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

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).

Keywords: Bariatric/metabolic surgery; Behavioural therapy; Conservative treatment; GPs; Management; Motivational interviewing; Obesity; Overweight; Primary care.

Fig. 1

Overall synopsis of obesity management. Focus in this article is placed on communication with GPs and education of the patient.

Fig. 2

History taking: schematic view of the major endogenous and exogenous aetiological factors. To identify and understand the natural history of obesity from the pre-obese state is part of the process. Note that weight loss per se is not considered the first priority of obesity treatment. Rather, managing comorbidities and preventing weight gain or regain after weight loss is the priority.

Fig. 3

The measurement of abdominal circumference with a non-stretchable tape is not as easy as it looks on the schematic silhouette. It has a relatively poor inter-investigator accuracy, particularly in obese individuals. Alternative objective circumference assessment without skin contact (e.g. by a laser beam) is currently available but the instrument is too costly for GPs’ routine medical practice [66].

Fig. 4

Obesity and its multiple comorbidities affecting many systems, organs and tissues (source: Jeffrey Newman).

Fig. 5

Overview of a comprehensive step-by-step management of obesity in medical practice. The decision algorithm is obviously a simplification of the reality and shows the vast number of factors to be considered for optimizing the individual management with its four non-dogmatic non-competitive treatments options.

Fig. 6

How to communicate with the patient with obesity? The GP presents this scheme to the patient during the consultation in order to help him/her choose which area they would like to initiate behavioural modification.

Fig. 7

The plate (“normal” size) shows the typical balanced Mediterranean style diet, which is used as a model to show the proportion represented by each of the components: about half for vegetables, about one quarter for food rich in protein (meat, fish, cheese and legumes) and the last quarter for starchy food including cereals and grains. Fruits are shown on the periphery of the plate because they can be eaten between meals (apples, berries, etc.). (From: diet http://nutrition-sante.ch/l-assiette-equilibree).

Fig. 8

The principle of the physical activity pyramid is that the more you climb the pyramid, the less amount of time needs to be dedicated to physical activity. This is because the intensity of exercise becomes gradually higher. The last level (at the top) constitutes the inactivity component, which must be taken into account, since the more time spent sedentary in daily life, the less time is available for exercise.

Fig. 9

Bariatric surgery, typically used for massive obesity treatment, requires continuous medical surveillance both before and after gastric surgery, irrespective of the surgical procedure used. The time scale for post-surgery management is virtually lifelong.

Fig. 10

Primary, secondary, tertiary and quaternary preventions with their respective explanations. The quaternary prevention is a new paradigm important to how GPs manage obesity. It is defined as actions taken by GPs to protect the patients from medical interventions that are likely to cause “more harm than good.” Adapted from [67].