Obesity is a chronic metabolic disease characterised by an increase of body fat stores. It is a gateway to ill health, and it has become one of the leading causes of disability and death, affecting not only adults but also children and adolescents worldwide. In clinical practice, the body fatness is estimated by BMI, and the accumulation of intra-abdominal fat (marker for higher metabolic and cardiovascular disease risk) can be assessed by waist circumference. Complex interactions between biological, behavioural, social and environmental factors are involved in regulation of energy balance and fat stores. A comprehensive history, physical examination and laboratory assessment relevant to the patient's obesity should be obtained. Appropriate goals of weight management emphasise realistic weight loss to achieve a reduction in health risks and should include promotion of weight loss, maintenance and prevention of weight regain. Management of co-morbidities and improving quality of life of obese patients are also included in treatment aims. Balanced hypocaloric diets result in clinically meaningful weight loss regardless of which macronutrients they emphasise. Aerobic training is the optimal mode of exercise for reducing fat mass while a programme including resistance training is needed for increasing lean mass in middle-aged and overweight/obese individuals. Cognitive behavioural therapy directly addresses behaviours that require change for successful weight loss and weight loss maintenance. Pharmacotherapy can help patients to maintain compliance and ameliorate obesity-related health risks. Surgery is the most effective treatment for morbid obesity in terms of long-term weight loss. A comprehensive obesity management can only be accomplished by a multidisciplinary obesity management team. We conclude that physicians have a responsibility to recognise obesity as a disease and help obese patients with appropriate prevention and treatment. Treatment should be based on good clinical care, and evidence-based interventions; should focus on realistic goals and lifelong multidisciplinary management.

/pdf/european-guidelines-for-obesity-management-in-adults-3inmplyepp.pdf

European Guidelines for Obesity Management in Adults

2013 AHA/ACC/TOS Guideline for the Management of Overweight

Obesity has proven to be a gateway to ill health. It has already reached epidemic proportions becoming one of the leading causes of death and disability in Europe and world-wide. Obesity plays a central role in the development of a number of risk factors and chronic diseases like hypertension, dyslipidaemia and type 2 diabetes mellitus inducing cardiovascular morbidity and mortality. Therefore weight management plays a central role in controlling the respective risk factors and their consequences. Obesity is a complex condition of multifactorial origin. Biological but also psychological and social factors interfere to lead to excess body weight and its deleterious outcomes. Obesity management cannot focus any more only on weight (and BMI) reduction. More attention is to be paid to waist circumference (or waist-to-hip ratio, especially in females), the improvement in body composition (measured with body composition tracking systems like BOD POD, dual energy X-ray absorptiometry or bioelectrical impedance analysis) which is focusing on ameliorating or maintaining fat-free mass and decreasing fat mass. Management of co-morbidities, improving quality of life and well-being of obese patients are also included in treatment aims. This statement emphasises the importance of a comprehensive approach to obesity management.

/pdf/an-easo-position-statement-on-multidisciplinary-obesity-424prsqycb.pdf

An EASO Position Statement on Multidisciplinary Obesity Management in Adults

Despite decades of unequivocal evidence that waist circumference provides both independent and additive information to BMI for predicting morbidity and risk of death, this measurement is not routinely obtained in clinical practice. This Consensus Statement proposes that measurements of waist circumference afford practitioners with an important opportunity to improve the management and health of patients. We argue that BMI alone is not sufficient to properly assess or manage the cardiometabolic risk associated with increased adiposity in adults and provide a thorough review of the evidence that will empower health practitioners and professional societies to routinely include waist circumference in the evaluation and management of patients with overweight or obesity. We recommend that decreases in waist circumference are a critically important treatment target for reducing adverse health risks for both men and women. Moreover, we describe evidence that clinically relevant reductions in waist circumference can be achieved by routine, moderate-intensity exercise and/or dietary interventions. We identify gaps in the knowledge, including the refinement of waist circumference threshold values for a given BMI category, to optimize obesity risk stratification across age, sex and ethnicity. We recommend that health professionals are trained to properly perform this simple measurement and consider it as an important 'vital sign' in clinical practice.

/pdf/waist-circumference-as-a-vital-sign-in-clinical-practice-a-3kmzb1s12y.pdf

Waist circumference as a vital sign in clinical practice: a Consensus Statement from the IAS and ICCR Working Group on Visceral Obesity

https://air.unimi.it/bitstream/2434/672335/7/1-s2.0-S2213858719300841-main.pdf

Visceral and ectopic fat, atherosclerosis, and cardiometabolic disease: a position statement

The development of consensus guidelines for obesity is complex. It involves recommending both treatment interventions and interventions related to screening and prevention. With so many publications and claims, and with the awareness that success for the individual is short-lived, many find it difficult to know what action is appropriate in the management of obesity. Furthermore, the significant variation in existing service provision both within countries as well as across the regions of Europe makes a standardised approach, even if evidence-based, difficult to implement. In formulating these guidelines, we have attempted to use an evidence-based approach while allowing flexibility for the practicing clinician in domains where evidence is currently lacking and ensuring that in treatment there is recognition of clinical judgment and of regional diversity as well as the necessity of an agreed approach by the individual and family. We conclude that i) physicians have a responsibility to recognise obesity as a disease and help obese patients with appropriate prevention and treatment, ii) treatment should be based on good clinical care and evidence-based interventions and iii) obesity treatment should focus on realistic goals and lifelong management.

https://www.konsument.at/gesundheit-kosmetik/util/getDownload.jsp?param=39ced8b1db5820b421a06a66e01a4d568e7df9637bf35d8a0bdf5899d8339de5be13b73dbeb626d5c37b00f4b57bb855c40726647d369549

Management of obesity in adults: European clinical practice guidelines

Stworzenie jednolitych wytycznych postepowania w otylości jest
zlozone. Obejmują one zarowno zalecenia diagnostyczne, lecznicze,
jak i dzialania w zakresie prewencji. Wobec wielu publikacji
i roznic poglądow oraz świadomości krotkotrwalości efektu odchudzającego
u poszczegolnych osob wielu uwaza, ze trudno jest
ustalic wlaściwe postepowanie w otylości. Roznorodnośc zasad
postepowania w kraju oraz pomiedzy regionami Europy utrudnia
ustalenie i wprowadzenie standardow. W ustalaniu obecnych wytycznych
za podstawe brano wiedze opartą na dowodach (EBM), a w razie wątpliwości uzupelniano na podstawie doświadczenia
klinicznego i roznorodności regionalnej oraz uzgodnionego stanowiska
zespolu. W podsumowaniu stwierdzono, ze: 1) lekarz jest odpowiedzialny
za rozpoznanie otylości jako choroby oraz pomoc w odpowiedniej
prewencji i leczeniu; 2) leczenie powinno byc oparte na dobrej
praktyce klinicznej i EBM; 3) leczenie otylości powinno wyznaczac
indywidualne realne cele i dozywotnie postepowanie.

/pdf/postepowanie-w-otylosci-doroslych-europejskie-wytyczne-dla-5dlncnu46x.pdf

Postępowanie w otyłości dorosłych: europejskie wytyczne dla praktyki klinicznej

Obesity is recognised as a global epidemic and the most prevalent metabolic disease world-wide. Specialised obesity services, however, are not widely available in Europe, and obesity care can vary enormously across European regions. The European Association for the Study of Obesity (EASO, www.easo.org) has developed these criteria to form a pan-European network of accredited EASO-Collaborating Centres for Obesity Management (EASO-COMs) in accordance with accepted European and academic guidelines. This network will include university, public and private clinics and will ensure that the obese and overweight patient is managed by a holistic team of specialists and receives comprehensive state-ofthe-art clinical care. Furthermore, the participating centres, under the umbrella of EASO, will work closely for quality control, data collection, and analysis as well as for education and research for the advancement of obesity care and obesity science.

/pdf/criteria-for-easo-collaborating-centres-for-obesity-3lnopv3b5o.pdf

Criteria for EASO-collaborating centres for obesity management.

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Management of obesity in adults: European clinical practice guidelines

Postępowanie w otyłości dorosłych: europejskie wytyczne dla praktyki klinicznej

Criteria for EASO-collaborating centres for obesity management.