Supporting Weight Management for Kidney Transplant Candidates in People With Obesity on Haemodialysis: The First National Survey of UK Kidney Healthcare Providers

Aims
Access to kidney transplantation (KTx) for people living with obesity and kidney failure is often challenging, especially given the inconsistent availability of publicly funded obesity services across the United Kingdom. This study explored UK kidney healthcare providers' views on weight management support for patients with obesity on haemodialysis before KTx, criteria for transplant waitlisting and the potential presence of weight stigma in clinical settings.

Materials and Methods
An online national UK cross-sectional survey was conducted (July–December 2024), using purposive and snowball sampling of kidney/transplant centres. Weight bias was assessed using the Fat Phobia Scale (F-Scale). Descriptive and multivariable regression analyses were conducted.

Results
In total, 227 respondents took part, representing 78.6% of UK kidney centres. Most providers (93%) reported that access to transplantation was the main motivator for patient weight loss, while major challenges included poor access to obesity services (61.7%), long waiting times (59.9%) and limited funding (58.6%). Only 60.1% had access to any obesity service, and referrals to bariatric/metabolic surgery (38.9%) and use of incretin-based therapies (34.7%) were uncommon. KTx waitlisting criteria varied widely, the most common BMI cut-off was ≤ 35 kg/m2. Weight stigma was prevalent, with a mean F-Scale score of 3.42 and 99.5% showing negative attitudes towards obesity.

Conclusions
This study provides the first UK-wide overview of practice demonstrating inconsistent access to obesity treatment services, BMI-based listing criteria and presence of weight stigma. These data underscore the urgent need for improved obesity care and equitable access to transplantation.