Prevalence and impact of obesity in people with haemophilia: Review of literature and expert discussion around implementing weight management guidelines

Abstract

Obesity affects more than 35% of Americans, increasing the risk of more than 200 comorbid conditions, impaired quality of life and premature mortality. This review aimed to summarize literature published over the past 15 years regarding the prevalence and impact of obesity in people with haemophilia (PWH) and to discuss implementing general guidelines for weight management in the context of the haemophilia comprehensive care team. Although few studies have assessed the effects of obesity on haemophilia-specific outcomes, existing evidence indicates an important impact of weight status on lower extremity joint range of motion and functional disability, with potentially important effects on overall quality of life. Data regarding bleeding tendency in PWH with coexisting obesity are largely inconclusive; however, some individuals may experience reduced joint bleeds following moderate weight loss. Additionally, conventional weight-based dosing of factor replacement therapy leads to increased treatment costs for PWH with obesity or overweight, suggesting pharmacoeconomic benefits of weight loss. Evidence-based recommendations for weight loss include behavioural strategies to reduce caloric intake and increase physical activity, pharmacotherapy and surgical therapy in appropriate patients. Unique considerations in PWH include bleed-related risks with physical activity; thus, healthcare professionals should advise patients on types and intensities of, and approaches to, physical activity, how to adjust treatment to accommodate exercise and how to manage potential activity-related bleeding. Increasing awareness of these issues may improve identification of PWH with coexisting obesity and referral to appropriate specialists, with potentially wide-ranging benefits in overall health and well-being.

Sleeve gastrectomy in haemophilia type A: Reducing the costs of prophylaxis

“…4 Our experience suggests that this procedure could be performed safely with the support of an interdisciplinary group and with adequate monitoring in the pre-and post-operative periods. Evaluation by a bariatric surgeon is recommended along with lifestyle intervention in patients with BMI ≥ 40 kg/m 2 or BMI ≥ 35 kg/m 2 with obesity-related comorbidities.…”

“…[4][5][6][7] Currently, there is scarce information about the effect of weight reduction on the cost of treatment of this disease. Since current dosing regimens are based on body weight, even a weight reduction as low as 5% would potentially result in a reduction in factor costs that could offset the costs of any weight loss interventions.…”

“…4,7 For instance, although it appears that haemophilic patients are partially protected against cardiovascular events as compared to the general population, the mechanism is not fully understood, and it may be altered due to the increased life expectancy. Complications of overweight and obesity in the general population have been thoroughly studied; however, there is no detailed research about the natural history of these conditions in the haemophilia population.…”

Awareness, Care and Treatment In Obesity maNagement to inform Haemophilia Obesity Patient Empowerment (ACTION‐TO‐HOPE): Results of a survey of US patients with haemophilia and obesity (PwHO) and their partners and caregivers

“…Bleeding into joints, muscles and other tissues can cause acute dysfunction and chronic joint damage and disability. [8][9][10][11][12][13][14][15] Data on bleeding tendency in obese PwH are largely inconclusive; however, some individuals may experience reduced joint bleeds following moderate weight loss. 1 Current factor replacement strategies provide improved management of haemophilia compared with prior decades; however, weight status has an important impact on lower extremity joint range of motion and functional disability.…”

“…[2][3][4][5][6][7] In people with haemophilia (PwH), the prevalence of overweight (adults, 19%-59%; children, 15%-21%) and obesity (adults, 18%-36%; children, 17%-22%) is similar to that of the general US population. 9,20 The Awareness, Care and Treatment In Obesity MaNagement (ACTION) study examined obesity-related perceptions, attitudes and behaviours among people with obesity (PwO), healthcare providers (HCPs) and employer representatives (ERs). 3,6,16,17 Limited data exist on the longitudinal impact of obesity and changes of weight, which are mostly derived from case reports.…”