The document is available at www.guiasobesidadchile.com

Currently, Chile does not have a clinical practice guide for the treatment of obesity in adults. The Chilean Society of Bariatric and Metabolic Surgery (SCCBM) led the development of the first clinical practice guide for adult obesity in Chile, as a result of funding granted by Obesity Canada and the European Association for the Study of Obesity to adapt the Canadian guide.

The clinical practice guide (CPG) for adult obesity in Canada was a transformative proposal, adopting a non-traditional approach to obesity management that does not use body mass index as the main assessment tool or weight loss as the primary goal. This non-stigmatizing approach was applied in the new Chilean document. Dr. Yudith Preiss, a member of the SCCBM, from the Nutrition and Bariatric Surgery Center of the Clínica Las Condes and responsible for the project, stated that: "Just like the original guide from Canada, the guide for Chile is evidence-based and patient-centered, with an emphasis on improving health and quality of life, avoiding body mass index or a number on the scale as the sole metrics of health status".

The process of developing a CPG for adult obesity in Chile involved 58 professionals, with members of the Chilean Coalition for the Study of Obesity participating in the writing of chapters, as well as in the review and adaptation of the guide summary presented in this article. Unprecedentedly, an Intersocietal Committee was formed, including the Chilean Association of Clinical Nutrition, Obesity and Metabolism, the Chilean Society of Family Medicine, the Chilean Society of Neurology, Psychiatry, and Neurosurgery, the Chilean Society of Nutrition, the Chilean Society of Sleep Medicine, and the Chilean Society of Gynecology and Obstetrics. Professionals from different societies participated as chapter authors and/or external reviewers.

The prevalence of obesity in Chile is one of the highest in the world

Globally, the prevalence of obesity has steadily increased over the last 30 years. In Chile, the population aged 15 and over with obesity is 34.4%, according to the latest National Health Survey (2016-2017). On the other hand, the prevalence of excess weight is 74.2%, and overweight is 40%.

Obesity is undeniably a public health problem that not only negatively impacts the physical and psychological health of individuals but also healthcare costs. Despite this, the national health system did not have a clinical practice guide for the treatment of obesity in adults.

The new guide is aimed at healthcare professionals in Chile, especially those in primary care, as well as individuals living with obesity, their families, and decision-makers involved in the management and administration of resources for obesity care.

Adaptation of the Canadian guide

The Chilean Coalition for the Study of Obesity, composed of representatives from 7 scientific and medical societies in Chile, led by the Chilean Society of Bariatric and Metabolic Surgery, secured funding in 2021 to adapt the obesity clinical practice guide from Canada to Chile.

The Canadian guide, published in 2020, was developed by Obesity Canada and the Canadian Association of Bariatric Physicians and Surgeons. The development process took 2 years and required the review of over 550,000 articles. The result was a CPG with 80 recommendations that follow a person-centered and stigma-free approach to weight. The approach is based on clinical decisions guided by the Edmonton Obesity Staging System (EOSS), which considers metabolic, physical, and psychological parameters to determine optimal obesity treatment. The EOSS has proven to be a better predictor of all-cause mortality compared to measurements of body mass index or waist circumference alone.

Obesity Canada implemented a pilot project designed to adapt and implement the Canadian CPG to local contexts in other countries, a call that Chile and Ireland won. In Chile, the adaptation process considered the cultural, social, and organizational context of healthcare delivery in the country, service availability, experience, and resources. Population characteristics and cultural beliefs were also taken into account. Thus, 76 of the 80 recommendations from the Canadian guide were adopted, 1 recommendation was adapted, and 12 new questions with their respective recommendations were developed. Remarkably, the adaptation process for Chile took about a year, and costs were lower compared to developing a guide from scratch.

In the case of the CPG for adult obesity in Chile, methodological guidance was provided by the Epistemonikos Foundation. In particular, guidance was provided in applying the GRADE framework for the adoption, adaptation, and de novo development of recommendations, known as GRADE-ADOLOPMENT, using the guide developed by Canada as a base and considering all criteria in the GRADE-Evidence to Decision (EtD) framework.

The authors considered it essential to develop 12 new recommendations, for which the Epistemonikos Foundation team conducted the search, selection, and synthesis of evidence on the L.OVE platform. Subsequently, the iEtD software was used to transparently document all judgments made by the authors. Finally, the recommendations were formulated by the steering committee, leaders, and chapter authors based on the highest level of available evidence.

A living document

Like the Canadian CPG, which is updated based on new evidence, the guide developed for Chile aims to remain a living document. The format of living clinical guidelines arises from the problem of the rapid obsolescence of these guidelines and the high costs of traditional updates, which involve reviewing all recommendations every 3 to 5 years.

To achieve this goal, an independent website was developed as a repository for the 18 complete chapters, recommendations, and methodology: www.guiasobesidadchile.com. The authors note that the website will feature videos, webinars, and educational material for patients living with obesity in the near future.

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