Care pathway guide: overweight and obesity in adults
This guide describes the care, support and overall follow-up of adults with overweight or obesity. It reasserts the importance of early identification, coupled with a lifestyle assessment. It details the role of professionals (health, social and medico-social field, adapted physical activity, occupational health) and looks at the situations in which the person’s primary care physician may consult them.
To help professionals assimilate this work, the HAS proposes:
- A summary of the critical points in the care pathway
- 14 key messages to improve practices
- 8 toolkit guides reiterating the role of each professional and the arrangements for sharing information with the primary care physician:
- Social worker
- Adapted physical activity trainer
- Occupational therapist
- Psychomotor therapist
14 key messages
SYSTEMATICALLY PERFORM LIFE-LONG SCREENING FOR OVERWEIGHT OR OBESITY
1. Calculate BMI, measure waist circumference and monitor their evolution annually.
IMMEDIATELY A SITUATION OF OVERWEIGHT OR OBESITY HAS BEEN DIAGNOSED, JOINTLY PUT TOGETHER A PERSONALISED CARE PLAN
2. Conduct a multi-component, multidisciplinary assessment.
3. Identify dietary problems and eating disorders.
4. Systematically assess and provide early support for any psychological difficulties, psychiatric problems and any form of social, family or professional vulnerability
5. Recognise, detect, prevent and support any stigmatisation.
6. Consult user associations throughout the care pathway.
SCALE CARE AND SUPPORT DEPENDING ON THREE COMPLEXITY SITUATIONS AND ADJUST THEM BASED ON THE EVOLUTION
7. Define care and support priorities based on the impact on health and the person’s needs and expectations.
8. Propose personalised patient education from the time of diagnosis of overweight or obesity, continue and consolidate it.
9. Organise time for coordination in all situations, and in complex and highly complex situations, organise a multidisciplinary team meeting and appoint a care pathway coordinator
10. Regularly monitor health over several years in situations of non-complex obesity and for life in situations of complex and highly complex obesity.
11. Reassess the entire situation in the event of difficulties maintaining lifestyle improvements and stabilising weight or in the event of resistance to continuation of weight loss.
BE ATTENTIVE TO SPECIFIC POPULATIONS AND SITUATIONS
12. Prevent overweight and its progression to obesity in people with disabilities.
13. In women with obesity, ensure regular gynaecological follow-up, identify any risks before and during pregnancy, be vigilant in the event of bariatric surgery, stabilise weight postpartum and support a return to a healthy weight.
14. Encourage physical activity during the perimenopause and menopause, be vigilant in the event of abdominal obesity.
Screening and diagnosis
Calculation of body mass index (BMI), measurement of waist circumference and annual monitoring of their evolution are the starting point to detect overweight, obesity or a cardiovascular risk.
While absolutely necessary, these measurements and their analysis are not in themselves sufficient to make a diagnosis. They must be combined with a multi-component assessment to investigate the factors, causes or consequences of overweight or obesity. This approach provides the keys to understand the situation, and to personalise care and support.
If necessary, the assessment can be performed by local professionals (health, social, medico-social, occupational health fields) or a specialist obesity physician or team. This multidisciplinary approach enables the primary care physician to extend or supplement the assessment, and to access advice for the diagnostic or care approach.
Care and support
The guide proposes personalised and scaled management based on three levels of complexity:
- overweight and obesity without complications;
- severe obesity with an accumulation of associated factors;
- highly complex obesity when it exacerbates an existing chronic condition or is very severe with an accumulation of associated factors.
To help professionals, the guide details the common points and specificities of each situation, and identifies the care or treatments to be given as a priority, simultaneously or otherwise. In particular, it warns of the importance of taking early action in the event of psychological difficulties, dietary problems and eating disorders, or any form of social vulnerability.
In all cases, in the event of overweight or obesity, it is recommended to implement personalised patient education sessions to support lifestyle changes and ensure they are maintained in the long term.
Regular overall health follow-up
The arrangements for the follow-up of overweight and obesity depend on the complexity of each individual situation. In the event of non-complex obesity, follow-up over a period of several years is recommended. However, lifelong follow-up will be necessary in situations of complex and highly complex obesity. Regular assessments by the professionals involved in the care pathway and the support of a local coordinator are key elements to adjust the care project based on the person’s own experience and perceptions and the evolution of their individual situation.
As part of this long-term approach, the cared-for person must be involved in the decisions that concern them: reformulating new goals, taking a break from care. These requests must be listened to, while ensuring the link with caregivers is maintained.
Be attentive to specific situations
The guide provides professionals with tools to ensure the management of specific populations: people with disabilities and women with obesity.
In a person with a disability, the multi-component assessment is conducted with additional vigilance and adjustment depending on the disability. It is essential to involve families and/or medico-social service or facility professionals.
In women with obesity, it is crucial to ensure regular gynaecological follow-up, identify any risks before and during pregnancy, be vigilant in the event of bariatric surgery, stabilise weight postpartum and support a return to a healthy weight.
In the menopause period, be vigilant if overweight is combined with abdominal obesity promoting cardiovascular risks.
Ma Santé 2022
This work was conducted jointly with the French national health insurance fund, in the context of the healthcare system transformation strategy, to meet the objectives of the “Ma santé 2022” [“My Health 2022] programme. It was produced with the assistance of a multidisciplinary working group and patient association representatives. It completes and updates the HAS good practice guidelines published in 2011 drawing on an analysis on the international literature.