A new consensus recommends care, management of obesity in Asia

A new consensus paper on preliminary recommendations for the management and care of obesity in adults and children was released in October.

The regional consensus, titled “Obesity in South and Southeast Asia – A new consensus on care and management,” is an important advancement as it calls for the recognition of obesity as a chronic disease, a crucial step in acknowledging the science of obesity, and a unified approach to combat obesity with a whole-systems approach, from prevention to treatment. It also puts obesity management in the context of the region’s unique biological characteristics in obesity (excess adiposity in the Asian phenotype, and double burden of over- and under-nutrition), cultural nuances, and healthcare landscape (inconsistent quality of obesity care). [https://onlinelibrary.wiley.com/doi/full/10.1111/obr.13520] A panel of medical experts from 10 countries* in South and Southeast Asia (S-SEA) developed the consensus, consisting of 42 clinical recommendations, for clinicians across the region to improve the quality of care for people living with obesity (PwO).

Speaking to MIMS Doctor, Professor Dr Rohana Abdul Ghani, Deputy Dean, Postgraduate Studies and Professional Training at Universiti Teknologi MARA, said: “The consensus highlights the importance of screening and identifying the problem ie, obesity as a disease, [and] then to initiate conversation regarding its management. The consensus also provides information/ guidelines to healthcare providers regarding the treatment options available in the country and in the region.”

It is important to note that obesity is caused by multiple factors. In Malaysia, the common causes of obesity are lifestyle ie, food and physical activity; lack of awareness, lack of ‘healthy’ culture, lack of accessibility to resources, and genetic predisposition to abdominal fat accumulation, explained Rohana. She added that it is important to treat obesity as there are multiple complications associated with it such as metabolic, musculoskeletal, psychological, and social.

Obesity is a progressive disease. Therefore, it should be screened as early as possible so that treatment can be initiated. These include healthy lifestyle and not necessarily just pharmacological/ surgical interventions. Children and adolescents should also be screened for obesity, said Rohana.

Healthy lifestyle has a fundamental role in obesity management. Patients and healthcare professionals (HCPs) need to increase their understanding about energy and metabolism that will result in weight gain or weight loss. “However, obesity is not just energy consumption vs expenditure. There are other factors involved as obesity is caused by multiple factors, and healthy lifestyle is a lifelong endeavour,” said Rohana.

A holistic consensus in terms of diagnosis and management

The consensus further developed previously published guidance that exist in some of the countries represented and drew from internationally recognized obesity guidelines. It holistically encompasses diagnosis specific to the S-SEA region and medical goals of management, as well as personal aspects of psychological and social support for PwO. The consensus addresses optimal approaches for identifying and staging obesity, treatment and long-term maintenance of weight, as well as issues related to weight stigma and patient engagement in the clinical setting.

Certain areas identified for action specific to this region have been included in the consensus such as addressing malnutrition in many parts of S-SEA, which poses increased risk for obesity; highlighting the coordinated action to increase public awareness, addressing food security, encouraging healthful habits and early life nutrition, and improving access to care for people with overweight or obesity. Recognizing there may be a paucity of treatments for obesity in the region, the consensus called for policies and healthcare resources to prioritize training of HCPs and multidisciplinary teams.

“Despite the size and diversity of this region, there are sufficient cultural and social demographic similarities to justify this shared effort,” explained Professor Brian Oldfield, co-chair of the consensus and President of the Asia-Oceania Association for the Study of Obesity (AOASO), which led the development of the consensus. “It is our hope that with clear definitions and recommendations, we are one step closer to optimum care for people living with obesity in South and Southeast Asia,” said Oldfield.

According to the World Atlas 2022 published by the World Obesity Federation, the prevalence of obesity worldwide is predicted to double between 2010 and 2030. [https://www.worldobesityday.org/assets/downloads/World_Obesity_Atlas_2022_WEB.pdf] The S-SEA region is seeing a rapid rise in obesity, which calls for more urgent attention to obesity prevention and treatment.

Obesity is a complex condition driven by a combination of factors including those that are biological and genetic in combination with environmental, social, and economic influences. The World Health Organization and medical associations around the world recognize obesity as a chronic disease. By recognizing obesity as a chronic disease, the consensus supports the notion that the challenge of obesity management does not only lie in the promotion of personal choices to modify lifestyle to lose excess weight, but in introducing treatment strategies to address the underlying causes and drivers of obesity for long-term weight loss and maintenance.

“By fundamentally recognizing obesity as a chronic disease, we aim to shift a variety of erroneous beliefs, for example, that obesity results from solely a lack of willpower leading to poor lifestyle choices or that it should be regarded merely as a risk factor for other conditions, to acknowledging the science of obesity,” said Dr Tham Kwang Wei, the lead author of the consensus who is also the Secretary of AOASO. “When we approach obesity as a chronic disease with a propensity for relapse and progression, we not only enable the provision of a whole-systems approach for effective prevention and treatment for the long-term, but also shift the focus on PwO and combat the stigma and discrimination associated with weight, which impedes PwO in seeking appropriate care.”

With the ultimate aim to reduce the disease burden of obesity in the long-term, it is important to channel resources for either proper public education or awareness raising. Two vital next steps include training healthcare teams in holistic obesity management and enabling PwO to get access to effective obesity care and management. The consensus was presented at the International Congress of Obesity in Melbourne on 19 October 2022 and published recently. [https://onlinelibrary.wiley.com/doi/full/10.1111/obr.13520]

The consensus was made possible through an unrestricted grant to AOASO by Novo Nordisk Business Area South East Asia (BASEA). “As a company that is committed to improving the lives of patients, Novo Nordisk is proud to be able to support the development of such an important consensus in the South and Southeast Asia region that can directly impact the quality of care for people living with obesity,” said Dr Vinay Prusty, Senior Director of Clinical, Medical, Regulatory, and Quality, Novo Nordisk Business Area South East Asia.