Diabetes Obes MetabWeight LossCohortDecember 17, 2025

Burden of long-term conditions and management of people with overweight and obesity: Data from the United Kingdom primary care cohort of the IMPACT-O study.

Khunti K, Capehorn M, Artime E, von Arx LB, Davies AL, Adam A, Lampropoulou A

Key Finding

Among UK patients first identified with obesity, 58% already had at least one obesity-related complication, yet only 6% received weight-loss medications or surgery - revealing a massive treatment gap.

What This Study Found

Think of this study as taking a snapshot of UK healthcare records to see what's really happening when doctors first identify someone as overweight or obese. The researchers found three groups: 73,279 people newly flagged as overweight/obese (BMI ≥25), 62,226 people flagged as obese (BMI ≥30), and 343,755 people who actually received some kind of weight intervention. Here's the sobering reality - by the time patients get their first official 'overweight' or 'obesity' label in their medical record, nearly half (48%) of the overweight group and well over half (58.4%) of the obesity group already have obesity-related complications like high blood pressure or depression. It's like arriving at a house fire only to discover the foundation has already been damaged. Even more striking: among the 343,755 people who actually got treatment, three-quarters (77%) already had complications, and their average BMI was 29 - meaning many were getting help relatively early, yet most still had health problems. The treatment approach was heavily skewed toward lifestyle advice (96.8% got diet and exercise counseling), while only a tiny fraction received the more intensive tools: 3.6% got GLP-1 medications, 2.5% got orlistat, and just 0.3% had bariatric surgery.

Statistics Decoded

Key numbers decoded: 58.4% of obese patients had complications - imagine if 6 out of every 10 people walking into a doctor's office with obesity already had high blood pressure, diabetes, or depression. The 96.8% getting lifestyle interventions versus 6.1% getting medications/surgery (3.6% + 2.5% + 0.3%) shows a 16-to-1 ratio favoring lifestyle advice over medical treatments. The 343,755 intervention patients had an average BMI of 29 - right at the obesity threshold - suggesting treatment often starts when people cross into the obesity category rather than earlier in the overweight range.

Why This Matters

This reveals a critical timing problem in UK obesity care - patients are accumulating serious health complications before receiving adequate treatment, and when they do get help, it's overwhelmingly limited to lifestyle advice despite available medications and surgical options. For patients, this suggests advocating earlier for comprehensive treatment options rather than waiting for complications to develop.

Original Abstract

The multi-country epIdeMiology landscape PAtient Care paThways of Obesity (IMPACT-O) retrospective cohort study utilised existing electronic medical records to gather data on overweight and obesity. We report UK data on obesity-related complications (ORCs) and management strategies. The UK IQVIA Medical Research Database, The Health Improvement Network database, includes routine data from UK primary care. Outcomes analysed included sociodemographic and clinical characteristics, ORCs and treatments for three cohorts: adults (≥18 years) with a new record of overweight or obesity (body mass index [BMI] ≥25 kg/m2; overweight/obesity cohort) or obesity (BMI ≥30 kg/m2; obesity cohort) identified by BMI recordings and/or diagnosis codes, and adults with ≥1 recorded interventions with an effect on weight (intervention cohort) between 2018 and 2022. There were 73 279 adults in the overweight/obesity cohort, 62 226 adults in the obesity cohort and 343 755 adults in the intervention cohort. Most adults had ≥1 ORC with a numerically higher proportion of ORCs recorded in the obesity cohort (58.4%) than in the overweight/obesity cohort (48.0%). For the intervention cohort, 77.0% had ≥1 ORC. Lifestyle interventions were recorded for 96.8% of this cohort, followed by pharmacological therapies with an effect on weight (glucagon-like peptide-1 receptor agonists, 3.6%; orlistat, 2.5%), and bariatric surgery (0.3%). Results confirm the high burden of ORCs in adults at first identification of overweight or obesity in primary care and the limited use of pharmacotherapy and bariatric surgery; this suggests a need to evaluate treatment strategies and support for people with overweight and obesity in the UK. What is the context and purpose of this research study? Health-related information recorded in electronic medical records during visits to your doctor can help increase understanding of the impact of overweight and obesity in healthcare settings. What was done? The epIdeMiology landscape and PAtient Care paThways of Obesity (IMPACT-O) was a study conducted in selected countries in Europe and the Asia-Pacific region that used information from existing healthcare records to report the impact of overweight and obesity. This paper reports the results from the UK part of the study, using information provided by general practitioners. Data on social, demographic and health-related characteristics of people with overweight and obesity were collected for adults (at least 18 years of age) at the time their first record of overweight or obesity was recorded, either with a diagnosis from the doctor or a body mass index (BMI) of ≥25 kg/m2 (overweight/obesity group) or ≥30 kg/m2 (obesity group) and for adults with at least one record indicating the use of a method for weight loss (intervention cohort). What were the main results? Most adults included in the study had at least one additional condition that was related to their obesity, and more people in the obesity group than the overweight/obesity group had an additional obesity-related condition. The most commonly recorded additional obesity-related condition was high blood pressure in the obesity group and depression in the overweight/obesity group. In the group who had a method of weight loss recorded, three in every four adults had at least one additional obesity-related condition. The average BMI of adults in this group was 29.0 kg/m2. Lifestyle changes, such as diet and exercise, were recorded for nearly all adults in this group, followed by medications with an effect on weight (such as glucagon-like peptide-1 receptor agonists and orlistat), and weight-loss surgery. What is the originality and relevance of this study? The study results confirm that adults are already heavily affected by obesity-related conditions by the time of their first formal documentation of overweight or obesity in primary care. Only a small number of adults with overweight or obesity had records of medication or surgery for weight loss management. These results mean that there is a need for improved surveillance of these adults in the UK.