Management of Adult Obesity - EASO (2019) Clinical Practice Guidelines
The European Association for the Study of Obesity (EASO) has released guidelines on the management of adult obesity.
World Health Organization (WHO), classification based on body mass index (BMI) is as follows:
- Grade 1 overweight (commonly and simply called overweight) - BMI of 25-29.9 kg/m2
- Grade 2 overweight (commonly called obesity) - BMI of 30-39.9 kg/m2
- Grade 3 overweight (commonly called severe or morbid obesity) - BMI ≥40 kg/m2
Other definition of obesity based on percentage of body fat is as follows:
- Men: Percentage of body fat greater than 25%, with 21-25% being borderline
- Women: Percentage of body fat great than 33%, with 31-33% being borderline
Key Recommendations are:
- After clinical evaluation, have a discussion about obesity with the patient avoiding stigmatization and using motivational interviewing (a collaborative discussion that reinforces the patient's own motivation towards behavioral change).
- Communicate that modest slimming (eg, 3-5% from initial body weight) can have health benefits. Guide the patient toward weight loss amount based on the patient's motivation. A 5-10% weight loss has a significant impact on reducing comorbidities.
- Set realistic calendar goals with the patient based on fat mass loss and a decrease in waist circumference rather than concentrating on body weight.
- The first treatment goal is to stabilize body weight. Monitor weight loss and waist circumference every 1-2 weeks initially to evaluate the treatment plan. Monitor once a month after 6 months of treatment.
- Initiate obesity management with a specific area (physical activity, nutrition, or psychological aspects).
- Treat comorbidities first with lifestyle modification or pharmacotherapy if necessary.
- Communicate the risks of weight cycling after weight loss.
Physicians have a responsibility to recognize obesity as a gateway disease and help patients with appropriate prevention and treatment schemes for obesity and its co-morbidities. Along with physicians, all caregivers have the same responsibility. Obesity care needs to be delivered by certified obesity experts in specialized and accredited obesity centers. Treatment should be based on good clinical care and evidence-based interventions and it should be individualized and multidisciplinary, focus on realistic goals, weight maintenance and prevention of weight regain. Everybody in the field, including the patients, should understand that, since obesity is a chronic disease, weight management will need to be lifelong.
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