European Guidelines for Obesity Management in Adults

Abstract

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.

Living a successful weight loss after severe obesity

“…Whether modest weight loss is experienced as enough may depend on initial size, weight and health. Non-surgical weight loss initiatives for people suffering from severe obesity typically aim for a loss of 20% or more to achieve health benefits (Yumuk et al, 2015). Approximately 20% of those who obtain weight loss maintain it for one year or longer (Dombrowski, Knittle, Avenell, Araújo-Soares, & Sniehotta, 2014; Wing & Phelan, 2005).…”

The Association Between Obesity and Visit-to-Visit Variability in Systolic Blood Pressure: A Prospective Study

“…The measurement of WC was performed in a standing position, with heels apart, arms relaxed besides the body, and was measured in the middle distance between the rib cage and the iliac bone on the middle axillary line (at the level of the umbilicus). WC was used as an index of central obesity (17).…”

Controversial alternative diets in the light of current dietary recommendations for overweight and obesity treatment

“…According to the guidelines of American and European societies (including Polish) dealing with the scope of problems concerning nutrition in obesity [8][9][10][11], an obesity management pattern in all adult patients should start with the performance of basic anthropometric measurements, including the BMI and waist circumference. However, with the reservation that the BMI index does not consider inter-individual differences related with gender, age, muscle mass, hydration status, oedemas, large tumours, and sarcopenia [9], therefore, the assessment of the state of nutrition should be expanded by analysis of the body composition, including, among others, an evaluation of adipose tissue content, fat-free body mass, muscle mass, and content of water in the body, performed with the use of the BIA method (Bioelectrical Impedance Analysis) [8][9][10].…”

“…However, with the reservation that the BMI index does not consider inter-individual differences related with gender, age, muscle mass, hydration status, oedemas, large tumours, and sarcopenia [9], therefore, the assessment of the state of nutrition should be expanded by analysis of the body composition, including, among others, an evaluation of adipose tissue content, fat-free body mass, muscle mass, and content of water in the body, performed with the use of the BIA method (Bioelectrical Impedance Analysis) [8][9][10]. The Polish Association of Dietitians also recommends the performance of biochemical diagnostics with consideration of, among others, lipid profile, parameters of carbohydrate homeostasis (taking into consideration fasting glycaemia, casual glycaemia, HBA1c, and insulin), as well as hepatic aminotransferases, uric acid, creatinine, measurement of arterial blood pressure or, potentially, other parameters in accordance with the physician's decision [8,10]. In all patients with excessive body weight, a detailed nutritional and clinical history should be taken, including information concerning socio-demographic characteristics of the patient, concomitant diseases, medicines and/or dietary supplements taken, and habitual mode of eating [8,10].…”

“…The Polish Association of Dietitians also recommends the performance of biochemical diagnostics with consideration of, among others, lipid profile, parameters of carbohydrate homeostasis (taking into consideration fasting glycaemia, casual glycaemia, HBA1c, and insulin), as well as hepatic aminotransferases, uric acid, creatinine, measurement of arterial blood pressure or, potentially, other parameters in accordance with the physician's decision [8,10]. In all patients with excessive body weight, a detailed nutritional and clinical history should be taken, including information concerning socio-demographic characteristics of the patient, concomitant diseases, medicines and/or dietary supplements taken, and habitual mode of eating [8,10]. A nutritional interview should be characterised by motivational interviewing and should be conducted in accordance with the principles of the Code of Ethics for Professional Dieticians.…”