HKOS Adult Consensus Statements

Consensus Statement for Obesity Care in Hong Kong
Voting Round: 2

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Statement 1: Clinicians should recognize and treat obesity as a chronic, progressive and relapsing disease.

Statement 2: All adults should be screened at least annually using BMI (kg/m²) for a convenient and practical estimate of adiposity.

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Statement 3: We suggest using the WHO (2000) Asia Pacific BMI cut-offs to diagnose overweight (≥23.0 kg/m²) or obesity (≥25.0 kg/m²) in adults. We recommend using 27.5 kg/m² as a trigger point for additional interventions.

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Statement 4: For individuals who are at risk of obesity-associated comorbidities (by BMI or presentation), one may consider using additional anthropometric measures (e.g.  WC, WHR) to inform risk stratification and trigger intervention.

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Statement 5: Non-anthropometric measures (e.g. BIA, DXA, MRI, CT) can be used to measure body fat and composition. However, with the exception of BIA (which is more readily accessible), we do not recommend these tools for routine clinical assessment and monitoring.

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Prognosis

Statement 6: Healthcare providers should recognize that increased adiposity is a risk factor for obesity-associated comorbidities and premature mortality.

Statement 7: For patients with obesity-associated comorbidities, we recommend that healthcare providers to conduct a measurement of adiposity and weight change at every clinical evaluation.

Lifestyle & behavioural modification

Statement 8: The cornerstone of obesity management is lifestyle modification through a combination of nutrition therapy, physical activity and behavioural therapy.

Statement 9: An effective management strategy should first focus on setting realistic, clinically meaningful weight loss goals that will reduce health risks or improve quality of life, and subsequently, support long-term weight maintenance.

Statement 10: Weight loss of 5-10% over 6 months represents a safe and realistic strategy for health benefits.

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Statement 11: An individualized diet plan of 500kcal deficit per day, can be taken as a starting point for a sustainable long-term diet pattern.

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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:

• aerobic exercise, at least 5 days/week
• resistance exercises, 2–3 days/week

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Statement 13: To support lifestyle changes, behavioural interventions should be recommended for all individuals undergoing weight management (e.g. self-monitoring and cognitive techniques, psychological therapy).

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Statement 14: Given the epidemic nature of obesity, all healthcare providers should learn the principles of achieving behavioural change to promote health and prevent disease as part of their professional education; those not able to offer informed behavioural interventions should advise individuals in finding the appropriate professional help.

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Statement 15: Behavioural treatment should be tailored to the individual patient and provided by a multidisciplinary team.

Statement 16: We recommend the continuation of behavioural therapy in a weight maintenance programme.

Pharmacological management

Statement 17: Pharmacotherapy should be used as an adjunct to lifestyle modification in individuals who do not achieve 5% weight loss in 3─6 months through lifestyle changes or have BMI 27.5kg/m² (the action point for Asians).

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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.

Statement 19: Change or discontinuation of medication(s) for weight reduction should be considered if there is inadequate response over 3 months despite optimal adherence and dose (e.g. <5% weight loss from baseline, no improvement in obesity-associated comorbidities or visceral fat content), or if the medication is not tolerated.

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Bariatric surgery

Statement 20: Bariatric and metabolic surgery may be considered for Asians with BMI ≥32.5 kg/m².

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Statement 21: Bariatric and metabolic surgery may be considered for Asians with BMI ≥27.5 kg/m² if they have diabetes or at least 2 obesity-related comorbidities and are not achieving planned weight-loss or comorbidity-control targets despite lifestyle changes and pharmacological treatment.

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Statement 22: If eligible, bariatric and metabolic surgery should be considered in addition to lifestyle modification, with or without pharmacotherapy, to improve or maintain weight loss and control obesity-related complications.

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