We performed a modified Delphi study5,6 to identify a set of statements that can aid in the diagnosis, staging and management of obesity according to a framework that is more adherent to the concept of obesity as an adiposity-based chronic disease (ABCD)1.
In each round of voting, experts were also asked to provide comments to explain their voting score, and responses were anonymized.
The steering committee evaluated the voting and comments received at each round and generated a modified set of statements for the subsequent round of voting.
The steering committee evaluated voting and comments and generated a second set of 28 statements submitted for a second Delphi round.
Table 1 Statements to aid in the diagnosis, staging and management of obesity Full size table
We performed a modified Delphi study5,6 to identify a set of statements that can aid in the diagnosis, staging and management of obesity according to a framework that is more adherent to the concept of obesity as an adiposity-based chronic disease (ABCD)1. A steering committee identified by the EASO, consisting of the authors of this paper, discussed and prepared an initial set of statements used for a voting process by a group of experts. Voting was performed on a five-point scale, as follows: (1) strongly disagree; (2) disagree; (3) neither agree nor disagree; (4) agree; and (5) strongly agree. In each round of voting, experts were also asked to provide comments to explain their voting score, and responses were anonymized. The steering committee evaluated the voting and comments received at each round and generated a modified set of statements for the subsequent round of voting. Consensus was defined as ≥75% of expert agreement on a statement (score ≥4).
The steering committee retained responsibility for the selection of experts involved in the process. Selection was based on international reputation and known expertise in obesity science and management. In total, 29 experts were contacted, and all agreed to participate in the present study. Most of the experts belong to the endocrinology, nutrition or internal medicine fields (72%), but the group also included five bariatric surgeons, two primary care physicians and one expert on patient advocacy. A standard conflict of interest form was completed by each participant before the start of the Delphi process. This study was performed by the EASO without any external funding, and approval by the ethics committee was not required.
The study comprised three Delphi rounds. In the first round, 25 experts (86%) voted and commented on 30 original statements that were prepared by the steering committee. A total of 21 statements (70%) received consensus. The steering committee evaluated voting and comments and generated a second set of 28 statements submitted for a second Delphi round. In the second round, 24 experts (83%) voted and commented on the statements. A total of 24 statements (86%) received consensus. The steering committee discussed the comments received for the four non-consented statements, reconsidered the formulations of these statements, and submitted the four revised statements for the final Delphi round. In the third round, 24 experts (83%) voted and provided final comments related to the four revised statements. One of these four statements (statement 12) reached full consensus, whereas most experts approved the other three revised statements (statements 3–5), with only a few experts providing a score <3 (that is, strongly disagree or disagree). The steering committee performed a final revision and decided to approve a list of 28 statements, covering clinical diagnosis and staging of obesity, pillars of treatment, therapeutic targets, and initial level of intervention. The final list of statements and final percentages of approval by the experts is shown in Table 1. A flowchart of the diagnostic and therapeutic pathways resulting from the statements is presented in Fig. 1.
Table 1 Statements to aid in the diagnosis, staging and management of obesity Full size table
