Obesidade em adultos: visão geral do tratamento

Abstract

Introduction: Overweight refers to weight above the "normal" range, with normal defined based on actuarial data. This is determined by calculating your body mass index (BMI; defined as weight in kilograms divided by height in meters squared). Overweight is defined as a BMI of 25 to 29.9 kg/m2; Obesity is defined as a BMI of ≥30 kg/m2, with increasing classes as the BMI category increases. Class 3 obesity is defined as a BMI ≥40 kg/m2 (or ≥35 kg/m2 in the presence of comorbidities). Although these categorical definitions are clinically useful, the risks conveyed by increased body mass follow a continuum and vary considerably between individuals. Objectives: discuss an overview of the management of obesity in adults. Methodology: Integrative literature review based on scientific databases from Scielo, PubMed and VHL, from January to April 2024, with the descriptors “Obesity”, “Adults” AND “Management”. Articles from 2019-2024 (total 55) were included, excluding other criteria and choosing 5 full articles. Results and Discussion: All patients who would benefit from weight loss should receive counseling about diet, exercise, and weight management goals. Candidates for pharmacological therapy include adults with a body mass index (BMI) greater than 30 kg/m2, or a BMI of 27 to 29.9 kg/m2 with comorbidities, who have not achieved weight loss goals (loss of at least 5% of total body weight in three to six months) with a comprehensive lifestyle intervention. The decision to initiate drug therapy must be individualized and made after careful assessment of the risks and benefits of all treatment options (lifestyle, pharmacological, surgical). Candidates for bariatric surgery include adults with a BMI ≥35 kg/m2, regardless of the presence or absence of obesity-related comorbidities, or a BMI of 30 to 34.9 kg/m2 with type 2 diabetes mellitus. Consumption of a reduced diet in calories, frequent self-weighing, increasing physical activity levels, and participating in a lifestyle intervention program are strategies to help maintain weight loss. However, the body appears to have a "set point" of adipose tissue mass, and strategies that assume that effective treatment of obesity is solely a matter of an individual's "willpower" may lead to repeated failure due to the tendency of the body from reverting to its set point. Bariatric surgery, which can alter the body's adipose tissue set point, and long-term use of anti-obesity pharmacological therapy can help address these underlying physiological changes. Conclusion: The medical rationale for weight loss is that obesity is a serious, chronic, progressive disease and is associated with a significant increase in mortality and many health risks, including type 2 diabetes mellitus, hypertension, dyslipidemia, and coronary heart disease. . The benefits of weight loss include a reduction in the rate of progression from impaired glucose tolerance to diabetes, blood pressure in hypertensive patients, and lipid levels in higher-risk patients. Other non-cardiac benefits of weight loss include reductions in urinary incontinence, sleep apnea and depression, as well as improvements in quality of life, physical functioning and mobility.