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Controlled Obesity: What do you need to know?

Obesity is considered a chronic disease and is associated with several complications that can worsen other conditions, reducing life expectancy. Often stigmatized as a "lifestyle choice" and with treatment based solely on behavioral changes. However, the reality is different, as obesity is related to high rates of treatment failure, even after several attempts, increasingly drastic throughout life.



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A new approach to "controlled obesity."

Standard classifications of obesity use the Body Mass Index (BMI), which is based on the relationship between weight and height. However, this metric may be limited to assessing the health of obese patients thoroughly. The concept of "controlled obesity" then emerges. ABESO and SBEM proposed a new view based on the lifetime weight trajectory to address this issue, offering a more comprehensive perspective on obesity.

"Managed obesity" refers to a person's state after losing their highest achieved weight. This implies a significant percentage reduction in BMI and a stagnation in weight loss. The critical criterion for determining this is the maximum weight the person has ever reached. This often-overlooked information can provide valuable insights into the patient's condition.

  1. "Doctor, I weighed 130 kg. When I reached 100kg, I couldn't lose anything else, and I'm extremely frustrated."

Concept of Controlled Obesity

Weight variation throughout a person's life is an everyday reality. Many people go through cycles of weight gain and weight loss, and this fluctuation can significantly impact your metabolic health. This is why doctors treating obesity must ask about the patient's maximum weight.

It is crucial to understand that controlled obesity does not mean that the person is cured of obesity. On the contrary, it indicates that the person has managed to reduce their weight to a considered level. It should always be noted that obesity is a chronic condition. Even when a person reaches an average weight, they still face health risks related to obesity, such as sarcopenia and weight regain. 


New Obesity Classification Proposal

The study Proposal of an obesity classification based on weight history: an official document by the Brazilian Society of Endocrinology and Metabolism (SBEM) and the Brazilian Society for the Study of Obesity and Metabolic Syndrome (ABESO), published on April 28 2022, in the Archives of Endocrinology and Metabolism Magazine, explains that for individuals aged 18 to 65 years, with a BMI between 30 and 39.9 kg/m², the proposed classification of obesity based on weight trajectory is enlightening. According to the text, weight losses representing 5% to 10% of the highest value achieved in life indicate a condition of "reduced obesity." On the other hand, weight losses more significant than 10% point to "controlled obesity," which is associated with a substantial reduction in health risks. 

The criteria are slightly adjusted for individuals with a BMI equal to or greater than 40 kg/m². To be considered "reduced obesity," weight loss must exceed 10% of your highest weight. To achieve the classification of "controlled obesity," the loss must exceed 15% of this value.

It is important to emphasize that the intention of ABESO and SBEM is not to replace previous classifications but rather to provide an additional and complementary tool for assessing patients with obesity. Furthermore, the proposal aims to disseminate the fundamental concept that, when evaluating obesity, it is crucial to question the maximum weight the individual reaches throughout their life. This information is essential to understand the patient's history and offer the most appropriate treatment.


Weight Loss Sustainability

The new classification focuses on the importance of sustainable weight loss: people's ability to maintain lost weight in the long term. This recognizes that this is often the most challenging part of treating obesity and emphasizes the need for strategies that promote lasting health rather than simply targeting numbers on the scale, which can be difficult to maintain and lead to undesirable concertina effects.< /p>

Indeed, this new perspective on obesity helps and offers a complete understanding of the condition. It allows healthcare professionals to consider the patient's obesity treatment journey. It also highlights the relevance of evaluating the patient's history, promoting a complete and personalized approach to treating obesity to understand where this patient is in the trajectory. Thus, it is possible to intervene in nutritional and dietary deficiencies and medication adjustments correctly. 

It can be seen, then, that controlled obesity is a vital concept for the treatment of obesity. Obesity is a chronic condition that requires ongoing attention. Even when the patient reduces in considered weight, understanding the patient's history, including maximum lifetime weight, plays an essential role in assessing and treating obesity. 


Exceptions to Weight Gain History

Finally, there are some exceptional cases, such as pregnancy and lactation. Weight gain is undoubtedly expected to occur during pregnancy. Although some women gain more weight than expected, there is a struggle to lose weight postpartum, but weight usually comes off naturally during and after lactation. The maximum weight achieved during pregnancy should be written accurately in the patient's medical history but should not be used for the proposed classification. Therefore, the maximum weight reached in life must consider non-pregnancy conditions. On the other hand, if the total weight gained in life was caught in the postpartum period, the weight gained after lactation should be considered the maximum weight born in life.


Bibliographic References

Suggested Reading: Obesity

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