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Aintree LOSS is a community-based, multidisciplinary weight management programme for patients with severe and complex obesity, focusing on a flexible and individualized service with follow-up for up to 2 years. We evaluated all 2472 patients referred to the service between October 2009 and 2013. Demographic data were recorded at baseline, with the Index of Multiple Deprivation (IMD) used to measure socioeconomic deprivation. Weight was recorded at each visit. Mean body mass index at baseline was 45.6 (standard deviation 6.8), and 58.9% of patients lived in areas in the most deprived decile nationally. Of 2315 appropriate referrals, 1249 (55.1%) attended >2 visits; mean final weight loss was 3.50 ± 8.55 kg, and 24.1% achieved ≥5% weight loss. Of the patients, 754 (33.3%) attended for over 6 months; mean final weight loss was 4.94 ± 10 kg, and 34% achieved 5% weight loss. Multivariate logistic regression analysis showed increasing age, residence in a less deprived area and sleep apnoea to be independently associated with attendance for >6 months, and there was a linear relationship between 6-month attendance and deprivation quintile. Year-on-year analyses showed improvement in engagement over time, coinciding with efforts to improve access to the service. This work shows a multidisciplinary, community-based weight loss programme prioritizing a fully flexible and individualized approach functioning effectively in real-world practice. Maintaining engagement remains a challenge in weight loss programmes, and our results suggest younger patients living in areas with greater deprivation should be a target for efforts to improve engagement.

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Background: The clinic was established in 1998 in response to the need for a local service for patients with obesity. It offers a multidisciplinary approach to managing obesity in a secondary care setting. Key members of the team include doctors, dietitians, physiotherapists and nurses. Referral criteria were a body mass index (BMI) >40 or BMI > 35 with two or more comorbidities. Referrals were accepted from primary or secondary care. The aims of the clinic are to halt further weight gain and promote 5-10% weight loss and then weight maintenance over 2 years. There are few published studies looking at the outcomes of hospital-based obesity clinics. Patients referred to such clinics are likely to have made several attempts at weight loss and be considerably heavier than patients presenting in primary care for weight management. The aims of this study were to assess weight change and initial nonattendance rates in patients referred to a multidisciplinary weight management clinic. Methods: Data were collected from 103 consecutive patients referred to the weight management clinic over 7 months starting in March 2005. The data were collected retrospectively from clinical letters. Data collected included initial weight and BMI, weight at 6 and 12 months and the latest weight available if after 12 months. Absolute weight change and percentage change were calculated as well as the number of patients achieving clinically significant weight losses at each of the time points. Results: Initial nonattendance rates to the clinic was 15%. Table 1 shows the weight change at each of the time-points audited: