WHAT ARE THE CRITERIA FOR INTERVENTION?
Although the treatment of obesity is difficult and, in the long term, positive results are generally scarce (a recuperation of lost weight in many patients), obesity must always be treated through the completion of a meticulous study of the patient of causing factors and accompanying illness. Treatment must be personalized and adapted to the particular characteristics of each individual case.
In reports of the treatment of obesity a moderate loss in body weight (5-10% weight loss) has demonstrated an improvement in quality of life (physical and psychological) and improvement in the pathologies associated in obesity, grades I and II. In addition, it is necessary to establish reasonable and realistic objectives for each patient, intending in each case to maintain the loss of weight for the middle and long term.
In the form of consensus, criteria and methods have been created to proceed according to the BMI of the individual, being adapted in cases of infantile obesity, in the elderly or if there are associated illnesses that need more precise and strict intervention.
Population With A Bmi Less Than 22kg/M2
In these individuals an intervention is never justified to decrease body weight. In the case of incorrect eating habits or physical activity, a need for appropriate health counseling for the general population. Maintaining varied eating and light to moderate physical activity is indicated.
Population With A Bmi Between 22 And 24.0 Kg/M2
In this group intervention is only justified when weight is unstable, with a progressive increase in a relatively short period of time (an increase of more than 5 Kg in less than 1 year). In this case, dietary counseling and a light, hypocaloric diet containing a limited amount of fat, and increased physical activity is indicated.
Population With A Bmi Between 25 And 26.9 Kg/M2 (Grade I Of Overweight)
Around 20% of the Spanish population is situated in this range. A medical visit is recommended to evaluate the grade of stability of body weight, distribution of fat and to determine if there are other cardiovascular (dyslipemia, diabetes mellitus, arterial hypertension, smoking, etc) risk factors. If weight is stable, the distribution of fat is femora-gluteus or gynecoid, and that are not other associated risk factors, medical intervention would not be justified. If the patient does not fulfill any of the above conditions, treatment is appropriate and should be limited to counseling related to healthy eating, moderate physical exercise and periodic clinical examinations.
Population With A Bmi Between 27 And 29.9 Kg/M2 (Grade Ii Of Overweight)
This is the range in which 20 % of the Spanish population is included and where we start to see a slight increase in comorbidities and associated mortalities because of the accumulation of fat, especially if the patient has a central or android type of distribution. In this population, a visit and medical evaluation is obligatory. If weight is stable, the distribution is femora-gluteus and no other associated risk factors exist, medical intervention is optional, although dietary counseling, physical activity and periodic medical evaluations are recommended. If there are any cited conditions that are not fulfilled, the patient should be treated with physical activity and a light hypocaloric diet with an objective to lose 5-10% of their body weight and maintain that level in the future. If the proposed objective is not achieved in a maximum term of 6 months, the use of pharmaceuticals is justified.
Grade I Obesity (Bmi Between 20-34.9 Kg/M2)
This situation warrants a medical visit and treatment. The comorbidities should be adequately treated in every case and should be seen as significant. A maintained effort between the patient, family and doctor to achieve a stable 10% body weight loss in an acceptable time is necessary. To reach this objective, the use of pharmaceuticals, physical activity and modification of eating, and a hypocaloric diet is justified.
Grade II Obesity (Bmi Between 35-39.9 Kg/M2)
With this grade of obesity the health risks and the appearance of comorbidities is significant, as well as a decrease in quality of life. In this case the strategy should be similar to that established above, but should have the intention of reducing more than 10% of body weight, although arriving at this point shows vast improvement. If the cited objectives are not obtained in a period of approximately 6 months, and the patient suffers significant associated illnesses they should be referred to a specialized unit where other more intense treatment possibilities are used such as very low calorie diets or bariatric surgery.
Grade III And IV Obesity (Bmi = 40 Kg/M2). Morbid And Extreme Obesity
In these grades of obesity, a stable loss of 10% of body weight (always difficult to achieve) usually represents a significant improvement, but is never sufficient. The desired loss would be between 20-30% (and more still in those extreme cases of obesity where the BMI is = 50 Kg/m2) that can only be achieved, except in very exceptional cases, through bariatric surgery. Those patients should always be referred to specialized units where they employ intense therapeutic methods and evaluate the need for bariatric surgery, with the patient always needing to fulfill rigorous conditions and protocols to indicate this type of surgery.