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

Abstract

<b><i>Background:</i></b> 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. <b><i>Summary:</i></b> 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. <b><i>Key Messages:</i></b> 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.

How do people living with obesity who use obesity services perceive healthcare professionals’ representation of the disease on social media? An interpretative phenomenological analysis

“…Challenges include long waiting times and resource constraints. Accessibility to obesity-related services can be challenging 4. Our study reflects the experience of both participants accessing public and private healthcare from varying geographical areas.…”

“…Historically, obesity has been defined as a body mass index >30 kg/m²3 and management focused on weight reduction. However, an improved understanding of obesity as a complex and heterogeneous disease has led to a shift in obesity management with a focus on improving patient-centred health rather than weight loss alone 4…”

Weight stigma experienced by patients with obesity in healthcare settings: A qualitative evidence synthesis

“…The following recommendations are informed by the patients' suggestions to reduce weight stigma collected from the included studies and underpinned by widely accepted clinical practice guidelines 68–70 to improve the provision of care for overweight and obesity. Adopt a person‐centered approach to weight‐based communication inclusive of person first language.…”

“…67 The obesity clinical practice guidelines seek to address stigmatizing medical treatment through the implementation of evidence-based practice guidelines that reflect advances in our understanding of the complexity of the disease. [68][69][70] The guidelines recommend taking a personcentered approach to the treatment of obesity, which initiates with evidence-based discussions between patients and providers using the 5A's framework to guide the collaborative exploration of informed and individualized treatment options for patients with obesity. 71,72…”

Systematic Development of National Guidelines for Obesity Care: The Swedish Approach

“…The first European guidelines on management of obesity in adults were published in 2004 [8] and subsequently updated [9][10][11]. Guidelines or medical care programs on obesity management are commonly issued by professional societies [12][13][14][15] and often aim to target the local context such as national models of obesity health care systems [16,17]. Currently, a number of guidelines have been updated to reflect the state of the art for certain patient groups, for example, clinical practice guidelines for the treatment of children and adolescents with obesity [18,19] and indications for metabolic and bariatric surgery [15].…”