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Obesity in adults: a clinical practice guideline

Author/s: 
Wharton, Sean, Lau, David C., Vallis, Mchael, Sharma, Arya M., Biertho, Laurent, Campbell-Scherer, Denise, Adamo, Kristi, Alberga, Anela, Bell, Rhonda, Boule, Normand, Boyling, Elaine, Calam, Betty, Brown, Jennifer, Clarke, Carol, Crowshoe, Lindsay", Mary, Freedhoff, Yoni, Gagner, Michel, Grand, Cindy, Glazer, Stephen", Michael, Hahn, Margaret, Hawa, Raed, Henderson, Rita, Hong, Dennis, Hung, Pam, Janssen, Ian, Jacklin, Kristen, Johnson-Stoklossa, Carlene, Kemp, Amy, Kirk, Sra, :Kuk, Jennifer, Langlois, Marie-France, Lear, Scott, McInnes, Ashley, Macklin, David, Naji, Leen, Manjoo, Priya, Morin, Marie-Philippe, Nerenberg, Kara, Patton, Ian, Pedersen, Sue, Pereira, Leticia, Piccinini-Vallis, Helena, Poddar, Megha, Poirier, Paul, Prud'homme, Denis, Romos Salas, Ximena, Rueda-Clausen, Christian, Russell-Mayhew, Shelly, Shiau, Judy, Sherifali, Diana, Sievenpiper, John, Sockalingam, Sanjeev, Taylor, Valerie, Toth, Ellen, Twells, Laurie, Tytus, RIchard, Walji, Shahebina, Walker, Leah

  • Obesity is a prevalent, complex, progressive and relapsing chronic disease, characterized by abnormal or excessive body fat (adiposity), that impairs health.

  • People living with obesity face substantial bias and stigma, which contribute to increased morbidity and mortality independent of weight or body mass index.

  • This guideline update reflects substantial advances in the epidemiology, determinants, pathophysiology, assessment, prevention and treatment of obesity, and shifts the focus of obesity management toward improving patient-centred health outcomes, rather than weight loss alone.

  • Obesity care should be based on evidence-based principles of chronic disease management, must validate patients’ lived experiences, move beyond simplistic approaches of “eat less, move more,” and address the root drivers of obesity.

  • People living with obesity should have access to evidence-informed interventions, including medical nutrition therapy, physical activity, psychological interventions, pharmacotherapy and surgery.

Keywords 
obesity Stigmas diabetes, type 2 diabetes Gallbladder disease non-alcoholic fatty liver disease Gout

Diagnosis and Management of Nonalcoholic Liver Disease

Author/s: 
Paul, Sonali, Davis, Andrew M.

MAJOR RECOMMENDATIONS

• Patients with incidental hepatic steatosis detected on imaging who lack any liver-related symptoms or signs and have normal liver biochemistries should be assessed for metabolic risk factors (eg, obesity, diabetes mellitus, dyslipidemia) and other causes of hepatic steatosis, including alcohol consumption (>14 drinks per week for women; >21 drinks per week for men) and medications.

• Routine screening for NAFLD in high-risk groups is not advised because of uncertainties surrounding diagnostic tests and treatment options, along with lack of knowledge about long-term benefits and cost-effectiveness of screening.

• The FIB-4 (age, aspartate aminotransferase, alanine aminotransferase, platelets) and NAFLD Fibrosis Score (NFS, which adds body mass index and albumin) are clinically useful tools to predict bridging fibrosis.

• Vibration-controlled transient elastography (VCTE) or magnetic resonance elastography (MRE) can noninvasively assess for advanced fibrosis.

• Weight loss generally reduces hepatic steatosis, either by hypocaloric diet alone or in conjunction with increased physical activity.

• Pharmacologic treatments should be limited to patients with biopsy-proven nonalcoholic steatohepatitis (NASH) and advanced fibrosis.

• Statins can be used to treat dyslipidemia in patients with NAFLD, NASH, and compensated NASH cirrhosis.

Keywords 
non-alcoholic liver disease non-alcoholic fatty liver disease liver disease liver cirrhosis
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