Obesity podcourse with Dr Patrick Holmes, part 3: multiple comorbidities

There's been quite a progression with Sophie, hasn't there? I mean, how has her clinical picture changed?

There certainly has.

And it's not an uncommon thing we see here with people living with obesity.

So she's moved from a risk stage now to clear evidence of damage.

She's living with sleep apnea.

That fatty liver disease, the Maslod, is taking its toll.

We believe she's developed a neuropathy.

There's worsening blood pressure.

And clearly, there's significant functional limitation now.

So these signs are a long term thing.

caused by her metabolic disease, not just abnormal blood tests.

So the first time we saw Sophie, she was pregnant.

And for that reason, a GLP-1 medication would have been contraindicated.

However, even if she had not been pregnant, she would not have been eligible for Tazepatide under the current Phase 1 rollout.

The second time we saw Sophie, she was eligible for a GLP-1 medication such as Tazepatide, but that was only because she had young onset type 2 diabetes.

If she didn't have young onset type 2 diabetes, she wouldn't have been eligible for tisepatide under the current NHS rollout on the basis of her weight alone.

So this is the third time we've seen her.

Given her BMI has increased... and she now has more comorbidities, ignoring that she had young onset type 2 diabetes when we last saw her, would she now be eligible for septide under the phase 1 rollout?

Yes, she clearly now meets the highest priority criteria.

She has a BMI over 40 and has at least four major obesity-related complications, so she would fall into cohort 1 under the interim guidance.

I'm sure our listeners know this, but could you just expand on what the cohort one is?

So the interim guidance which we've been given for the use of Tizepatide for the management of obesity, you need to be living with obesity and have a BMI above 40 with four qualifying obesity-related conditions.

These include type 2 diabetes, cardiovascular disease, hypertension, dyslipidemia, obstructive sleep apnea.

So this is a high-risk cohort which are the first to be receiving Tizepatide under that guidance.