Title: Semaglutide for managing overweight and obesity (ID3850)
Funder: Department of Health and Social Care

Abstract: Overweight and obesity is a chronic condition characterised by increased body fat. People living with overweight or obesity are at an increased risk of developing cardiovascular disease, type 2 diabetes, atherosclerosis (the presence of fatty deposits in the arteries), hypertension and dyslipidaemia (abnormal levels of fats in the blood). Other conditions associated with obesity are non-alcoholic fatty liver disease, non-diabetic hyperglycaemia, subfertility, osteoarthritis, dyslipidaemia, obstructive sleep apnoea and idiopathic intracranial hypertension. The most common method for measuring obesity is body mass index (BMI) which is calculated as the ratio of weight to height squared. Overweight is typically defined by a BMI of 25 kg/m2 to <30 kg/m2 and obesity by a BMI of 30 kg/m2 or more. Some ethnic groups may be at increased risk of some ill health conditions at lower BMI than people of European family origin._x000D_ _x000D_ Obesity affects approximately one in four adults in the UK, with 67% of men and 60% of women in England living with overweight or obesity.[1],[2] In 2018/19 there were 11,117 hospital admissions directly attributable to obesity, an increase of 4% on 2017/18 (10,660 admissions). There has been an upward trend since 2014/15, with an increase of 22% over that period.[2]_x000D_ _x000D_ NICE clinical guideline 189 (CG189) ‘Obesity: identification, assessment and management’ states multicomponent interventions are the treatment of choice. Weight management programmes include behaviour change strategies to increase people's physical activity levels or decrease inactivity, improve eating behaviour and the quality of the person's diet, and reduce energy intake. Pharmacological treatments are usually considered only after dietary, exercise and behavioural approaches have been started and evaluated. It recommends orlistat for the management of obesity in people with a BMI of 30 kg/m2 or more, and in people with a BMI of 28 kg/m2 or more and significant comorbidities. If dietary and lifestyle advice, behaviour modification and drug treatments are unsuccessful, the NICE clinical guideline recommends bariatric surgery for people with: a BMI of =40 kg/m2; a BMI of between 35 kg/m2 and <40 kg/m2 with significant comorbidities, a BMI between 30 kg/m2 and <35 kg/m2 and with recent-onset of type 2 diabetes (surgery can be considered for people of Asian family origin who have recent-onset type 2 diabetes at a lower BMI than other populations). NICE technology appraisal 664 recommends liraglutide as an option for managing overweight and obesity alongside a reduced-calorie diet and increased activity in adults if they have a BMI of at least 35 kg/m2 (or at least 32.5 kg/m2 for members of minority ethnic groups known to be at equivalent risk of the consequences of obesity at a lower BMI than the white population) and they have non-diabetic hyperglycaemia (defined as a haemoglobin A1c level of 42 mmol/mol to 47 mmol/mol [6.0% to 6.4%] or a fasting plasma glucose level of 5.5 mmol/litre to 6.9 mmol/litre) and they have a high risk of cardiovascular disease based on risk factors such as hypertension and dyslipidaemia and it is prescribed in secondary care by a specialist multidisciplinary tier 3 weight management service._x000D_ _x000D_ References_x000D_ 1. NHS. Obesity. 2019. Available from: https://www.nhs.uk/conditions/obesity/ [Accessed October 2020]._x000D_ 2. NHS Digital. Statistics on Obesity, Physical Activity and Diet, England, 2020. 2020. Available from: https://digital.nhs.uk/data-and-information/publications/statistical/statistics-on-obesity-physical-activity-and-diet/england-2020 [Accessed October 2020].

Lay abstract: To appraise the clinical and cost effectiveness of semaglutide, within its marketing authorisation, in addition to a reduced calorie diet and increased physical activity, for the management of people with obesity or overweight with risk factors.

Research activity codes: 6.1 PHARMACEUTICALS
Health categories: METABOLIC AND ENDOCRINE