49
views
0
recommends
+1 Recommend
1 collections
    0
    shares
      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

      European Practical and Patient-Centred Guidelines for Adult Obesity Management in Primary Care

      other

      Read this article at

      ScienceOpenPublisherPubMed
      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          The first contact for patients with obesity for any medical treatment or other issues is generally with General Practitioners (GPs). Therefore, given the complexity of the disease, continuing GPs’ education on obesity management is essential. This article aims to provide obesity management guidelines specifically tailored to GPs, favouring a practical patient-centred approach. The focus is on GP communication and motivational interviewing as well as on therapeutic patient education. The new guidelines highlight the importance of avoiding stigmatization, something frequently seen in different health care settings. In addition, managing the psychological aspects of the disease, such as improving self-esteem, body image and quality of life must not be neglected. Finally, the report considers that achieving maximum weight loss in the shortest possible time is not the key to successful treatment. It suggests that 5–10% weight loss is sufficient to obtain substantial health benefits from decreasing comorbidities. Reducing waist circumference should be considered even more important than weight loss per se, as it is linked to a decrease in visceral fat and associated cardiometabolic risks. Finally, preventing weight regain is the cornerstone of lifelong treatment, for any weight loss techniques used (behavioural or pharmaceutical treatments or bariatric surgery).

          Related collections

          Most cited references33

          • Record: found
          • Abstract: found
          • Article: found
          Is Open Access

          European Guidelines for Obesity Management in Adults

          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.
            Bookmark
            • Record: found
            • Abstract: found
            • Article: not found

            Gluteofemoral body fat as a determinant of metabolic health.

            Body fat distribution is an important metabolic and cardiovascular risk factor, because the proportion of abdominal to gluteofemoral body fat correlates with obesity-associated diseases and mortality. Here, we review the evidence and possible mechanisms that support a specific protective role of gluteofemoral body fat. Population studies show that an increased gluteofemoral fat mass is independently associated with a protective lipid and glucose profile, as well as a decrease in cardiovascular and metabolic risk. Studies of adipose tissue physiology in vitro and in vivo confirm distinct properties of the gluteofemoral fat depot with regards to lipolysis and fatty acid uptake: in day-to-day metabolism it appears to be more passive than the abdominal depot and it exerts its protective properties by long-term fatty acid storage. Further, a beneficial adipokine profile is associated with gluteofemoral fat. Leptin and adiponectin levels are positively associated with gluteofemoral fat while the level of inflammatory cytokines is negatively associated. Finally, loss of gluteofemoral fat, as observed in Cushing's syndrome and lipodystrophy is associated with an increased metabolic and cardiovascular risk. This underlines gluteofemoral fat's role as a determinant of health by the long-term entrapment of excess fatty acids, thus protecting from the adverse effects associated with ectopic fat deposition.
              Bookmark
              • Record: found
              • Abstract: found
              • Article: not found

              Motivational interviewing to improve weight loss in overweight and/or obese patients: a systematic review and meta-analysis of randomized controlled trials.

              Motivational interviewing, a directive, patient-centred counselling approach focused on exploring and resolving ambivalence, has emerged as an effective therapeutic approach within the addictions field. However, the effectiveness of motivational interviewing in weight-loss interventions is unclear. Electronic databases were systematically searched for randomized controlled trials evaluating behaviour change interventions using motivational interviewing in overweight or obese adults. Standardized mean difference (SMD) for change in body mass, reported as either body mass index (BMI; kg m(-2) ) or body weight (kg), was the primary outcome, with weighted mean difference (WMD) for change in body weight and BMI as secondary outcomes. The search strategy yielded 3540 citations and of the 101 potentially relevant studies, 12 met the inclusion criteria and 11 were included for meta-analysis. Motivational interviewing was associated with a greater reduction in body mass compared to controls (SMD = -0.51 [95% CI -1.04, 0.01]). There was a significant reduction in body weight (kg) for those in the intervention group compared with those in the control group (WMD = -1.47 kg [95% CI -2.05, -0.88]). For the BMI outcome, the WMD was -0.25 kg m(-2) (95% CI -0.50, 0.01). Motivational interviewing appears to enhance weight loss in overweight and obese patients. © 2011 The Authors. obesity reviews © 2011 International Association for the Study of Obesity.
                Bookmark

                Author and article information

                Journal
                OFA
                OFA
                Obes Facts
                10.1159/issn.1662-4025
                Obesity Facts
                S. Karger AG
                1662-4025
                1662-4033
                2019
                March 2019
                23 January 2019
                : 12
                : 1
                : 40-66
                Affiliations
                [_a] aService d’enseignement thérapeutique pour maladies chroniques, Département de médecine communautaire, Hôpitaux Universitaires de Genève, Genève/Eurobesitas COMs Center, Vevey, Switzerland
                [_b] bDepartment of Medicine, Padova University Hospital, Bariatric Unit, University of Padova, Padova, Italy
                [_c] cInternal Medicine D & Obesity Clinic, Hasharon Hospital, Rabin Medical Centre, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
                [_d] dService d’enseignement thérapeutique pour maladies chroniques, Département de médecine communautaire, de premier recours et des urgencies, Hôpitaux Universitaires de Genève, Geneva, Switzerland
                [_e] eGP Winyates Health Centre, Fellow National Institute for Health and Care Excellence, Winyates, United Kingdom
                [_f] fDepartment of Internal Medicine, Medical University of Graz, Graz, Austria
                [_g] gVice President of <italic>European Union of General Practitioners</italic> (UEMO), Lausanne, Switzerland
                [_h] hDivision of Endocrinology, Metabolism and Diabetes, Department of Medicine, Istanbul University, Cerrahpasa Medical Faculty, Istanbul, Turkey
                [_i] iDepartment of Integrative Physiology, Faculty of Medicine, University of Fribourg, Fribourg, Switzerland
                Author notes
                *Professor Yves Schutz, Department of Integrative Physiology, Faculty of Medicine, University of Fribourg, Chemin du Musée 5, CH1700 Fribourg (Switzerland), E-Mail Yves.Schutz@unifr.ch
                Article
                496183 Obes Facts 2019;12:40–66
                10.1159/000496183
                30673677
                74f79b37-b3fe-4198-bdc7-d67edc0a3ba1
                © 2019 The Author(s) Published by S. Karger AG, Basel

                This article is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND). Usage and distribution for commercial purposes as well as any distribution of modified material requires written permission. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                History
                : 27 May 2018
                : 12 December 2018
                Page count
                Figures: 10, Tables: 9, Pages: 27
                Categories
                Guidelines

                Nutrition & Dietetics,Health & Social care,Public health
                Behavioural therapy,GPs,Conservative treatment,Bariatric/metabolic surgery,Obesity,Overweight,Primary care,Management,Motivational interviewing

                Comments

                Comment on this article