Intern Med. 2002 Oct 14;162(18):2061–9.
  3. Sharma AM, Kushner RF. A proposed clinical staging system for obesity. Int J Obes. 2009 Mar;33(3):289–95.