Obesity is not always recognized as a primary disease, leading to shortage of insurance coverage, clear dispositions about therapeutic strategies, prevention programs and legislation. Worldwide, physicians face the challenge to design affordable and effective treatments against obesity, to improve patient health and wellbeing and reduce the burden on healthcare systems. While international guidelines for obesity management are available, straightforward recommendations applicable in developing countries are needed. In order to develop local consensus recommendations, a panel of endocrinologists with experience in overweight and obesity convened and provided opinions about obesity aetiology, diagnosis, and management, in a structured discussion. Opinions were then developed into recommendations. There was unanimous agreement on recognizing obesity as a disease, which could be diagnosed by any trained physician and best managed by endocrinologists or obesity-trained physicians. The panel reiterated that lifestyle and behaviour changes remain the cornerstone of treatment; underscoring, however, the need for pharmacotherapy or bariatric surgery in some cases. They also identified stakeholders in the fight against obesity (ministries, third-party payers, healthcare providers and others). The establishment of an obesity registry was encouraged, which will pave the way for enhanced obesity research and prevention programs. These recommendations, endorsed by the World Obesity Federation, would be of interest to clinicians worldwide.
References
[1]
World Health Organization (2018) Overweight and Obesity Factsheet. https://www.who.int/en/news-room/fact-sheets/detail/obesity-and-overweight
[2]
Nasreddine, L., et al. (2012) Trends in Overweight and Obesity in Lebanon: Evidence from Two National Cross-Sectional Surveys (1997 and 2009). BMC Public Health, 12, Article No. 798. https://doi.org/10.1186/1471-2458-12-798
[3]
Global Health Observatory (GHO) and World Health Organization (2016) Prevalence of Overweight among Adults. https://www.who.int/gho/ncd/risk_factors/overweight/en/
[4]
World Health Organization (2014) Noncommunicable Diseases Country Profiles. https://apps.who.int/iris/bitstream/handle/10665/128038/9789241507509_eng.pdf
[5]
Mallat, S., et al. (2016) Obesity in Lebanon: A National Problem. World Journal of Cardiovascular Diseases, 6, 166-174. https://doi.org/10.4236/wjcd.2016.66017
[6]
El-Kassas, G. and Ziade, F. (2017) Exploration of the Risk Factors of Generalized and Central Obesity among Adolescents in North Lebanon. Journal of Environmental and Public Health, 2017, Article ID: 2879075. https://doi.org/10.1155/2017/2879075
[7]
Nasreddine, L., et al. (2014) Dietary, Lifestyle and Socio-Economic Correlates of Overweight, Obesity and Central Adiposity in Lebanese Children and Adolescents. Nutrients, 6, 1038-1062. https://doi.org/10.3390/nu6031038
[8]
Boone, J.E., et al. (2007) Screen Time and Physical Activity during Adolescence: Longitudinal Effects on Obesity in Young Adulthood. International Journal of Behavioral Nutrition and Physical Activity, 4, Article No. 26. https://doi.org/10.1186/1479-5868-4-26
[9]
Abdelaal, M., le Roux, C.W. and Docherty, N.G. (2017) Morbidity and Mortality Associated with Obesity. Annals of Translational Medicine, 5, e161. https://doi.org/10.21037/atm.2017.03.107
[10]
Aune, D., et al. (2016) BMI and All Cause Mortality: Systematic Review and Non-Linear Dose-Response Meta-Analysis of 230 Cohort Studies with 3.74 Million Deaths among 30.3 Million Participants. BMJ, 353, i2156. https://doi.org/10.1136/bmj.i2156
[11]
The Global BMI Mortality Collaboration (2016) Body-Mass Index and All-Cause Mortality: Individual-Participant-Data Meta-Analysis of 239 Prospective Studies in Four Continents. The Lancet, 388, 776-786. https://doi.org/10.1016/S0140-6736(16)30175-1
[12]
Liu, Y. and Ding, Z. (2017) Obesity, a Serious Etiologic Factor for Male Subfertility in Modern Society. Reproduction, 154, R123-R131. https://doi.org/10.1530/REP-17-0161
[13]
Barazzoni, R., et al. (2018) Sarcopenic Obesity: Time to Meet the Challenge. Obesity Facts, 11, 294-305. https://doi.org/10.1159/000490361
[14]
Haslam, D.W. and James, W.P. (2005) Obesity. The Lancet, 366, 1197-209. https://doi.org/10.1016/S0140-6736(05)67483-1
[15]
Lennon, H., et al. (2016) The Obesity Paradox in Cancer: A Review. Current Oncology Reports, 18, Article No. 56. https://doi.org/10.1007/s11912-016-0539-4
[16]
Apovian, C.M., et al. (2015) Pharmacological Management of Obesity: An Endocrine Society Clinical Practice Guideline. The Journal of Clinical Endocrinology & Metabolism, 100, 342-362. https://doi.org/10.1210/jc.2014-3415
[17]
Yumuk, V., et al. (2015) European Guidelines for Obesity Management in Adults. Obesity Facts, 8, 402-424. https://doi.org/10.1159/000442721
[18]
Nimeri, A., et al. (2017) The Peri-Operative Bariatric Surgery Care in the Middle East Region. Obesity Surgery, 27, 1543-1547. https://doi.org/10.1007/s11695-016-2503-7
[19]
Okorodudu, D.O., et al. (2010) Diagnostic Performance of Body Mass Index to Identify Obesity as Defined by Body Adiposity: A Systematic Review and Meta-Analysis. International Journal of Obesity, 34, 791-799. https://doi.org/10.1038/ijo.2010.5
[20]
Gonzalez, M.C., Correia, M. and Heymsfield, S.B. (2017) A Requiem for BMI in the Clinical Setting. Current Opinion in Clinical Nutrition and Metabolic Care, 20, 314-321. https://doi.org/10.1097/MCO.0000000000000395
[21]
Ross, R., et al. (2020) Waist Circumference as a Vital Sign in Clinical Practice: A Consensus Statement from the IAS and ICCR Working Group on Visceral Obesity. Nature Reviews Endocrinology, 16, 177-189. https://doi.org/10.1038/s41574-019-0310-7
[22]
Tanamas, S.K., et al. (2016) Quantifying the Proportion of Deaths Due to Body Mass Index- and Waist Circumference-Defined Obesity. Obesity, 24, 735-742. https://doi.org/10.1002/oby.21386
[23]
WHO Expert Committee on Physical Status: The Use and Interpretation of Anthropometry (1993: Geneva, Switzerland) & World Health Organization (1995) Physical Status: The Use of and Interpretation of Anthropometry, Report of a WHO Expert Committee. World Health Organization. https://apps.who.int/iris/handle/10665/37003
[24]
Pischon, T., et al. (2008) General and Abdominal Adiposity and Risk of Death in Europe. The New England Journal of Medicine, 359, 2105-2120. https://doi.org/10.1056/NEJMoa0801891
[25]
Zhang, C., et al. (2008) Abdominal Obesity and the Risk of All-Cause, Cardiovascular, and Cancer Mortality: Sixteen Years of Follow-Up in US Women. Circulation, 117, 1658-1667. https://doi.org/10.1161/CIRCULATIONAHA.107.739714
[26]
Allison, D.B., et al. (2008) Obesity as a Disease: A White Paper on Evidence and Arguments Commissioned by the Council of the Obesity Society. Obesity, 16, 1161-1177. https://doi.org/10.1038/oby.2008.231
[27]
Apovian, C.M. and Mechanick, J.I. (2013) Obesity IS a Disease! Current Opinion in Endocrinology & Diabetes and Obesity, 20, 367-368. https://doi.org/10.1097/01.med.0000433068.09294.a1
[28]
Stunkard, A.J., et al. (1990) The Body-Mass Index of Twins Who Have Been Reared Apart. The New England Journal of Medicine, 322, 1483-1487. https://doi.org/10.1056/NEJM199005243222102
[29]
Bouchard, C., et al. (1990) The Response to Long-Term Overfeeding in Identical Twins. The New England Journal of Medicine, 322, 1477-1482. https://doi.org/10.1056/NEJM199005243222101
[30]
United Nations Development Programme (2015) Sustainable Development Goals: Sustainable Cities and Communities. https://www.undp.org/sustainable-development-goals
[31]
World Health Organization (2000) The Asia-Pacific Perspective: Redefining Obesity and Its Treatment. Health Communications Australia, Sydney. https://apps.who.int/iris/handle/10665/206936
[32]
Bataille, D. and Dalle, S. (2014) The Forgotten Members of the Glucagon Family. Diabetes Research and Clinical Practice, 106, 1-10. https://doi.org/10.1016/j.diabres.2014.06.010
[33]
McAllister, E.J., et al. (2009) Ten Putative Contributors to the Obesity Epidemic. Critical Reviews in Food Science and Nutrition, 49, 868-913. https://doi.org/10.1080/10408390903372599
[34]
Simpson, K., et al. (2012) CCK, PYY and PP: The Control of Energy Balance. In: Joost, H.G., Ed., Handbook of Experimental Pharmacology, Springer, Berlin, 209-230. https://doi.org/10.1007/978-3-642-24716-3_9
[35]
Skelton, J.A., et al. (2011) Etiologies of Obesity in Children: Nature and Nurture. Pediatric Clinics of North America, 58, 333-354. https://doi.org/10.1016/j.pcl.2011.09.006
[36]
American Congress of Obstetrics and Gynecology (ACOG) Polycystic Ovary Syndrome (PCOS). https://www.acog.org/patient-resources/faqs/gynecologic-problems/polycystic-ovary-syndrome
[37]
Apovian, C.M. (2016) Obesity: Definition, Comorbidities, Causes, and Burden. The American Journal of Managed Care, 22, S176-S185. https://www.ajmc.com/view/obesity-definition-comorbidities-causes-burden
[38]
Tchernof, A. and Despres, J.P. (2013) Pathophysiology of Human Visceral Obesity: An Update. Physiological Reviews, 93, 359-404. https://doi.org/10.1152/physrev.00033.2011
[39]
Lamarche, B., et al. (1998) Fasting Insulin and Apolipoprotein B Levels and Low-Density Lipoprotein Particle Size as Risk Factors for Ischemic Heart Disease. JAMA, 279, 1955-1961. https://doi.org/10.1001/jama.279.24.1955
[40]
Boyle, M.A. (2016) Community Nutrition in Action: An Entrepreneurial Approach. 7th Edition, Cengage Learning, Boston.
[41]
Bailey, R.L. (2021) Overview of Dietary Assessment Methods for Measuring Intakes of Foods, Beverages, and Dietary Supplements in Research Studies. Current Opinion in Biotechnology, 70, 91-96. https://doi.org/10.1016/j.copbio.2021.02.007
[42]
Montesi, L., et al. (2016) Long-Term Weight Loss Maintenance for Obesity: A Multidisciplinary Approach. Diabetes, Metabolic Syndrome and Obesity, 9, 37-46. https://doi.org/10.2147/DMSO.S89836
[43]
Garvey, W.T., et al. (2016) American Association of Clinical Endocrinologists and American College of Endocrinology Comprehensive Clinical Practice Guidelines for Medical Care of Patients with Obesity. Endocrine Practice, 22, 1-203. https://doi.org/10.4158/EP161365.GL
[44]
Delahanty, L.M. and Nathan, D.M. (2008) Implications of the Diabetes Prevention Program and Look AHEAD Clinical Trials for Lifestyle Interventions. Journal of the Academy of Nutrition and Dietetics, 108, S66-S72. https://doi.org/10.1016/j.jada.2008.01.026
[45]
de Souza, R.J., et al. (2012) Effects of 4 Weight-Loss Diets Differing in Fat, Protein, and Carbohydrate on Fat Mass, Lean Mass, Visceral Adipose Tissue, and Hepatic Fat: Results from the Pounds Lost Trial. The American Journal of Clinical Nutrition, 95, 614-625. https://doi.org/10.3945/ajcn.111.026328
[46]
Jensen, M.D., et al. (2014) 2013 AHA/ACC/TOS Guideline for the Management of Overweight and Obesity in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society. Circulation, 129, S102-S138. https://doi.org/10.1161/01.cir.0000437739.71477.ee
[47]
Sacks, F.M., et al. (2009) Comparison of Weight-Loss Diets with Different Compositions of Fat, Protein, and Carbohydrates. The New England Journal of Medicine, 360, 859-873. https://doi.org/10.1056/NEJMoa0804748
[48]
Bray, G.A., et al. (2018) The Science of Obesity Management: An Endocrine Society Scientific Statement. Endocrine Reviews, 39, 79-132. https://doi.org/10.1210/er.2017-00253
[49]
Gardner, C.D., et al. (2018) Effect of Low-Fat vs Low-Carbohydrate Diet on 12-Month Weight Loss in Overweight Adults and the Association with Genotype Pattern or Insulin Secretion: The DIETFITS Randomized Clinical Trial. JAMA, 319, 667-679. https://doi.org/10.1001/jama.2018.0245
[50]
Estruch, R., et al. (2018) Primary Prevention of Cardiovascular Disease with a Mediterranean Diet Supplemented with Extra-Virgin Olive Oil or Nuts. The New England Journal of Medicine, 378, e34. https://doi.org/10.1056/NEJMoa1800389
[51]
Estruch, R., et al. (2013) Primary Prevention of Cardiovascular Disease with a Mediterranean Diet. The New England Journal of Medicine, 368, 1279-1290. https://doi.org/10.1056/NEJMoa1200303
[52]
Westerterp, K.R. (2018) Changes in Physical Activity over the Lifespan: Impact on Body Composition and Sarcopenic Obesity. Obesity Reviews, 19, 8-13. https://doi.org/10.1111/obr.12781
[53]
World Health Organization (2008) Pacific Physical Activity Guidelines for Adults: Framework for Accelerating the Communication of Physical Activity Guidelines. World Health Organization, Geneva. https://www.ncbi.nlm.nih.gov/books/NBK143639/
[54]
Saunders, K.H., et al. (2018) Obesity Pharmacotherapy. Medical Clinics of North America, 102, 135-148. https://doi.org/10.1016/j.mcna.2017.08.010
[55]
Keith, J.N. (2016) Pharmacotherapy in Treatment of Obesity. Gastroenterology Clinics of North America, 45, 663-672. https://doi.org/10.1016/j.gtc.2016.07.011
[56]
US Food and Drug Administration (2017) Drugs @ FDA: FDA Approved Drug Products. Saxenda, Department of Health and Human Services. https://www.accessdata.fda.gov/scripts/cder/daf/
[57]
US Food and Drug Administration (1999) Orlistat (Marketed as Alli and Xenical) Information. https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/orlistat-marketed-alli-and-xenical-information
[58]
Takeda Pharmaceuticals America (2014) Highlights of Prescribing Information—Contrave.
[59]
Agency, E.M. (2015) Summary of the European Public Assessment Report (EPAR) for Mysimba. https://www.ema.europa.eu/en/medicines/human/EPAR/mysimba#overview-section
[60]
European Medicines Agency (2015) Saxenda Recommended for Approval in Weight Management in Adults. https://www.ema.europa.eu/en/news/saxenda-recommended-approval-weight-management-adults
[61]
European Medicines Agency (2019) Summary of the European Public Assessment Report (EPAR) for Xenical. https://www.ema.europa.eu/en/medicines/human/EPAR/xenical
[62]
Garvey, W.T., et al. (2014) American Association of Clinical Endocrinologists and American College of Endocrinology Position Statement on the 2014 Advanced Framework for a New Diagnosis of Obesity as a Chronic Disease. Endocrine Practice, 20, 977-989. https://doi.org/10.4158/EP14280.PS
[63]
Mechanick, J.I., et al. (2013) Clinical Practice Guidelines for the Perioperative Nutritional, Metabolic, and Nonsurgical Support of the Bariatric Surgery Patient—2013 Update: Cosponsored by American Association of Clinical Endocrinologists, the Obesity Society, and American Society for Metabolic & Bariatric Surgery. Obesity, 21, S1-S27. https://doi.org/10.1002/oby.20461
[64]
Sudlow, A., le Roux, C.W. and Pournaras, D.J. (2020) The Metabolic Benefits of Different Bariatric Operations: What Procedure to Choose? Endocrine Connections, 9, R28-R35. https://doi.org/10.1530/EC-19-0467
[65]
Mechanick, J.I., et al. (2019) Clinical Practice Guidelines for The Perioperative Nutrition, Metabolic, And Nonsurgical Support Of Patients Undergoing Bariatric Procedures—2019 Update: Cosponsored By American Association Of Clinical Endocrinologists/American College Of Endocrinology, The Obesity Society, American Society for Metabolic & Bariatric Surgery, Obesity Medicine Association, and American Society of Anesthesiologists—Executive Summary. Endocrine Practice, 25, 1346-1359. https://doi.org/10.4158/GL-2019-0406
[66]
Smith, M.D., et al. (2010) Relationship between Surgeon Volume and Adverse Outcomes after RYGB in Longitudinal Assessment of Bariatric Surgery (LABS) Study. Surgery for Obesity and Related Diseases, 6, 118-125. https://doi.org/10.1016/j.soard.2009.09.009
[67]
Raynor, H.A. and Champagne, C.M. (2016) Position of the Academy of Nutrition and Dietetics: Interventions for the Treatment of Overweight and Obesity in Adults. Journal of the Academy of Nutrition and Dietetics Home, 116, 129-147. https://doi.org/10.1016/j.jand.2015.10.031
