Recomendaciones en la primera consulta en personas adultas con obesidad / Recomendations for the first appointment of adult persons with obesity

El objetivo de esta recomendación es establecer las mejores estrategias para el abordaje de la obesidad en la primera consulta de un paciente adulto con obesidad. Para ello se formularon tres preguntas PICO con respuestas basadas en el análisis de la evidencia científica disponible. Nuestros principales hallazgos fueron: • En la primera consulta de un paciente adulto con obesidad, la entrevista motivacional es más efectiva frente al abordaje tradicional para el descenso de peso dado que, además, permite reforzar la motivación del paciente y estimular su participación en un cambio de comportamiento. • Para el diagnóstico de obesidad, el índice de masa corporal (IMC) sigue siendo una herramienta útil y sencilla de detección, sin embargo, es imperativo ampliar la visión de la obesidad y establecer el riesgo de complicaciones en la primera consulta; para esto tanto el sistema de estadificación de Edmonton como el método ABCD son herramientas útiles adicionales al IMC. • La actividad física aeróbica sigue siendo recomendada por su beneficio en la pérdida de masa grasa, principalmente visceral, no obstante, al combinar una actividad física anaeróbica, los resultados son superiores a la estrategia aeróbica aislada. Conclusiones: el abordaje de la obesidad en la primera consulta debería basarse en una entrevista motivacional para mejorar la adherencia; el diagnóstico de obesidad debería realizarse mediante el cálculo del IMC y una herramienta que permita predecir el riesgo de complicaciones; la actividad física debería combinar estrategias aeróbicas y anaeróbicas para mejorar los parámetros antropométricos y metabólicos.

The main objective of this recommendation is to establish the best strategies for obesity management in the first medical appointmet. For this, we formulated three "PICO questions" and we have answered based on the analysis of the available scientific evidence. Our main conclusions were: • In the first medical appointment of an adult patient with obesity, the motivational interview is more effective compared to the traditional approach for weight loss since it also allows to reinforce the patient's motivation and stimulate their participation in a behavioral change. • For the obesity diagnosis, the body mass index continues to be a useful and simple detection tool; however, it is imperative to extend the view of obesity and establish the risk of complications in the first appointment, for this both the Edmonton staging system and the ABCD method are useful tools in addition to the body mass index. • Aerobic physical activity is still recommended for its benefit in fat mass loss, mainly visceral, however, when combining anaerobic physical activity, the results are superior to the isolated aerobic strategy. Conclusions: the approach to obesity in the first consultation should be based on a motivational interview to improve adherence; the diagnosis of obesity should be made by calculating the body mass index with an aditional tool that allows predicting the risk of complications; physical activity should combine aerobic as well as anaerobic strategies to improve both anthropometric and metabolic parameters.

Recomendaciones en la primera consulta en personas adultas con obesidad. Parte A / Recomendations for the first appointment of adult persons with obesity. Part A

Resumen El objetivo de esta recomendación es establecer las mejores estrategias para el abordaje de la obesidad en la primera consulta de un paciente adulto con obesidad. Para ello se formularon tres preguntas PICO con respuestas basadas en el análisis de la evidencia científica disponible. Nuestros principales hallazgos fueron: • En la primera consulta de un paciente adulto con obesidad, la entrevista motivacional es más efectiva frente al abordaje tradicional para el descenso de peso dado que, además, permite reforzar la motivación del paciente y estimular su participación en un cambio de comportamiento. • Para el diagnóstico de obesidad, el índice de masa corporal (IMC) sigue siendo una herramienta útil y sencilla de detección, sin embargo, es imperativo ampliar la visión de la obesidad y establecer el riesgo de complicaciones en la primera consulta; para esto tanto el sistema de estadificación de Edmonton como el método ABCD son herramientas útiles adicionales al IMC. • La actividad física aeróbica sigue siendo recomendada por su beneficio en la pérdida de masa grasa, principalmente visceral, no obstante, al combinar una actividad física anaeróbica, los resultados son superiores a la estrategia aeróbica aislada. Conclusiones: el abordaje de la obesidad en la primera consulta debería basarse en una entrevista motivacional para mejorar la adherencia; el diagnóstico de obesidad debería realizarse mediante el cálculo del IMC y una herramienta que permita predecir el riesgo de complicaciones; la actividad física debería combinar estrategias aeróbicas y anaeróbicas para mejorar los parámetros antropométricos y metabólicos.

Abstract The main objective of this recommendation is to establish the best strategies for obesity management in the first medical appointmet. For this, we formulated three "PICO questions" and we have answered based on the analysis of the available scientific evidence. Our main conclusions were: • In the first medical appointment of an adult patient with obesity, the motivational interview is more effective compared to the traditional approach for weight loss since it also allows to reinforce the patient's motivation and stimulate their participation in a behavioral change. • For the obesity diagnosis, the body mass index continues to be a useful and simple detection tool; however, it is imperative to extend the view of obesity and establish the risk of complications in the first appointment, for this both the Edmonton staging system and the ABCD method are useful tools in addition to the body mass index. • Aerobic physical activity is still recommended for its benefit in fat mass loss, mainly visceral, however, when combining anaerobic physical activity, the results are superior to the isolated aerobic strategy. Conclusions: the approach to obesity in the first consultation should be based on a motivational interview to improve adherence; the diagnosis of obesity should be made by calculating the body mass index with an aditional tool that allows predicting the risk of complications; physical activity should combine aerobic as well as anaerobic strategies to improve both anthropometric and metabolic parameters.

Recomendaciones en la primera consulta en personas adultas con obesidad. Parte B / Recomendations for the first appointment of adult persons with obesity. Part B

Resumen El objetivo de esta recomendación es establecer las mejores estrategias para el abordaje de la obesidad en la primera consulta de un paciente adulto con obesidad. Para ello se formularon tres preguntas PICO con respuestas basadas en el análisis de la evidencia científica disponible. Nuestros principales hallazgos fueron: • En la primera consulta de un paciente adulto con obesidad, la entrevista motivacional es más efectiva frente al abordaje tradicional para el descenso de peso dado que, además, permite reforzar la motivación del paciente y estimular su participación en un cambio de comportamiento. • Para el diagnóstico de obesidad, el índice de masa corporal (IMC) sigue siendo una herramienta útil y sencilla de detección, sin embargo, es imperativo ampliar la visión de la obesidad y establecer el riesgo de complicaciones en la primera consulta; para esto tanto el sistema de estadificación de Edmonton como el método ABCD son herramientas útiles adicionales al IMC. • La actividad física aeróbica sigue siendo recomendada por su beneficio en la pérdida de masa grasa, principalmente visceral, no obstante, al combinar una actividad física anaeróbica, los resultados son superiores a la estrategia aeróbica aislada. Conclusiones: el abordaje de la obesidad en la primera consulta debería basarse en una entrevista motivacional para mejorar la adherencia; el diagnóstico de obesidad debería realizarse mediante el cálculo del IMC y una herramienta que permita predecir el riesgo de complicaciones; la actividad física debería combinar estrategias aeróbicas y anaeróbicas para mejorar los parámetros antropométricos y metabólicos.

Abstract The main objective of this recommendation is to establish the best strategies for obesity management in the first medical appointmet. For this, we formulated three "PICO questions" and we have answered based on the analysis of the available scientific evidence. Our main conclusions were: • In the first medical appointment of an adult patient with obesity, the motivational interview is more effective compared to the traditional approach for weight loss since it also allows to reinforce the patient's motivation and stimulate their participation in a behavioral change. • For the obesity diagnosis, the body mass index continues to be a useful and simple detection tool; however, it is imperative to extend the view of obesity and establish the risk of complications in the first appointment, for this both the Edmonton staging system and the ABCD method are useful tools in addition to the body mass index. • Aerobic physical activity is still recommended for its benefit in fat mass loss, mainly visceral, however, when combining anaerobic physical activity, the results are superior to the isolated aerobic strategy. Conclusions: the approach to obesity in the first consultation should be based on a motivational interview to improve adherence; the diagnosis of obesity should be made by calculating the body mass index with an aditional tool that allows predicting the risk of complications; physical activity should combine aerobic as well as anaerobic strategies to improve both anthropometric and metabolic parameters.

Recomendaciones en la primera consulta en personas adultas con obesidad. Parte B2 / Recomendations for the first appointment of adult persons with obesity. Part B2

Resumen El objetivo de esta recomendación es establecer las mejores estrategias para el abordaje de la obesidad en la primera consulta de un paciente adulto con obesidad. Para ello se formularon tres preguntas PICO con respuestas basadas en el análisis de la evidencia científica disponible. Nuestros principales hallazgos fueron: • En la primera consulta de un paciente adulto con obesidad, la entrevista motivacional es más efectiva frente al abordaje tradicional para el descenso de peso dado que, además, permite reforzar la motivación del paciente y estimular su participación en un cambio de comportamiento. • Para el diagnóstico de obesidad, el índice de masa corporal (IMC) sigue siendo una herramienta útil y sencilla de detección, sin embargo, es imperativo ampliar la visión de la obesidad y establecer el riesgo de complicaciones en la primera consulta; para esto tanto el sistema de estadificación de Edmonton como el método ABCD son herramientas útiles adicionales al IMC. • La actividad física aeróbica sigue siendo recomendada por su beneficio en la pérdida de masa grasa, principalmente visceral, no obstante, al combinar una actividad física anaeróbica, los resultados son superiores a la estrategia aeróbica aislada. Conclusiones: el abordaje de la obesidad en la primera consulta debería basarse en una entrevista motivacional para mejorar la adherencia; el diagnóstico de obesidad debería realizarse mediante el cálculo del IMC y una herramienta que permita predecir el riesgo de complicaciones; la actividad física debería combinar estrategias aeróbicas y anaeróbicas para mejorar los parámetros antropométricos y metabólicos.

Abstract The main objective of this recommendation is to establish the best strategies for obesity management in the first medical appointmet. For this, we formulated three "PICO questions" and we have answered based on the analysis of the available scientific evidence. Our main conclusions were: • In the first medical appointment of an adult patient with obesity, the motivational interview is more effective compared to the traditional approach for weight loss since it also allows to reinforce the patient's motivation and stimulate their participation in a behavioral change. • For the obesity diagnosis, the body mass index continues to be a useful and simple detection tool; however, it is imperative to extend the view of obesity and establish the risk of complications in the first appointment, for this both the Edmonton staging system and the ABCD method are useful tools in addition to the body mass index. • Aerobic physical activity is still recommended for its benefit in fat mass loss, mainly visceral, however, when combining anaerobic physical activity, the results are superior to the isolated aerobic strategy. Conclusions: the approach to obesity in the first consultation should be based on a motivational interview to improve adherence; the diagnosis of obesity should be made by calculating the body mass index with an aditional tool that allows predicting the risk of complications; physical activity should combine aerobic as well as anaerobic strategies to improve both anthropometric and metabolic parameters.

Recomendaciones en la primera consulta en personas adultas con obesidad. Parte C / Recomendations for the first appointment of adult persons with obesity. Part C

Resumen El objetivo de esta recomendación es establecer las mejores estrategias para el abordaje de la obesidad en la primera consulta de un paciente adulto con obesidad. Para ello se formularon tres preguntas PICO con respuestas basadas en el análisis de la evidencia científica disponible. Nuestros principales hallazgos fueron: • En la primera consulta de un paciente adulto con obesidad, la entrevista motivacional es más efectiva frente al abordaje tradicional para el descenso de peso dado que, además, permite reforzar la motivación del paciente y estimular su participación en un cambio de comportamiento. • Para el diagnóstico de obesidad, el índice de masa corporal (IMC) sigue siendo una herramienta útil y sencilla de detección, sin embargo, es imperativo ampliar la visión de la obesidad y establecer el riesgo de complicaciones en la primera consulta; para esto tanto el sistema de estadificación de Edmonton como el método ABCD son herramientas útiles adicionales al IMC. • La actividad física aeróbica sigue siendo recomendada por su beneficio en la pérdida de masa grasa, principalmente visceral, no obstante, al combinar una actividad física anaeróbica, los resultados son superiores a la estrategia aeróbica aislada. Conclusiones: el abordaje de la obesidad en la primera consulta debería basarse en una entrevista motivacional para mejorar la adherencia; el diagnóstico de obesidad debería realizarse mediante el cálculo del IMC y una herramienta que permita predecir el riesgo de complicaciones; la actividad física debería combinar estrategias aeróbicas y anaeróbicas para mejorar los parámetros antropométricos y metabólicos.

Abstract The main objective of this recommendation is to establish the best strategies for obesity management in the first medical appointmet. For this, we formulated three "PICO questions" and we have answered based on the analysis of the available scientific evidence. Our main conclusions were: • In the first medical appointment of an adult patient with obesity, the motivational interview is more effective compared to the traditional approach for weight loss since it also allows to reinforce the patient's motivation and stimulate their participation in a behavioral change. • For the obesity diagnosis, the body mass index continues to be a useful and simple detection tool; however, it is imperative to extend the view of obesity and establish the risk of complications in the first appointment, for this both the Edmonton staging system and the ABCD method are useful tools in addition to the body mass index. • Aerobic physical activity is still recommended for its benefit in fat mass loss, mainly visceral, however, when combining anaerobic physical activity, the results are superior to the isolated aerobic strategy. Conclusions: the approach to obesity in the first consultation should be based on a motivational interview to improve adherence; the diagnosis of obesity should be made by calculating the body mass index with an aditional tool that allows predicting the risk of complications; physical activity should combine aerobic as well as anaerobic strategies to improve both anthropometric and metabolic parameters.

Incidence and predictive factors of postoperative hypocalcaemia according to type of thyroid surgery in older adults.

PURPOSE: Transient hypocalcaemia after thyroid surgery and its possible predictors have not been extensively described in the elderly. This study aimed to establish the frequency of postsurgical transient hypocalcaemia according to the extent of thyroid surgery in older adults and to assess mineral metabolism biochemical parameters as its predictors. METHODS: All patients ≥60 years undergoing thyroid surgery were prospectively included. Type of surgery (hemithyroidectomy(HT) or total thyroidectomy(TT)); and preoperative 25OH Vitamin D (25OHD) and pre and 6 (only TT), 24 h and 6 months postsurgical serum levels of calcium, magnesium, phosphate and parathormone (PTH) were considered. Postsurgical hypoparathyroidism (hPTpost) was defined at PTH levels ≤11 pg/mL. RESULTS: Out of 46 patients (87% female), age (mean ± SD) 70.1 ± 6.2 years, 24 h postsurgical hypocalcaemia was found in ten patients (22%). In 25 (54%) TT patients, 36% and 16% had postsurgical hypocalcaemia at 6 and 24 h respectively; 28% hPTpost but no definitive hPT was recorded and 44% had 25OHD deficiency. Lower 24 h magnesium levels were found in those TT patients with 24 h hypocalcaemia (1.6 ± 0.1 vs 1.9 ± 0.1 mg/dL (p = 0.005)). Among 21 (46%) HT patients, 28.6% had 24 h postsurgical hypocalcaemia; 9.5% had hPTpost. A positive correlation was observed between preoperative 25OHD and 24 h calcaemia (r:0.51,p = 0.02). 43% of the patients were 25OHD deficient, in whom 55% had 24 h hypocalcaemia vs only 9% in the 25OHD sufficient group (p = 0.049). CONCLUSION: Postsurgical hypocalcaemia was common in elderly thyroidectomized patients. After TT, lower magnesium levels were found in those patients with 24 h hypocalcaemia. In the HT group, preoperative 25OHD deficiency predicted lower postsurgical calcium levels.

Impact of Metabolic Surgery on Type 2 Diabetes Mellitus, Cardiovascular Risk Factors, and Mortality: A Review.

BACKGROUND: The association between obesity and a reduction in life expectancy is well established, and cardiovascular disease is a leading cause of mortality. Bariatric surgery has long been established as the most effective and durable intervention for obesity, and is the only intervention for obesity that consistently improves multiple comorbidities, reduces cardiovascular disease and long-term mortality. The purpose of this review is to describe the impact of metabolic/bariatric surgery on type 2 diabetes mellitus and cardiometabolic parameters, including cardiovascular mortality. METHODS: A systematic literature search of Pubmed, MEDLINE, and Cochrane Central Register was performed. We included randomized controlled trials, meta-analysis, case-control trials, and cohort studies that contain data on reductions in cardiovascular risk factors and cardiovascular mortality in subjects who underwent metabolic/bariatric surgery from January 1, 2005 to June 1, 2020. CONCLUSION: There is sufficient evidence from randomized controlled trials that metabolic/bariatric surgery is associated with a significant improvement of all cardiovascular risk factors. Although studies are showing a reduction of macrovascular events and cardiovascular mortality, these findings come from observational studies and should be confirmed in randomized clinical trials.

Comparison of different systems of ultrasound (US) risk stratification for malignancy in elderly patients with thyroid nodules. Real world experience.

PURPOSE: To comparatively assess the performance of three sonographic classification systems, American Thyroid Association (ATA), the American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS), and American Association of Clinical Endocrinologists (AACE)/American College of Endocrinology (ACE)/Associazione Medici Endocrinologi (AME) in identifying malignant nodules in an elderly population. METHODS: Cross-sectional study of patients referred for fine needle aspiration biopsy in an academic center for the elderly. One nodule/patient was considered. Nodules classified Bethesda V/VI were considered malignant. Receiver operating characteristics (ROC) curves were established and compared to evaluate diagnostic performance. Malignancy among biopsies below the size cutoff for each ultrasound classification was also compared. RESULTS: One thousand, eight hundred sixty-seven patients (92% females); median (Q1-Q3), age 71 (67-76) years, were studied showing 82.8% benign (Bethesda II) and 2.6% malignant cytology. The three classifications correctly identified malignancy (P < 0.01). Nonetheless, in the ATA and AACE/ACE/AME 16 and 2 malignant nodules, respectively, were unclassifiable. Including unclassified malignant nodules (n = 1234, malignant = 50), comparison of the ROC curves showed lower performance of ATA [area under the curve (AUC) = ATA (0.49) vs. ACR TI-RADS (0.62), p = 0.008 and ATA vs. AACE/ACE/AME (0.59), p = 0.022]. Proportion of below size cutoff biopsies for ATA, ACR TI-RADS, and AACE/ACE/AME was different [16, 42, and 29% (all p < 0.001)], but no differences in malignancy rate were observed in these nodules. CONCLUSION: The present study is the first to validate in elderly patients these classifications showing that AACE/ACE/AME and ACR TI-RADS can predict thyroid malignancy more accurately than the ATA when unclassifiable malignant nodules are considered. Moreover, in this aged segment of the population, the use of ACR TI-RADS avoided more invasive procedures.