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Review
. 2022;15(6):736-752.
doi: 10.1159/000527131. Epub 2022 Oct 24.

Obesity in Adults: A 2022 Adapted Clinical Practice Guideline for Ireland

Cathy Breen  1   2 , Jean O'Connell  1   2 , Justin Geoghegan  2 , Donal O'Shea  3   2 , Susie Birney  1   4 , Louise Tully  1   5 , Karen Gaynor  1   3 , Mark O'Kelly  6 , Grace O'Malley  1   5 , Clare O'Donovan  1   7 , Oonagh Lyons  1   7 , Mary Flynn  1   7 , Suzanne Allen  8 , Niamh Arthurs  1   5 , Sarah Browne  1   9 , Molly Byrne  10 , Shauna Callaghan  11 , Chris Collins  12 , Aoife Courtney  9 , Michael Crotty  13 , Ciara Donohue  14 , Caroline Donovan  1   15 , Colin Dunlevy  2 , Diarmuid Duggan  16 , Naomi Fearon  2 , Francis Finucane  12 , Ita Fitzgerald  17 , Siobhan Foy  12 , John Garvey  2 , Irene Gibson  18 , Liam Glynn  19 , Edward Gregg  20 , Anne Griffin  21 , Janas M Harrington  22 , Caroline Heary  10 , Helen Heneghan  2 , Andrew Hogan  23 , Mary Hynes  12 , Claire Kearney  2 , Dervla Kelly  19 , Karl Neff  2   24 , Carel W le Roux  24 , Sean Manning  25 , Fionnuala McAuliffe  26 , Susan Moore  27 , Niamh Moran  6 , Maura Murphy  1   4 , Celine Murrin  9 , Sarah M O'Brien  28 , Caitríona O'Donnell  2 , Sarah O'Dwyer  17 , Cara O'Grada  2 , Emer O'Malley  2 , Orlaith O'Reilly  29 , Sharleen O'Reilly  15 , Olivia Porter  1   9 , Helen M Roche  9 , Amanda Rhynehart  2 , Leona Ryan  10 , Suzanne Seery  3 , Corina Soare  2 , Ferrah Shaamile  2 , Abigail Walsh  2 , Catherine Woods  30 , Conor Woods  31 , Ruth Yoder  2
Affiliations
Review

Obesity in Adults: A 2022 Adapted Clinical Practice Guideline for Ireland

Cathy Breen et al. Obes Facts. 2022.

Abstract

Background: This Clinical Practice Guideline (CPG) for the management of obesity in adults in Ireland, adapted from the Canadian CPG, defines obesity as a complex chronic disease characterised by excess or dysfunctional adiposity that impairs health. The guideline reflects substantial advances in the understanding of the determinants, pathophysiology, assessment, and treatment of obesity.

Summary: It shifts the focus of obesity management toward improving patient-centred health outcomes, functional outcomes, and social and economic participation, rather than weight loss alone. It gives recommendations for care that are underpinned by evidence-based principles of chronic disease management; validate patients' lived experiences; move beyond simplistic approaches of "eat less, move more" and address the root drivers of obesity.

Key messages: People living with obesity face substantial bias and stigma, which contribute to increased morbidity and mortality independent of body weight. Education is needed for all healthcare professionals in Ireland to address the gap in skills, increase knowledge of evidence-based practice, and eliminate bias and stigma in healthcare settings. We call for people living with obesity in Ireland to have access to evidence-informed care, including medical, medical nutrition therapy, physical activity and physical rehabilitation interventions, psychological interventions, pharmacotherapy, and bariatric surgery. This can be best achieved by resourcing and fully implementing the Model of Care for the Management of Adult Overweight and Obesity. To address health inequalities, we also call for the inclusion of obesity in the Structured Chronic Disease Management Programme and for pharmacotherapy reimbursement, to ensure equal access to treatment based on health-need rather than ability to pay.

Keywords: Clinical practice guideline; Ireland; Obesity.

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Conflict of interest statement

The OC Executive Committee developed and managed the competing interest policy and procedures for mitigating bias for the original CPGs, which are available on the OC guideline website and reported previously [1]. Individuals with direct competing interests abstained from voting in the areas in which they had the conflict. Any discussion regarding off-label use of drugs included the caveat that the use was off label. Methodologists from MERST who had no competing interests reviewed and graded each included study to ensure the evidence had been appropriately assessed to ensure they aligned with the evidence. The Irish adaptation authors report the following competing interests.

The OC adaptation grant was used to provide part-time clinical backfill for Cathy Breen to act as project coordinator. She reports receiving honoraria for educational events or conference attendance from Astra Zeneca, Behaviour Change Training Ltd., Diabetes Ireland, EASO, International Medical Press, Eli Lily, Medscape, MSD, Novo Nordisk and Sanofi Aventis and is a member of the Dexcom Advisory Board, ONCP Clinical Advisory Group, and MECC working group. Susie Birney reports funding to ICPO from the HSE, Novo Nordisk, and the European Coalition for People Living with Obesity (ECPO) and consulting fees or honoraria from Diabetes Ireland, ECPO, Novo Nordisk, and International Medical Press. She also reports that she is the Secretary of ECPO. Sarah Browne reports receiving institutional research grants from the Irish Research Council and ASOI and honoraria for educational events from the European Federation of the Associations of Dietitians. Michael Crotty reports honoraria for educational events or conference attendance from Novo Nordisk and Consilient Health and is a member of a Novo Nordisk advisory board. He is a member of the ONCP Clinical Advisory Group, Adult Weight Management Working Group, and ASOI. Frances Finucane reports a Saolta Hospital Group Clinical Research Career Development Award, is Chair of DSMB − The LEGEND Study: Lifestyle Education about Nutrition for Diabetes, a board member of the Irish Heart Foundation and National Office for Clinical Audit, and a council member of the RCSI. Siobhan Foy reports support for conference attendance from Novo Nordisk. Karen Gaynor reports receiving honoraria from Behaviour Change Training Ltd. and is Programme Manager with the ONCP. Irene Gibson reports that she is the Chair of the European Society of Cardiology, Association of Cardiovascular Nurses and Allied Healthcare Professionals Committee and the Director of Programmes and Innovation at the National Institute for Prevention and Cardiovascular Health. Anne Griffin reports that she is Chair of the Executive Council of the Irish Nutrition and Dietetic Institute, a member of the CORU Dietitian Registration Board and the European Federation of Associations for Dietetics Education and Lifelong Learning Committee. Janas Harrington reports that she is Co-Chair of the EASO Public Health Task Force. Andrew Hogan reports receiving institutional research grants from the National Children's Research Centre, the Dublin Skin and Cancer Hospital Charity, and the Health Research Board. Dervla Kelly reports she is a member of the National Research Ethics Committee for Clinical Trials. Carel le Roux reports receiving institutional research grants from the Irish Research Council, Health Research Board, Science Foundational Ireland and Anabio; consulting fees for Global Advisory Boards for Boehringer Ingelheim, Eli Lily, GI Dynamics, Herbalife, Johnson & Johnson, and Novo Nordisk; and honoraria for educational events or conference attendance from Herbalife, Johnson & Johnson, and Novo Nordisk. He previously held stock and worked in a voluntary capacity as Chief Medical Officer and Director of the Medical Device Division with Keyron and continues to provide them with scientific advice. He is a member of the Irish Society for Nutrition and Metabolism. Niamh Moran reports she is Chair of the Irish Society of Lifestyle Medicine. Maura Murphy reports that she is the Secretary of ICPO. Celine Murrin reports that she is a member of the Nutrition Council of the Irish Heart Foundation. Karl Neff reports honoraria for educational events or conference attendance from Novo Nordisk and Sanofi Aventis. He is a member of a data monitoring board for Fractyl Health, and he attended an advisory board meeting for Novo Nordisk and Consilient Health. Jean O'Connell reports honoraria for educational events or conference attendance from Novo Nordisk and MSD and is Chair of ASOI. Grace O'Malley reports receiving institutional research grants from the Health Research Board, Temple Street Foundation, EASO, the HSE, and honoraria for educational events from the University of Minnesota Obesity Centre. She is a committee member of ASOI and is Director and Secretary of EASO. She has received support for committee meeting attendance. Sharleen O'Reilly reports receiving institutional research grants from the European Commission Horizon 2020, the National Health and Medical Research Council of Australia, the Health Research Board Ireland, Al Qasimi Foundation, and the University of Sharjah Grant. She is an Associate Editor with Diabetic Medicine, a member of the European Federation of Associations of Dietitians Executive Committee, the Nutrition and Dietetics Journal Editorial Board, and the Irish Section of the Nutrition Society. Donal O'Shea reports that he is the National Clinical Lead with the ONCP. Leona Ryan reports receiving institutional research support from the Science Foundation Ireland Centre for Research Training in Digitally Enhanced Reality. Suzanne Seery reports receiving honoraria for educational events from the National Institute for Prevention and Cardiovascular Health. Conor Woods reports receiving honoraria for educational events or conference attendance from Astra Zeneca and Novo Nordisk. No other competing interests were declared.

References

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