John Meni The guideline I like most is the European one for the treatment of obesity, which was published. His focus is on a practical, centered approach on the patient. It is based on topics that are often overlooked, such as communicating with patients suffering from obesity and motivating them to change, therapeutic education of the patient and avoiding stigmatization.
Different approaches to controlling obesity must be based on good communication with patients, promoting motivation, objective clinical assessment and behavioral therapy. The way the healthcare professional communicates with patients is crucial to establishing a therapeutic alliance.
We must recognize that discrimination and stigmatization of patients with obesity is surprisingly common in healthcare settings. Many professionals think that patients with obesity are lazy, disobedient, unintelligent, without willpower and even dishonest. Many patients feel neglected and therefore avoid consultations and treatments.
Stigmatization can cause an increase in eating disorders and a decrease in physical activity, both leading to additional weight gain and greater obesity, as well as increased depression, suicidal thoughts or even, in the worst cases, suicide. The management of the psychological aspects of the disease, such as improving self-esteem, body image and quality of life, should also not be neglected.
Another important point is that this guideline considers that achieving maximum weight loss in the shortest possible time is not the key to success! Treatment goals will obviously be adjusted for complications. Weight loss is given as an indicator of what could be achieved to decrease cardiometabolic risks. This loss can vary from 5 to 10%, depending on the pathology, and is sufficient to obtain substantial health benefits with the reduction of comorbidities. The reduction in waist circumference should be considered even more important than weight loss alone, as it is linked to a decrease in visceral fat and associated cardiometabolic risks.
And how can the management of patients with obesity be improved? The answer is: reducing negative attitudes and taking actions such as welcoming the patient with empathy and without judgment; understand that a patient with obesity may have already had negative experiences with health professionals; recognize that obesity is multifactorial; not using inappropriate or offensive words; ask if the patient wants to talk about his weight before starting the discussion; and change the term “obese” by “with obesity”, as this will be considered less stigmatizing by the patient.
The Canadian Adult Obesity Guideline, published in 2020, was also designed with a patient-centered approach. The document highlights 5 guidelines to be followed by health professionals in caring for people with obesity, they are:
-
Asking for permission: healthcare professionals should ask the patient for permission to offer advice and help treat this disease impartially.
-
Assess the patient’s history: using appropriate measures and identifying the causes, complications and barriers to the treatment of obesity.
-
Discuss treatment options: discussion of the main treatment options (medical nutritional therapy and physical activity) and adjuvant therapies that may be needed, including psychological, pharmacological and surgical interventions.
-
Set goals with the patient: agreement with the patient regarding the goals of the therapy, focusing mainly on the value that the person derives from interventions based on health.
-
Monitoring the patient: involvement of health professionals with the person with obesity in the continuous monitoring and reassessments and encouraging the promotion of improved care for this patient chronic disease.
Another very important guideline is the Brazilian Obesity Guidelines. They were published in 2016 with the aim of providing data on the etiology, diagnosis and dietary, cognitive-behavioral and pharmacological treatment of overweight. This publication also provides recommendations against some heterodox treatments and nutritional supplements, drawing attention to therapies without scientific basis, therefore practices not recommended for the treatment of obesity. Among them are acupuncture, aromatherapy and herbal supplements.
She also talks about “you know who”, who sells shakes and supplements for weight loss. And guess what is said… that’s right, there are published reports on liver damage after ingesting these products in at least 30 cases in several countries. The predominant pattern of injury was hepatocellular, but mixed and cholestasis patterns were also observed, with intensity ranging from mild to severe liver damage, including cirrhosis and acute liver failure requiring liver transplantation in two cases (successful in one patient, with death in the second).
Brand representatives deny the causal relationship between the consumption of their products and liver damage. But it remains speculative what could have caused liver damage in the published cases, as patients ingested up to 17 different components that were present in the products at the same time. This makes it almost impossible to identify the responsible compound. There are some hypotheses: immune-mediated liver damage or adulteration of products. Since “you know who” is produced in various regions of the world, it is speculated that products contaminated with germs or chemical compounds could have been responsible for hepatotoxicity.
I couldn’t help but also mention the AACE table ( American Association of Clinical Endocrinologists ), published in 2016, which brings a tripod with Nutrition, Physical Activity and Behavior. For those who do not know AACE is the American guideline of clinical practice for medical care of patients with obesity, despite being a Guideline of 2016, the guidelines follow timeless, I will talk briefly about them.
As a treatment, the importance of a healthy eating plan with reduced calories is emphasized, which according to the Guide, should be the main component of any intervention for weight loss. In addition, the modification of macronutrients (carbohydrate, lipid and protein) can be considered in order to optimize adherence and consequently improve the metabolic profile and clinical results as a whole.
Aerobic physical activity should be prescribed for patients with overweight or obesity, the initial prescription may over time be adjusted, requiring a progressive increase in the intensity and frequency of exercise, the end goal should be above or equal to 150 minutes / week of moderate exercise performed for 3 to 5 days a week. Resistance training is also indicated to help promote fat loss while preserving muscle mass, the goal should be resistance training 2 to 3 per week.
Behavioral interventions are effective in increasing adherence to overweight or obese patients, these interventions may include: self-monitoring of weight, intake of food and physical activity, in addition to an approach that works with issues such as stress reduction, motivational interview, psychological counseling and conversations with the health professional himself or in groups to answer questions and solve problems.
