A critical review of the new guidelines for the management of overweight and obesity in adults

Georgios A. Christou, Dimitrios N. Kiortsis



The management of obesity has a central role in the field of Preventive Medicine. Thus, new guidelines for the management of overweight and obesity in adults were published in 2013, after the previous ones in 1998. The cut-offs for Body Mass Index (BMI) (overweight: 25-30 Kg/ m2, obesity: ≥ 30 Kg/ m2) and waist circumference (> 102 cm for men, > 88 cm for women), that can discriminate between subjects with different levels of risk for cardiovascular events and all cause mortality, are the same in both the new and previous guidelines. Under the new guidelines all overweight and obese adults should be informed that weight loss (the initial target is a percentage change of 5-10 % from baseline body weight over 6 months) can result in the amelioration of dyslipidemia and glycemic profile, as well as in reduction of blood pressure. The new guidelines recommend a high intensity (≥ 14 sessions in 6 months) lifestyle intervention (a combination of diet, increased physical activity and behavioral strategies) for at least 1 year provided by a trained interventionist. The new guidelines do not recommend any specific diet and they claim that diet should be in general hypocaloric. If the lifestyle intervention is proven to be unsuccessful to meet the health outcome goals, orlistat treatment or bariatric surgery can be considered as potentially beneficial options. Eligible patients for bariatric surgery are the ones with BMI ≥ 40 kg/ m2 ή BMI ≥ 35 kg/ m2 with obesity-related cormobid conditions.

Keywords: obesity, overweight, body mass index, waist circumference, diet, physical activity