Consensus Statement for Obesity Care in Hong Kong

This survey is to assess the level of agreement among the author group with the proposed statements. These statements have been drafted by the HKOS committee members and have already received one round of voting at a consensus meeting earlier this year.  

The survey will rate your agreement with each recommendation on a 5-point Likert scale (i.e., Accept completely; Accept with some reservation; Accept with major reservation; Reject with reservation; Reject completely). Agreement by 75% of total voting group members is defined as the threshold for acceptance.

Please provide your personal information* below:

Statement 1.

Clinicians should recognize and treat obesity as a chronic, progressive, and relapsing disease.

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Statement 2.

All adults should be screened at least annually using a BMI measurement, a ratio of weight in kilograms divided by height in meters squared (kg/m²), for a convenient and practical estimate of adiposity

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Statement 3.

We suggest using the 2000 WHO Asia Pacific BMI cut-offs for Asians to diagnose overweight (≥23.0 kg/m²) or obesity (≥25.0 kg/m²) in adults. In addition, we recommend using 27.5 kg/m² as a trigger point for additional intervention.

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Statement 4.

For individuals who are at risk of obesity-associated comorbidities, you may consider using additional anthropometric measures such as WC and WHR to inform risk stratification and trigger intervention.

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Statement 5.

Non-anthropometric measures e.g., BIA, DXA, MRI and CT can be used to measure body fat and composition. However, with the exception of BIA, we do not recommend these tools be used routinely in clinical practice due to a lack of robust clinical data.

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Statement 6.

Healthcare providers should recognize that increased adiposity is a risk factor for obesity-associated comorbidities and premature mortality.

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Statement 7.

For patients with obesity-associated comorbidities, we recommend that healthcare providers conduct a measurement of adiposity and weight change in every clinical evaluation.

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Statement 8.

The cornerstone of obesity management is lifestyle modification through a combination of nutrition therapy, physical activity and behavioural therapy.

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Statement 9.

An effective management strategy should first focus on setting realistic, clinically meaningful weight loss goals that will reduce health risks or improve QoL, and subsequently, support long-term weight maintenance

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Statement 10.

Modest weight loss of 5-15% over a period of 6 months represents a safe and realistic short-term strategy for health benefits.

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Statement 11.

An individualized dietary intervention that reduces overall calorie intake by 500 kcal/day should be taken as a starting point.

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Statement 12.

To optimize health and prevent disease, adults with overweight or obesity should undertake aerobic and resistance exercises for weight loss and health benefits:

1. a. aerobic exercise, at least 5 days per week (200–300 min of moderate-intensity aerobic exercise per week or ≥150 min of vigorous aerobic activity per week); and
2. b. resistance exercises, 2–3 times per week, should be encouraged to enhance muscular strength and physical function

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Statement 13.

Behavioural interventions to support lifestyle changes should be recommended for all individuals undergoing weight management.

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Statement 14.

Behavioural treatment should be provided by healthcare professionals who have experience and training in the use of behavioural change techniques.

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Statement 15.

Behavioural treatment should be tailored to the individual patient and provided by a multidisciplinary team.

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Statement 16.

We recommend the continuation of behavioural therapy in a weight maintenance programme.

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Statement 17.

Pharmacotherapy should be used as an adjunct to lifestyle modification.

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Statement 18.

We recommend using only pharmacotherapies that have a strong clinical trial evidence base for efficacy and safety in weight reduction and have been approved by international regulatory bodies.

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Statement 19.

Change or discontinuation of medication(s) for weight reduction should be considered if there is less than 5% weight loss from baseline over 3 months despite optimal adherence and dose, or if medication is not tolerated.

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Statement 20.

Bariatric and metabolic surgery is recommended for Asians with BMI ≥32.5 kg/m².

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Statement 21.

Bariatric and metabolic surgery can be considered for Asians with BMI ≥27.5 km/m² with diabetes or with at least 2 obesity-related comorbidities who do not achieve substantial or durable weight loss or comorbidity improvement with lifestyle changes and medical treatment.

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Statement 22.

Bariatric and metabolic surgery should be considered in addition to lifestyle modification, with or without pharmacotherapy, to improve or maintain weight loss and to control obesity-related complications when the BMI criteria is reached.

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