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CROATIAN GUIDELINES FOR THE TREATMENT OF ADULTS WITH OBESITY
DAVOR ŠTIMAC
; Division of Gastroenterology, Department of Internal Medicine, Rijeka University Hospital Center / University of Rijeka, School of Medicine, Rijeka, Croatia
SANJA KLOBUČAR MAJANOVIĆ
orcid.org/0000-0002-0287-4735
; Division of Endocrinology, Diabetes and Metabolic Diseases, Department of Internal Medicine, Rijeka University Hospital Center / University of Rijeka, School of Medicine, Rijeka, Croatia
MAJA BARETIĆ
; Division of Endocrinology, Department of Internal Medicine, Zagreb University Hospital Center / Obesity Treatment Referral Center of the Ministry of Health of the Republic of Croatia / School of Medicine, University of Zagreb, Zagreb, Croatia
MIROSLAV BEKAVAC BEŠLIN
; Varaždin General Hospital, Varaždin, Croatia
ANDREJ BELANČIĆ
; Department of Clinical Pharmacology, Rijeka University Hospital Center / School of Medicine, University of Rijeka, Rijeka, Croatia
ŽELJKA CRNČEVIĆ ORLIĆ
; Medico Specialty Hospital /School of Medicine, University of Rijeka, Rijeka, Croatia
VELJKO ĐORĐEVIĆ
; School of Medicine, University of Zagreb, Zagreb, Croatia
DARKO MARČINKO
; Department of Psychiatry and Psychological Medicine, Zagreb University Hospital Center / School of Medicine, University of Zagreb, Zagreb, Croatia
DAVOR MILIČIĆ
; Department of Cardiovascular Diseases, Zagreb University Hospital Center / School of Medicine, University of Zagreb, Zagreb, Croatia
GORANA MIROŠEVIĆ
; Division of Endocrinology, Diabetes and Metabolic Diseases, Department of Internal Medicine, Sestre milosrdnice University Hospital Center / School of Dental Medicine, University of Zagreb, Zagreb, Croatia
SANJA MUSIĆ MILANOVIĆ
; Croatian Institute of Public Health, Health Promotion Division, Zagreb / School of Medicine, University of Zagreb / Andrija Štampar School of Public Health, Zagreb, Croatia
DINKA PAVIČIĆ BALDANI
; Division of Medical Assisted Reproduction, Department of Obstetrics and Gynecology, Zagreb University Hospital Center / School of Medicine, University of Zagreb, Zagreb, Croatia
ALESSANDRA POKRAJAC BULIAN
; Department of Psychology, Faculty of Humanities and Social Sciences, University of Rijeka, Rijeka, Croatia
SANJIN RAČKI
; Division of Nephrology, Dialysis and Renal Transplantation, Department of Internal Medicine, Rijeka University Hospital Center / University of Rijeka, School of Medicine, Rijeka, Croatia
DARIO RAHELIĆ
; Department of Diabetes and Endocrinology, Vuk Vrhovac University Clinic for Diabetes, Endocrinology and Metabolic Diseases, Merkur University Hospital / Catholic University of Croatia, School of Medicine / Josip Juraj Strossmayer University of Osijek, Faculty of Medicine, Osijek, Croatia
ŽELJKO REINER
; Division of Metabolic Disorders, Department of Internal Medicine, Zagreb University Hospital Center, Zagreb, Croatia
ALEN RUŽIĆ
; Department of Cardiovascular Diseases, Rijeka University Hospital Center / University of Rijeka, School of Medicine, Rijeka, Croatia
MIROSLAV SAMARŽIJA
; Department of Lung Diseases, Zagreb University Hospital Center / School of Medicine, University of Zagreb, Zagreb, Croatia
Abstract
Obesity is a chronic metabolic disease characterized by abnormal and excessive adipose tissue accumulation in the body. Although most people are concerned mainly for aesthetic reasons, obesity is primarily a health problem because it is associated with a wide range of diseases and shorter life expectancy. Obesity has recently been put in focus due to the COVID-19 pandemic since it has been revealed that patients with obesity are at an increased risk of both hospitalization and death related to COVID-19. In clinical practice, obesity is assessed by body mass index (BMI), whilst for additional assessment of visceral adipose tissue accumulation and distribution, which poses a greater risk of metabolic and cardiovascular disease development, waist circumference is used. A complex interaction among biological, behavioral, social and environmental factors is included in the regulation of energy balance and fat storage. Body weight control goals emphasize the importance of a realistic approach to weight loss in order to reduce health risks. They include promoting weight loss, maintenance of achieved lower/optimal body weight, and prevention of weight regain. Control of obesityrelated comorbidities and improvement of the quality of life of people living with overweight or obesity is an important aspect of treatment. Obesity treatment is primarily based on lifestyle changes and permanent acceptance of healthy habits. A combination of diet with an overall energy value of 500 kcal less than daily energy needs and regular physical activity are of utmost importance for reduction of excess weight, as well as its subsequent maintenance. The cognitive-behavioral approach is aimed at overcoming psychological barriers to the adoption and application of effective behaviors in weight control. Pharmacotherapy for weight loss is indicated as an adjunct to a low-calorie diet and increased physical activity in adults with a BMI ≥30 kg/m2, but also in overweight adults with a BMI ≥27 to <30 kg/m2 in the presence of at least one obesity-related comorbidity. Surgical approach is indicated in adults with BMI >35 kg/m2 with obesity-related comorbidities and in adults with BMI >40 kg/m2 with or without comorbidities. Bariatric surgery is the most effective therapeutic method for treating people with morbid obesity, and thus can ensure long-term weight loss. These guidelines can be easily applied in everyday clinical practice, and their goal is recognition and treatment of persons with overweight and obesity by each physician, with special emphasis on appropriate communication, motivational interviewing/conversation, and education.
Keywords
obesity; treatment; guidelines
Hrčak ID:
285231
URI
Publication date:
7.11.2022.
Visits: 1.843 *