People with complex clinical obesity often face significant barriers to accessing conventional weight-management and rehabilitation services. The Tertiary Obesity Multidisciplinary Service (TOMS) is a 12-month, three-phase outpatient program designed to deliver medically supervised weight loss and stabilisation for this complex population. To date, TOMS has supported 25 patients with body mass of >200kg.
A 22-year-old male was referred to TOMS following a diagnosis of right-sided heart failure. At baseline, body mass was 261.6 kg, (BMI 80.7 kg/m²), waist circumference 186 cm) 6-minute walk test (6MWT) 358m. Standard care outpatient heart failure rehabilitation was unlikely to meet his healthcare goals. Instead, care was delivered via a multidisciplinary team comprising physiotherapy, dietetics, pharmacy, psychology, and endocrinology. The intervention used a very-low-energy diet (VLED) via Optifast or Optislim (three meal replacements daily plus additional serves of protein), with cardiac monitoring at 3, 6 and 12 months.
Across all three phases, the patient achieved progressive weight loss (Phase 1 34.4kg, 13.1%, Phase 2 14.8kg, 5.7% and Phase 3 13.7kg, 5.2%), with a total loss of 62.9kg (−24.0% of baseline weight). BMI decreased fby 19.4 units to 61.3kg/m², and waist circumference decreased by 39cm to 147cm, (−21.0%). 6MWT increased by 99m to 457m (+27.7%). Right ventricular function improved over the same period, corresponding temporally with the weight, waist, and functional capacity changes. Beyond anthropometric and cardiovascular changes, the patient regained independence, improved mobility, capacity for self-care and ability to engage with community.
This case demonstrates that a specialised, structured multidisciplinary obesity service can safely achieve significant health outcomes for people living with clinical obesity and advanced cardiovascular disease whose needs are not met by conventional care pathways.