Approach to patients with obesity and other cardiovascular risk factors in primary care using the Delphi methodology

Abstract

Background: Implementing preventive strategies for patients with obesity would improve the future burden of cardiovascular diseases. The objective was to present the opinions of experts on the approach to treat patients with obesity and other cardiovascular risk factors from a primary care perspective in Spain.Methods: Using the Delphi technique, a 42-question questionnaire was developed based on results from the scientific literature and sent to 42 experts in primary care. The blocks of knowledge addressed were (1) evaluation of the degree of incidence of obesity and associated cardiovascular risk factors, (2) evaluation of the barriers in diagnosis, prescription, and follow-up by the primary care physician or specialist of these patients, (3) improvement in obesity-related parameters in a patient being treated with lipid-lowering and antihypertensive drugs, and (4) analysis of improvements in cardiovascular parameters in responding patients under pharmacological treatment. Two rounds of participation were held.Results: Overall, 78.57% of the experts agreed with the questions posed in block 1, 10.00% in block 2, 61.9% in block 3, and 85.71% in block 4. Our results show the high awareness of the close relationship between obesity and cardiovascular risk factors among primary care physicians. It is necessary to use a checklist in primary care that includes metabolic parameters such as body mass index, waist circumference, and levels of C-reactive protein and ferritin. It is also useful to combine pharmacological treatment, such as liraglutide, with a change in lifestyle to achieve therapeutic goals in this population.Conclusions: There is a high awareness among experts in Spain about obesity and other cardiovascular risk factors and the need to address this pathology comprehensively. The need to incorporate specific tools in primary care consultations that allow better assessment and follow-up of these patients, such as cuffs adapted to arm size or imaging techniques to assess body fat, is evident.