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Aim: This guideline (GL) is aimed at providing a clinical practice reference for the management of adult patients with overweight or obesity associated with metabolic complications who are resistant to lifestyle modification.

Methods: Surgeons, endocrinologists, gastroenterologists, psychologists, pharmacologists, a general practitioner, a nutritionist, a nurse and a patients' representative acted as multi-disciplinary panel. This GL has been developed following the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. A systematic review and network meta-analysis was performed by a methodologic group. For each question, the panel identified potentially relevant outcomes, which were then rated for their impact on therapeutic choices. Only outcomes classified as "critical" and "important" were considered in the systematic review of evidence. Those classified as "critical" were considered for clinical practice recommendations. Consensus on the direction (for or against) and strength (strong or conditional) of recommendations was reached through a majority vote.

Results: The present GL provides recommendations about the role of both pharmacological and surgical treatment for the clinical management of the adult patient population with BMI > 27 kg/m 2 and < 40 kg/m 2 associated with weight-related metabolic comorbidities, resistant to lifestyle changes. The panel: suggests the timely implementation of therapeutic interventions in addition to diet and physical activity; recommends the use of semaglutide 2.4 mg/week and suggests liraglutide 3 mg/day in patients with obesity or overweight also affected by diabetes or pre-diabetes; recommends semaglutide 2.4 mg/week in patients with obesity or overweight also affected by non-alcoholic fatty liver disease; recommends semaglutide 2.4 mg/week as first-line drug in patients with obesity or overweight that require a larger weight loss to reduce comorbidities; suggests the use of orlistat in patients with obesity or overweight also affected by hypertriglyceridemia that assume high-calorie and high-fat diet; suggests the use of naltrexone/bupropion combination in patients with obesity or overweight, with emotional eating; recommends surgical intervention (sleeve gastrectomy, Roux-en-Y gastric bypass, or metabolic gastric bypass/gastric bypass with single anastomosis/gastric mini bypass in patients with BMI ≥ 35 kg/m 2 who are suitable for metabolic surgery; and suggests gastric banding as a possible, though less effective, surgical alternative.

Conclusion: The present GL is directed to all physicians addressing people with obesity-working in hospitals, territorial services or private practice-and to general practitioners and patients. The recommendations should also consider the patient's preferences and the available resources and expertise.

Titel:	Italian guidelines for the management of adult individuals with overweight and obesity and metabolic comorbidities that are resistant to behavioral treatment.
Autor/in / Beteiligte Person:	Chianelli, M ; Busetto, L ; Vettor, R ; Annibale, B ; Paoletta, A ; Papini, E ; Albanese, A ; Carabotti, M ; Casarotto, D ; De Pergola, G ; Disoteo, OE ; Grandone, I ; Medea, G ; Nisoli, E ; Raffaelli, M ; Schiff, S ; Vignati, F ; Cinquini, M ; Gonzalez-Lorenzo, M ; Fittipaldo, VA ; Minozzi, S ; Monteforte, M ; Tralongo, AC ; Novizio, R ; Persichetti, A ; Samperi, I ; Scoppola, A ; Borretta, G ; Carruba, M ; Carbonelli, MG ; De Luca, M ; Frontoni, S ; Corradini, SG ; Muratori, F ; Attanasio, R
Link:	Full Text Finder (Volltext)
Zeitschrift:	Journal of endocrinological investigation, Jg. 47 (2024-06-01), Heft 6, S. 1361-1371
Veröffentlichung:	2014- : Berlin : Springer ; <i>Original Publication</i>: Milano, Published for the Italian Society of Endocrinology by Editrice Kurtis., 2024
Medientyp:	academicJournal
ISSN:	1720-8386 (electronic)
DOI:	10.1007/s40618-024-02361-y
Schlagwort:	Humans Adult Italy epidemiology Comorbidity Behavior Therapy methods Behavior Therapy standards Practice Guidelines as Topic standards Disease Management Bariatric Surgery methods Obesity therapy Obesity complications Obesity epidemiology Overweight therapy Overweight complications Overweight epidemiology
Sonstiges:	Nachgewiesen in: MEDLINE Sprachen: English Publication Type: Journal Article; Systematic Review; Practice Guideline Language: English [J Endocrinol Invest] 2024 Jun; Vol. 47 (6), pp. 1361-1371. <i>Date of Electronic Publication: </i>2024 Apr 17. MeSH Terms: Obesity* / therapy ; Obesity* / complications ; Obesity* / epidemiology ; Overweight* / therapy ; Overweight* / complications ; Overweight* / epidemiology ; Humans ; Adult ; Italy / epidemiology ; Comorbidity ; Behavior Therapy / methods ; Behavior Therapy / standards ; Practice Guidelines as Topic / standards ; Disease Management ; Bariatric Surgery / methods References: World Health Organization. Regional Office for Europe. (2022) WHO European Regional Obesity Report 2022. World Health Organization. Regional Office for Europe. https://apps.who.int/iris/handle/10665/353747 . License: CC BY-NC-SA 3.0 IGO. . ; (2022) 3. 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Italian guidelines for the management of adult individuals with overweight and obesity and metabolic comorbidities that are resistant to behavioral treatment.