The Australian Obesity Management Algorithm: A simple tool to guide the management of obesity in primary care

Tania P Markovic; Joseph Proietto; John B Dixon; Georgia Rigas; Gary Deed; Jeffrey M Hamdorf; Erica Bessell; Nathalie Kizirian; Sofianos Andrikopoulos; Stephen Colagiuri

doi:10.1016/j.orcp.2022.08.003

The Australian Obesity Management Algorithm: A simple tool to guide the management of obesity in primary care

Obes Res Clin Pract. 2022 Sep-Oct;16(5):353-363. doi: 10.1016/j.orcp.2022.08.003. Epub 2022 Aug 30.

Authors

Affiliations

¹ Metabolism & Obesity Service, Royal Prince Alfred Hospital, Camperdown, NSW 2050, Australia; Boden Initiative, Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney, NSW 2006, Australia. Electronic address: tania.markovic@sydney.edu.au.
² University of Melbourne, Parkville, VIC 3010, Australia. Electronic address: j.proietto@unimelb.edu.au.
³ Iverson Health Innovation Research Institute, Swinburne University of Technology, Hawthorn, VIC 3122, Australia. Electronic address: profjohndixon@gmail.com.
⁴ St George Private Hospital, Kogarah, NSW 2217, Australia. Electronic address: drgeorgiarigas@gmail.com.
⁵ HealthCarePlus Medical Centre, Carindale, QLD 4152, Australia; Monash University, Clayton, VIC 3800, Australia. Electronic address: drgarydeed@outlook.com.
⁶ Medical School, University of Western Australia, Crawley, WA 6009, Australia. Electronic address: jeffrey.hamdorf@uwa.edu.au.
⁷ Boden Initiative, Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney, NSW 2006, Australia. Electronic address: erica.bessell@sydney.edu.au.
⁸ Boden Initiative, Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney, NSW 2006, Australia. Electronic address: nathalie.kizirian@sydney.edu.au.
⁹ Australian Diabetes Society, 145 Macquarie St, Sydney, NSW 2000, Australia. Electronic address: ceo@diabetessociety.com.au.
¹⁰ Boden Initiative, Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney, NSW 2006, Australia. Electronic address: stephen.colagiuri@sydney.edu.au.

PMID: 36050266
DOI: 10.1016/j.orcp.2022.08.003

Abstract

Obesity is a complex and multifactorial chronic disease with genetic, environmental, physiological and behavioural determinants that requires long-term care. Obesity is associated with a broad range of complications including type 2 diabetes, cardiovascular disease, dyslipidaemia, metabolic associated fatty liver disease, reproductive hormonal abnormalities, sleep apnoea, depression, osteoarthritis and certain cancers. An algorithm has been developed (with PubMed and Medline searched for all relevant articles from 1 Jan 2000-1 Oct 2021) to (i) assist primary care physicians in treatment decisions for non-pregnant adults with obesity, and (ii) provide a practical clinical tool to guide the implementation of existing guidelines (summarised in Appendix 1) for the treatment of obesity in the Australian primary care setting. MAIN RECOMMENDATIONS AND CHANGES IN MANAGEMENT: Treatment pathways should be determined by a person's anthropometry (body mass index (BMI) and waist circumference (WC)) and the presence and severity of obesity-related complications. A target of 10-15% weight loss is recommended for people with BMI 30-40 kg/m² or abdominal obesity (WC > 88 cm in females, WC > 102 cm in males) without complications. The treatment focus should be supervised lifestyle interventions that may include a reduced or low energy diet, very low energy diet (VLED) or pharmacotherapy. For people with BMI 30-40 kg/m² or abdominal obesity and complications, or those with BMI > 40 kg/m² a weight loss target of 10-15% body weight is recommended, and management should include intensive interventions such as VLED, pharmacotherapy or bariatric surgery, which may be required in combination. A weight loss target of > 15% is recommended for those with BMI > 40 kg/m² and complications and they should be referred to specialist care. Their treatment should include a VLED with or without pharmacotherapy and bariatric surgery.

Keywords: Anti-obesity pharmacotherapy; Bariatric surgery; Low energy diet; Obesity; Physical activity; Reduced energy diet; Very low energy diet.

Publication types

Review

MeSH terms

Adult
Algorithms
Australia
Body Mass Index
Diabetes Mellitus, Type 2*
Female
Humans
Male
Obesity / complications
Obesity / therapy
Obesity Management*
Obesity, Abdominal
Primary Health Care
Weight Loss