Oral Presentation ESA-SRB-ANZOS 2025 in conjunction with ENSA

Aim

With increasing life expectancy in people living with cystic fibrosis (pwCF), new challenges such as obesity are emerging, particularly with the advent of CF modulator therapies. At our adult CF centre, median BMI rose from 23.57kg/m² to 25.15kg/m² following introduction of Elexacaftor/Tezacaftor/Ivacaftor. (1) This study aimed to co-develop and implement a metabolic care pathway to address the rising prevalence of obesity and associated metabolic complications.

Methods

Using the Consolidation Framework for implementation Research, we developed a broad-based survey targeting both consumer (pwCF) and multidisciplinary team (MDT) providers, followed by co-development workshops. These facilitated workshops were face-to-face and comprised respiratory physicians, dietitians, physiotherapists, nurses, social workers and psychologists. Each 60-minute workshop began with a brief presentation of consumer and healthcare provider perspectives gathered from the survey to frame the discussion. Participants were then invited to build consensus on key areas, including what should be continued, barriers to address, opportunities for innovation, and immediate actions to implement.

Results

Stakeholders agreed that (i) obesity is increasingly prevalent in pwCF, (ii) lifestyle optimisation should be first line management and (iii) a lack of CF-specific evidence requires adaptation from general population data. Barriers included limited evidence, fragmented metabolic data collection, cost-related access issues to community providers, and reduced in-person clinic visits. Key innovation included physiotherapy-dietetics co-consultations, routine metabolic screening for all outpatient in-person encounters and pharmacist alerts for anti-obesity medications. A pragmatic, tiered risk stratification approach (low, moderate, high) was co-developed and embedded into routine care using accessible, low cost screening tools.  

Conclusion

Through a structured implementation process, we co-developed and embedded a metabolic health pathway into a tertiary adult CF centre. This model of care enables early identification and intervention for obesity and metabolic risk in pwCF, while also providing specialist endocrinology support for pwCF with complex or treatment-resistant obesity.