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Review
. 2023 Feb;24(2):e13520.
doi: 10.1111/obr.13520. Epub 2022 Dec 1.

Obesity in South and Southeast Asia-A new consensus on care and management

Kwang Wei Tham  1 , Rohana Abdul Ghani  2 , Sioksoan C Cua  3   4 , Chaicharn Deerochanawong  5 , Mia Fojas  6 , Samantha Hocking  7   8   9 , June Lee  10 , Tran Quang Nam  11 , Faruque Pathan  12 , Banshi Saboo  13 , Sidartawan Soegondo  14   15 , Noel Somasundaram  16 , Alice M L Yong  17 , John Ashkenas  18 , Nicola Webster  18 , Brian Oldfield  19
Affiliations
Review

Obesity in South and Southeast Asia-A new consensus on care and management

Kwang Wei Tham et al. Obes Rev. 2023 Feb.

Abstract

Obesity is a chronic disease in which the abnormal or excessive accumulation of body fat leads to impaired health and increased risk of mortality and chronic health complications. Prevalence of obesity is rising rapidly in South and Southeast Asia, with potentially serious consequences for local economies, healthcare systems, and quality of life. Our group of obesity specialists from Bangladesh, Brunei Darussalam, India, Indonesia, Malaysia, Philippines, Singapore, Sri Lanka, Thailand, and Viet Nam undertook to develop consensus recommendations for management and care of adults and children with obesity in South and Southeast Asia. To this end, we identified and researched 12 clinical questions related to obesity. These questions address the optimal approaches for identifying and staging obesity, treatment (lifestyle, behavioral, pharmacologic, and surgical options) and maintenance of reduced weight, as well as issues related to weight stigma and patient engagement in the clinical setting. We achieved consensus on 42 clinical recommendations that address these questions. An algorithm describing obesity care is presented, keyed to the various consensus recommendations.

Keywords: childhood obesity in Southeast Asia; consensus on obesity in Southeast Asia; obesity management in Southeast Asia; weight stigma in Southeast Asia.

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Conflict of interest statement

KWT has disclosed receiving scientific advisory board fees, honoraria and consulting fees from Novo Nordisk, and an honorarium from DKSH Singapore. RAG has received research funding from AstraZeneca, Medtronic, Boehringer Ingelheim and Novo Nordisk, and sponsorship in the form of travel grants from AstraZeneca, Medtronic, Servier, Boehringer Ingelheim, MSD, Novo Nordisk, Novartis, and Eli Lilly. RAG has also received sponsorships for Continuous Medical Education for healthcare providers from Novo Nordisk, and has been involved in clinical trials with Johnson & Johnson, Boehringer Ingelheim, Bayer and AstraZeneca. RAG is currently involved as an investigator on multicentre clinical trials with Novo Nordisk. TN has disclosed receiving scientific advisory board fees from Novo Nordisk, Sanofi, Astra Zeneca, and Boehringer Ingelheim Viet Nam, and honoraria for acting as a speaker for Novo Nordisk, Sanofi, AstraZeneca, Boehringer Ingelheim, Novartis, MSD, and Merck Serono. NS has disclosed that he has received an honorarium for acting as a speaker for Novo Nordisk. BO has received consulting fees and honoraria from Novo Nordisk not related to this publication.

Figures

FIGURE 1
FIGURE 1
The Edmonton Obesity Staging System. Adapted from Sharma. Permission pending. BMI, body mass index; CV, cardiovascular; EOSS, Edmonton Obesity Staging System; GERD, gastroesophageal reflux disease; HTN, hypertension; PCOS, polycystic ovary syndrome; WHO, World Health Organization
FIGURE 2
FIGURE 2
Staging obesity in children: The EOSS‐P tool. Reprinted from Hadjiyannakis. Permission pending. ADHD, attention deficit hyperactivity disorder; ADL, activity of daily living; EOSS‐P, Edmonton Obesity Staging System for Pediatrics; FSGS, focal segmental glomerulosclerosis; GERD, gastroesophageal reflux disease; IGT, impaired glucose tolerance; LD, learning disability; MSK, musculoskeletal; OSA, obstructive sleep apnea; PAP, positive airway pressure; PCOS, polycystic ovary syndrome; T2DM, type 2 diabetes mellitus
FIGURE 3
FIGURE 3
Weight change trajectories over 8 years in patients enrolled in an intensive behavioral weight loss program vary with 2‐month outcomes. Reprinted from Unick et al. Permission pending
FIGURE 4
FIGURE 4
Algorithm for managing overweight and obesity in South and Southeast Asian adults. BMI, body mass index; DSS‐II, Second Diabetes Surgery Summit; EOSS, Edmonton Obesity Staging System; IFSO‐APC, International Federation for the Surgery of Obesity and Metabolic Disorders Asia Pacific Chapter; ORC, obesity‐related complication; WC, waist circumference. aFor some countries in the region, also calculate waist‐to‐hip ratio. bIn most South/Southeast Asian countries, overweight is defined by BMI ≥ 23 kg/m2 or WC ≥ 80 cm (women) or ≥90 cm (men). In Brunei Darussalam, overweight is defined as BMI ≥ 25 kg/m2. cCut points for bariatric surgery are based on the IFSO‐APC guidelines for Asian individuals with metabolic syndrome or T2DM. Refer to national guidance, where available. Alternative cut points are recommended in the DSS‐II guidelines (≥32.5 kg/m2 for individuals with poorly controlled T2DM, and ≥37.5 kg/m2 regardless of ORCs)
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