Early integrated management and characteristics of adult patients with overweight and obesity: a modified delphi consensus study in Italy.

PURPOSE: A comprehensive approach to the management of obesity, considering its complications besides the disease itself, may be advantageous, and effective obesity medications are now available. Several aspects of the integrated management of overweight/obesity are still unclear or are rapidly evolving.

METHODS

We conducted a multicenter, multispecialty consensus based on the iterative modified Delphi methodology. The study ensured the fundamental principles of anonymity, iteration, controlled feedback, and statistical stability of the consensus. Management of two main patient subgroups was investigated, i.e., patients with overweight (body mass index, BMI 27-<30 kg/m2) with ≥ 1 weight-related comorbidity, and patients with obesity (BMI ≥ 30 kg/m2). Fifteen panelists had the required criteria and participated in the survey. Two Delphi rounds were required to complete the study, for a total of 93 items investigated.

RESULTS

Almost all panelists (high consensus, 93% agreement) described their typical patient as one with overweight or obesity combined with other cardiovascular (CV) risk factors. Full consensus (100% agreement) emerged that early control of body weight in patients with overweight or obesity may exert a favorable long-term effect on CV risk and may decrease the risk of early mortality, and that early treatment with novel pharmacological treatments may decrease substantially the risk of CV events. The target for weight loss was agreed by the experts at 10% to 15% reduction in patients with overweight/comorbidities (full consensus, 100% agreement) and 15% reduction in patients with obesity (borderline consensus, 67% agreement). The panel recognized the improved control of multiple metabolic parameters (i.e., glycemia, blood pressure, lipids) among the main potential benefits of novel pharmacological treatments (full consensus, 100% agreement).

CONCLUSIONS

Broad agreement was found across several topics related to obesity management, including the recognized value of an early, effective pharmacological treatment to control overweight/obesity, and the relevance of addressing multiple CV risk factors in addition to reducing body weight.