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Pharmacology and Obesity Treatment / Adipokines, Inflammation, and Metabolic Diseases · Journal article
Frontiers in Aging · August 14, 2026
A consensus or society position rather than new primary data.
This is a consensus-based clinical framework developed by 23 Croatian multidisciplinary experts using modified Delphi methodology and grounded in contemporary international guidelines, RCTs, and meta-analyses. It proposes a disease-based diagnostic model integrating adiposity, complications, and functional status, along with a staging system and four-pillar management approach (lifestyle, psychological support, pharmacotherapy, and bariatric surgery). The framework prioritizes stage-based and comorbidity-driven pharmacotherapy with organ-protective agents and emphasizes long-term structured follow-up as a chronic disease model.
Consensus-based position statement using modified Delphi methodology. Multidisciplinary experts from academic and clinical institutions across Croatia; framework applies to adults with obesity across the lifespan, with emphasis on older adults in resource-constrained Croatian healthcare system.. Intervention: Clinical framework for obesity diagnosis, staging, and management integrating four pillars: lifestyle therapy, psychological support, pharmacotherapy, and metabolic/bariatric surgery. n = 23. Croatia.
Diagnosis requires confirmation of excess adiposity with evidence of clinical risk or dysfunction integrated across anthropometric, metabolic, mechanical, psychological, and functional domains Staging system aligned with EASO and Lancet frameworks guides treatment intensity according to disease severity Management based on four pillars: lifestyle therapy, psychological support, pharmacotherapy, and metabolic/bariatric surgery
Specific organ-protective pharmacotherapy agents and their efficacy metrics not detailed in this source Management based on four pillars: lifestyle therapy, psychological support, pharmacotherapy, and metabolic/bariatric surgery
Clinicians should use this framework to move beyond BMI-only assessment toward integrated disease staging that accounts for complications and functional status, tailoring treatment intensity accordingly. The emphasis on long-term structured follow-up and preservation of functional capacity in older adults provides concrete guidance for chronic disease management in resource-constrained settings.
A consensus-based position statement using modified Delphi methodology with multidisciplinary experts, grounded in contemporary international guidelines and evidence, providing nationally adapted clinical framework for obesity diagnosis and management.
As stated by the source record.
Quoted from the source exactly as published.
Clinicians should use this framework to move beyond BMI-only assessment toward integrated disease staging that accounts for complications and functional status, tailoring treatment intensity accordingly. The emphasis on long-term structured follow-up and preservation of functional capacity in older adults provides concrete guidance for chronic disease management in resource-constrained settings.
Graded across the dimensions that decide whether you should act, each from what the source actually supports. There is no single score, and where a dimension was not assessed it says so.
Background Obesity is a chronic, progressive, relapsing disease characterized by excess or dysfunctional adiposity that impairs health and contributes to multimorbidity, disability, and reduced life expectancy. Contemporary international frameworks recommend moving beyond BMI-only definitions toward disease-based diagnostic models that integrate adiposity, complications, and functional status. Croatia faces a high prevalence of obesity alongside constrained healthcare resources and limited reimbursement for modern pharmacotherapy, highlighting the need for nationally adapted clinical guidance. Methods This position statement was developed using a modified Delphi consensus process involving 23 multidisciplinary experts from academic and clinical institutions across Croatia. Consensus statements were derived from contemporary international guidelines, randomized controlled trials, and meta-analyses. Evidence quality and recommendation strength were graded using an adapted GRADE-based framework. Results The document establishes a Croatia-specific framework for the diagnosis, staging, and management of obesity. Diagnosis requires confirmation of excess adiposity with evidence of clinical risk or dysfunction and integrates anthropometric measures with metabolic, mechanical, psychological, and functional domains. A staging system aligned with EASO and Lancet frameworks guides treatment intensity according to disease severity. Management is based on four pillars: lifestyle therapy, psychological support, pharmacotherapy, and metabolic/bariatric surgery. Pharmacological treatment is stage-based and comorbidity-driven, prioritizing agents with proven organ-protective effects. Special considerations are provided for older adults, emphasizing preservation of muscle mass, functional capacity, independence, and quality of life. Long-term structured follow-up is recommended for all patients, reflecting the chronic disease model of obesity. Conclusion This position statement provides an evidence-based, nationally adapted clinical framework that aligns obesity management with modern chronic disease standards. By integrating disease staging, individualized therapy, and long-term care, it supports precision treatment across the lifespan and emphasizes obesity management as a key strategy for preventing complications, reducing disability, and promoting healthy longevity.
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