Stratégie d’approche surpoids et obésité chez l’adulte

Objectives

The guide frames overweight and obesity as preventable, chronic and multifactorial non-communicable diseases that contribute to diabetes, cardiovascular and respiratory disease, cancer and other complications. It seeks to strengthen prevention, early identification, risk assessment, personalised management, follow-up and appropriate referral for adults and children with excess weight or obesity, while reducing associated social and economic consequences.[1][2]

• Integrate obesity prevention within the national multisectoral response to non-communicable disease risk factors, including stronger health-worker capacity and resource mobilisation.[1]
• Identify excess weight early at all health-care contacts, recognising obesity as a disease and excess weight as a contributor to morbidity and mortality.[2][3]
• Assess weight status, severity, abdominal adiposity, complication risk and comorbidities through multidimensional clinical assessment.[1][4][5]
• Provide protocol-based, patient-centred care that combines therapeutic education, nutritional support, physical-activity guidance, psychological support, medical management where indicated, and treatment of comorbidities.[6][7][8]
• Set realistic, sustained weight-management goals, generally including loss of 5% to 15% of initial body weight, avoidance of weight cycling and durable lifestyle change.[6]
• Prevent progression to severe obesity and complications through continued monitoring of body mass index and waist circumference, maintenance of weight loss and escalation of care when necessary.[6][7]
• Organise a staged pathway from primary care to specialised second- and third-level services according to treatment response, body mass index, complications, comorbidities and clinical complexity.[7][8]
• Provide specialist management for severe, complex, genetic or multi-complicated obesity, including consideration of bariatric or metabolic surgery where clinically appropriate.[8][9]

Implementation

Implementation is organised as a structured, multidisciplinary care pathway embedded in routine first-level services and escalating to specialist obesity units and reference centres when needed. The general practitioner coordinates care with nurses, dietitians, psychologists, sports or rehabilitation specialists and other professionals, using a five-stage protocol of screening and referral, comprehensive assessment, therapeutic goal-setting, care delivery, and monitoring and evaluation.[10][2]

• Deliver first-level care through local facilities, including polyclinics, maternal and child protection services, university preventive medicine units, occupational medicine units in medico-social centres and private practices.[2]
• Measure each patient’s weight at every consultation, measure height at the first consultation, record both values in the patient record, and calculate body mass index for identification and longitudinal monitoring.[3]
• Equip community health structures with appropriately sized blood-pressure monitors, calibrated height measures, scales capable of weighing at least 150 kilograms and preferably 200 kilograms, and measuring tapes.[11]
• Measure waist circumference alongside body mass index to identify abdominal obesity and assess cardiovascular and metabolic risk, while interpreting body mass index cautiously because it does not distinguish fat from lean or bone mass or indicate fat distribution.[4]
• Conduct a structured assessment of weight history, possible causes of weight gain, family and medication history, dietary and eating behaviours, physical activity, smoking cessation and psychosocial consequences.[3]
• Provide dedicated, planned primary-care consultations using a non-judgemental approach, therapeutic education, nutritional advice, activity guidance and psychological support.[6]
• Agree individual therapeutic objectives with patients, including practical dietary changes, such as regular meals, portion control, reduced snacking, slower eating, meal diversification and changes to food purchasing and preparation.[6]
• Assess functional capacity and cardiovascular risk before advising a return to physical activity, then encourage at least 150 minutes of moderate-intensity activity weekly, with additional benefit from 300 minutes of moderate activity or 150 minutes of vigorous activity.[12]
• Adapt care for specific circumstances, including older people at risk of undernutrition, women planning pregnancy, pregnant women with obesity, and patients in whom secondary endocrine causes of obesity may need investigation.[5][12]
• Refer patients to second-level multidisciplinary units when first-level objectives are unmet after six months to one year, where body mass index exceeds 35 kg/m² with comorbidities, where complications or decompensated comorbidities occur, or where body mass index exceeds 40 kg/m².[7]
• Use second-level teams of nutritionists, dietitians, psychologists, psychiatrists, obesity specialists, rehabilitation specialists, nurses and physiotherapists to deepen assessment, manage comorbidities, reinforce therapeutic education and determine medical treatment.[7]
• Refer patients who do not achieve second-level therapeutic objectives after six months to one year to third-level reference centres with multidisciplinary, diagnostic, rehabilitation, anaesthetic and bariatric surgical capacity.[8]
• Schedule follow-up approximately monthly initially and then around every three months to support maintenance and stability of weight loss, monitor complications and use treatment response as a basis for referral decisions.[7][8]
• Reassess the effects of obesity medicines systematically after 12 weeks when such treatment is used.[8]

Monitoring & Evaluation

Monitoring is principally embedded in the clinical management pathway for overweight and obesity rather than in a population-level programme performance framework. It combines routine anthropometric assessment, multidimensional risk and complication assessment, scheduled follow-up, reassessment of treatment response, and referral between levels of care.[2][3][7][8]

• Measure weight at every consultation, measure height at the first consultation, record both measurements in the patient record, and calculate body mass index (BMI) to support early identification and ongoing monitoring of excess weight.[3][11]
• Classify BMI as underweight below 18, normal weight from 18 to 24.9, overweight from 25 to 29.9, class I moderate obesity from 30 to 34.9, class II severe obesity from 35 to 39.9, and class III morbid or massive obesity above 40.[4]
• Interpret BMI alongside other assessments, as it does not show fat distribution or distinguish fat from bone and muscle mass and may not independently establish health risk in muscular individuals.[4]
• Record waist circumference in centimetres as an indicator of abdominal adiposity and cardiovascular and metabolic risk; increased-risk thresholds are above 80 cm for women and 94 cm for men, while very increased-risk thresholds are above 88 cm for women and 102 cm for men.[4][5]
• Conduct structured clinical assessment covering weight history, possible causes of weight gain, family and medication history, dietary and eating behaviours, physical activity, smoking cessation, psychosocial effects, risk factors, comorbidities and complications.[3][5][9]
• Apply the five-stage protocol of screening and referral, comprehensive health assessment, therapeutic objective-setting, selection and implementation of a care model, and monitoring and evaluation.[2]
• Schedule follow-up consultations at approximately monthly intervals initially and, after initial progress, at around three-month intervals to support weight-loss maintenance, weight stability, lifestyle change and monitoring of complications.[12][7][8]
• Reassess the effect of obesity medication systematically after 12 weeks.[8]
• Use progress towards therapeutic objectives, treatment response, BMI, complications and comorbidity status to determine escalation from first-level care to multidisciplinary second-level units and subsequently to third-level reference centres.[7][8]
• Refer to second-level care when first-level objectives remain unmet after six months to one year, where BMI exceeds 35 kg/m² with comorbidities, where a comorbidity decompensates or a complication is identified, or where BMI exceeds 40 kg/m².[7]
• Refer to third-level care where second-level therapeutic objectives remain unmet after six months to one year, including for severe, complex, genetic or multi-complicated obesity requiring specialised diagnostic, rehabilitation, medical or surgical capacity.[8][9]

The extracts include epidemiological surveillance evidence, notably Algeria’s 2016–2017 STEPWise survey estimates and global projections to 2030, but do not establish a dedicated national surveillance architecture in the supplied material.[13][14]Formal implementation indicators, reporting requirements, data flows, audit arrangements, evaluation methodology, timelines and institutional accountability mechanisms are not specified beyond patient-record documentation, clinical monitoring and referral criteria.[3][4][7][8]

Costing & Financing

The material frames obesity as a substantial and growing economic burden and links prevention and sustained weight reduction with potentially lower future costs.[15][1][16]However, it does not provide a costed implementation plan, programme budget, source of funds, resource-mobilisation strategy, allocation formula, funding gap or economic assumptions for the Algerian care pathway.[1][16][7][8]

• Estimate the projected global economic cost of obesity at 3.3% of gross domestic product by 2060.[16]
• Report France’s obesity cost at 1.85% of gross domestic product, equivalent to 50 billion dollars, in 2019; project this to rise to 2.39% of gross domestic product, equivalent to 132 billion dollars, by 2060.[16]
• Estimate obesity-associated costs during the first wave of COVID-19 in Europe at 6.1 billion dollars, representing 44% of total healthcare costs.[16]
• Project savings from sustained weight reduction of 29.8 billion dollars over five years, 158.0 billion dollars over ten years and 611.7 billion dollars over 20 years.[16]
• Require community health structures to have appropriately sized blood-pressure monitors, calibrated height measures, scales capable of weighing at least 150 kilograms and preferably 200 kilograms, and measuring tapes, without specifying purchase, maintenance or replacement costs.[11]
• Identify third-level resource needs, including adapted technical facilities, patient-handling equipment and equipment for nutritional, metabolic and respiratory investigations, without assigning monetary values or financing responsibilities.[8]

Resource implications are therefore described primarily through required clinical equipment and specialist service capacity rather than through a funded budget.[11][8]The supplied extracts do not quantify costs for workforce training, multidisciplinary teams, medicines, therapeutic education, physical-activity support, referrals, bariatric surgery, monitoring systems or patient access.[11][6][7][8]