The first wave of the COVID-19 pandemic in Spring 2020 resulted in the cancellation of nearly all routine in-person obesity services provided across Europe, according to the outcomes of a survey of European physicians examining the impact of COVID-19 on the provision of obesity services across ten European countries. The findings were reported in the paper, ‘The impact of COVID-19 on obesity services across Europe: A physician survey’, published in Clinical Obesity.
The quantitative survey was undertaken with physicians involved in the treatment of people with obesity (PwO) to understand the impact of COVID-19 on obesity services across Europe in Spring 2020. To be included in the study, physicians were required to treat at least ten PwO (defined as BMI ≥30 kg/m2) per month, and specialise in the management of PwO (e.g., endocrinologists, obesity specialists, and internal medicine physicians who indicated a subspecialty on obesity; primary care physicians were excluded from the survey). The study included 10–11 physicians from each of the following 10 European countries: Belgium, Denmark, Finland, France, Ireland, the Netherlands, Portugal, Spain, Sweden and the UK.
Survey questions covered the following topic areas: referral of patients for bariatric surgery, cancellations of surgery or other weight loss services, and the management of patients whilst services are suspended and upon resumption. Respondents would only provide answers to services they are actively providing.
A total of 102 physicians completed the survey, the majority were endocrinologists (68 out of 102), obesity specialists (31 out of 102), and internal medicine specialists (3 out of 102). Prior to COVID-19 restrictions, physicians provided obesity care in an outpatient setting of a hospital (75 out of 102), an office-based/community practice setting (16 out of 102), by virtual consultations (9 out of 102), or an inpatient setting (2 out of 102). The physicians manage obesity with either non-pharmacological disease management (100 out of 102), and/or unspecified pharmacotherapy (98 out of 102), and/or bariatric surgery (95 out of 102).
In total, 95 out of 102 physicians reported an impact of COVID-19 on medical consultations, 87 out of 102 on consultations at specialised obesity centres, 84 out of 102 on bariatric procedures, 74 out of 102 on local/community weight management services, and 62 out of 102 on other health-related consultations led by a multidisciplinary team. All countries reported that COVID-19 pandemic impacted all obesity services, with routine medical consultations by specialists and non-specialists, and bariatric procedures reported as affected by the greatest number of physicians per country, whilst other health-related consultations by a multi-disciplinary team were reported to be affected by COVID-19 by the least number of physicians per country.
Physicians were asked to provide the percentage of obesity appointments cancelled or suspended by the provider or patient due to the COVID-19 pandemic. For all physicians, the percentage of cancellations or suspensions was:
87% for local/community weight management services
86% for bariatric procedures
84% for consultations at speciality obesity centres
80% for other health-related consultations led by a multidisciplinary team, and;
79% for medical consultations.
Interestingly, the cancellations were mainly driven by the provider (57%–71%) and fewer cancellations were due to the patient (15%–23%).
The highest percentage of cancellations of services were reported in France (97%–100%) and Spain (96%–98%), compared to Ireland (58%–81%), Portugal (61%–80%) and Sweden (69–79%) where the least number of cancellations for such services were reported. Physicians in France reported cancellation of all bariatric procedures, mainly driven by the provider, during the COVID-19 pandemic.
Despite the cancellation of obesity-related services, most physicians provided at least one form of alternative treatments for PwO for whom in person services had been cancelled or postponed. The majority of physicians provided online consultations/clinics (87 out of 101), unspecified pharmacological therapy (72 out of 101), digital weight-loss tools (70 out of 101) and mental health support (70 out of 101) as alternative treatments. However, four out of 101 physicians reported no provision of alternative services.
“Despite alternative services being provided to patients, due to the cancellation of in-person services and bariatric procedures, their long-term risk of morbidity and mortality may be impacted,” the authors concluded. “With obesity being a risk factor for severe disease and mortality due to COVID-19, physicians anticipate a change in treatment guidance to prioritise bariatric surgery, and potentially pharmacotherapy, as a long-term strategy for the management of PwO post-COVID-19.”