Methodology and Results of a Joint IFSO-WGO Delphi Survey of 94 Intercontinental, Interdisciplinary Experts in Obesity Management

Overview

Journal Obes Surg

Date 2023 Oct 13

PMID 37831326

Authors

Lilian Kow

Reem Z Sharaiha

Mary OKane

Kevin P White

Guilherme Macedo

Jim Toouli

Scott Shikora

Affiliations

Soon will be listed here.

Abstract

Background: Obesity affects 1.5 billion people worldwide, yet few are treated effectively and considerable variability exists in its management. In 2020, a joint International Federation of Surgery for Obesity and Metabolic Diseases (IFSO) and World Gastroenterology Organization (WGO) advisory committee initiated the drafting of consensus guidelines on obesity management, to be based on detailed literature reviews and the results of an extensive multi-disciplinary survey of intercontinental experts. This paper reports on the latter. The objective of this study is to identify areas of consensus and non-consensus among intercontinental, inter-disciplinary experts in obesity management.

Methods: Guided by an international consensus-survey expert, a three-round online Delphi survey was conducted in the summer of 2021 of international obesity-management experts spanning the fields of medicine, bariatric endoscopy and surgery, psychology, and nutrition. Issues like epidemiology and risk factors, patient selection for metabolic and bariatric surgery (ASMBS-Clinical-Issues-Committee, Surg Obes Relat Dis : Off J Am Soc Bariatric Surg. 8:e27-32, 1), psychological issues, patient preparation for MBS, bariatric endoscopy, and outcomes and follow-up were addressed.

Results: Ninety-four experts from six continents voted on 180 statements, with consensus reached on 158, including consensus agreement with 96 and disagreement with 24 statements (38 had other response options besides agree/disagree). Among unanimous opinions were the need for all medical societies to work together to address obesity, for regular regional and national obesity surveillance, for multi-disciplinary management, to recognize the increasing impact of childhood and adolescent obesity, to accept some weight regain as normal after MBS, and for life-long follow-up of MBS patients.

Conclusions: Obesity is a major health issue that requires aggressive surveillance and thoughtful multidisciplinary management.

Citing Articles

Weight Loss with an AI-Powered Digital Platform for Lifestyle Intervention.

Khokhar S, Holden J, Toomer C, Del Parigi A Obes Surg. 2024; 34(5):1810-1818.

PMID: 38573389 DOI: 10.1007/s11695-024-07209-1.

Summarizing Consensus Guidelines on Obesity Management: A Joint, Multidisciplinary Venture of the International Federation for the Surgery of Obesity & Metabolic Disorders (IFSO) and World Gastroenterology Organisation (WGO).

Sharaiha R, Shikora S, White K, Macedo G, Toouli J, Kow L J Clin Gastroenterol. 2023; 57(10):967-976.

PMID: 37831466 PMC: 10566600. DOI: 10.1097/MCG.0000000000001916.

References

Edholm D, Sundbom M . Comparison between circular- and linear-stapled gastrojejunostomy in laparoscopic Roux-en-Y gastric bypass--a cohort from the Scandinavian Obesity Registry. Surg Obes Relat Dis. 2015; 11(6):1233-6. DOI: 10.1016/j.soard.2015.03.010. View

Tao W, Holmberg D, Naslund E, Naslund I, Mattsson F, Lagergren J . Validation of Obesity Surgery Data in the Swedish National Patient Registry and Scandinavian Obesity Registry (SOReg). Obes Surg. 2015; 26(8):1750-6. DOI: 10.1007/s11695-015-1994-y. View

Lupoli R, Lembo E, Saldalamacchia G, Avola C, Angrisani L, Capaldo B . Bariatric surgery and long-term nutritional issues. World J Diabetes. 2017; 8(11):464-474. PMC: 5700383. DOI: 10.4239/wjd.v8.i11.464. View

King W, Hinerman A, Courcoulas A . Weight regain after bariatric surgery: a systematic literature review and comparison across studies using a large reference sample. Surg Obes Relat Dis. 2020; 16(8):1133-1144. DOI: 10.1016/j.soard.2020.03.034. View

Tremmel M, Gerdtham U, Nilsson P, Saha S . Economic Burden of Obesity: A Systematic Literature Review. Int J Environ Res Public Health. 2017; 14(4). PMC: 5409636. DOI: 10.3390/ijerph14040435. View

Powell-Wiley T, Poirier P, Burke L, Despres J, Gordon-Larsen P, Lavie C . Obesity and Cardiovascular Disease: A Scientific Statement From the American Heart Association. Circulation. 2021; 143(21):e984-e1010. PMC: 8493650. DOI: 10.1161/CIR.0000000000000973. View

Hajer A, Wolff S, Benedix F, Hukauf M, Manger T, Stroh C . Trends in Early Morbidity and Mortality after Sleeve Gastrectomy in Patients over 60 Years : Retrospective Review and Data Analysis of the German Bariatric Surgery Registry. Obes Surg. 2018; 28(7):1831-1837. DOI: 10.1007/s11695-018-3110-6. View

. Trends in adult body-mass index in 200 countries from 1975 to 2014: a pooled analysis of 1698 population-based measurement studies with 19·2 million participants. Lancet. 2016; 387(10026):1377-1396. PMC: 7615134. DOI: 10.1016/S0140-6736(16)30054-X. View

Abdullah A, Peeters A, de Courten M, Stoelwinder J . The magnitude of association between overweight and obesity and the risk of diabetes: a meta-analysis of prospective cohort studies. Diabetes Res Clin Pract. 2010; 89(3):309-19. DOI: 10.1016/j.diabres.2010.04.012. View

10.

Gerber P, Anderin C, Gustafsson U, Thorell A . Weight loss before gastric bypass and postoperative weight change: data from the Scandinavian Obesity Registry (SOReg). Surg Obes Relat Dis. 2016; 12(3):556-562. DOI: 10.1016/j.soard.2015.08.519. View

11.

Peeters A, Barendregt J, Willekens F, Mackenbach J, Al Mamun A, Bonneux L . Obesity in adulthood and its consequences for life expectancy: a life-table analysis. Ann Intern Med. 2003; 138(1):24-32. DOI: 10.7326/0003-4819-138-1-200301070-00008. View

12.

Calle E, Rodriguez C, Walker-Thurmond K, Thun M . Overweight, obesity, and mortality from cancer in a prospectively studied cohort of U.S. adults. N Engl J Med. 2003; 348(17):1625-38. DOI: 10.1056/NEJMoa021423. View

13.

Choban P, Jackson B, Poplawski S, Bistolarides P . Bariatric surgery for morbid obesity: why, who, when, how, where, and then what?. Cleve Clin J Med. 2002; 69(11):897-903. DOI: 10.3949/ccjm.69.11.897. View

14.

Black J, White B, Viner R, Simmons R . Bariatric surgery for obese children and adolescents: a systematic review and meta-analysis. Obes Rev. 2013; 14(8):634-44. DOI: 10.1111/obr.12037. View

15.

Malik V, Willett W, Hu F . Global obesity: trends, risk factors and policy implications. Nat Rev Endocrinol. 2012; 9(1):13-27. DOI: 10.1038/nrendo.2012.199. View

16.

Pop B, Fetica B, Blaga M, Trifa A, Achimas-Cadariu P, Vlad C . The role of medical registries, potential applications and limitations. Med Pharm Rep. 2019; 92(1):7-14. PMC: 6448488. DOI: 10.15386/cjmed-1015. View

17.

Seidell J, Halberstadt J . The global burden of obesity and the challenges of prevention. Ann Nutr Metab. 2015; 66 Suppl 2:7-12. DOI: 10.1159/000375143. View

18.

OKane M . Nutritional consequences of bariatric surgery - prevention, detection and management. Curr Opin Gastroenterol. 2020; 37(2):135-144. DOI: 10.1097/MOG.0000000000000707. View

19.

Reynolds C, Byrne S, Hamdorf J . Treatment Success: Investigating Clinically Significant Change in Quality of Life Following Bariatric Surgery. Obes Surg. 2017; 27(7):1842-1848. DOI: 10.1007/s11695-017-2568-y. View

20.

Pedroso F, Angriman F, Endo A, Dasenbrock H, Storino A, Castillo R . Weight loss after bariatric surgery in obese adolescents: a systematic review and meta-analysis. Surg Obes Relat Dis. 2017; 14(3):413-422. DOI: 10.1016/j.soard.2017.10.003. View