Italian clinical practice GRADE-based guidelines on the diagnosis and treatment of overweight and obesity, endorsed by the Italian National Institute of Health

Obesity is a chronic relapsing disease associated with increased morbidity and mortality and reduced quality of life. The present GRADE-based guidelines have been commissioned by the Italian Society of Obesity (SIO) by the Italian National Health Institute to provide evidence-based recommendations on obesity diagnosis and treatment. The panel identified 13 clinical questions, organised into four domains: A. diagnostic criteria (4 questions); B. medical nutrition therapy (4 questions); C. pharmacological, surgical, and endoscopic treatments (4 questions); and D. miscellaneous (1 question). The expert panel recommends adopting at least one anthropometric index of abdominal visceral fat distribution beyond body mass index (BMI) for better clinical risk stratification. A structured lifestyle intervention (i.e., medical-nutritional treatment-MNT), preferably based on cognitive-behavioural therapeutic approach and including physical activity and a balanced diet, should be offered to all subjects living with obesity. Pharmacological or surgical treatment should be offered in addition to MNT when MNT is unable to reach clinical goals. In particular, pharmacological treatment should be considered as the preferred option for subjects with BMI > 27 kg/m<sup>2</sup> with comorbidities, and for those with BMI 30-39.9 kg/m<sup>2</sup>, based on individual therapeutic goals and needs, adopting surgical treatment in selected cases or in case of OMM failure to reach clinical goals. For subjects with a BMI > 40 kg/m<sup>2</sup>, surgical treatment may be considered conversely as a preferable option. Reduction of at least 10% of the initial body weight is associated with a better quality of life and a reduced risk of incident depression. The current guideline is endorsed by the Italian National Institute of Health, providing the new, updated clinical and legal reference for professionals involved in the management of subjects living with obesity in Italy.

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Journal
Eating and Weight Disorders - Studies on Anorexia Bulimia and Obesity
Published
2026-01-14
DOI
https://doi.org/10.1007/s40519-026-01813-z
Primary Topic
Bariatric Surgery and Outcomes
Type
article
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article

Italian clinical practice GRADE-based guidelines on the diagnosis and treatment of overweight and obesity, endorsed by the Italian National Institute of Health

Emanuele Cereda, Benedetta Ragghianti, Vincenzo Provenzano, Patrizia Todisco et al.
Eating and Weight Disorders - Studies on Anorexia Bulimia and Obesity
Bariatric Surgery and Outcomes
article

Italian clinical practice GRADE-based guidelines on the diagnosis and treatment of overweight and obesity, endorsed by the Italian National Institute of Health

Emanuele Cereda, Benedetta Ragghianti, Vincenzo Provenzano, Patrizia Todisco, R. Barazzoni, Giovanni PAPA, Giuseppe Galloro, Primiano Iannone, M Santomauro, Giuseppe NAVARRA, Federico Spandonaro, Luca Busetto, Cristina Segura García, Valentina Vanzi, Iris Zani, Fabrizia Lisso, Uberto Pagotto, De Caro W, C. Rizzo, Anna Maria Moretti, Silvio Buscemi, Nicola Perrotta, Vincenzo Pilone, Riccardo Williams, Maria Caterina Manca, Giovanni Docimo, Riccardo Dalle Grave, Frida Leonetti, Simona Bo, Paolo Sbraccia, Marco Chianelli, Matteo Monami, Barbara Paolini, Samir Sukkar, Amanda Belluzzi, Andrea Vania, Maddalena Redini, Andrea Pession, Giovanni Antonio Silverii, Dario Tuccinardi, Maria Masulli, Gerardo Medea, Manuela Merli
article en

Abstract

Obesity is a chronic relapsing disease associated with increased morbidity and mortality and reduced quality of life. The present GRADE-based guidelines have been commissioned by the Italian Society of Obesity (SIO) by the Italian National Health Institute to provide evidence-based recommendations on obesity diagnosis and treatment. The panel identified 13 clinical questions, organised into four domains: A. diagnostic criteria (4 questions); B. medical nutrition therapy (4 questions); C. pharmacological, surgical, and endoscopic treatments (4 questions); and D. miscellaneous (1 question). The expert panel recommends adopting at least one anthropometric index of abdominal visceral fat distribution beyond body mass index (BMI) for better clinical risk stratification. A structured lifestyle intervention (i.e., medical-nutritional treatment-MNT), preferably based on cognitive-behavioural therapeutic approach and including physical activity and a balanced diet, should be offered to all subjects living with obesity. Pharmacological or surgical treatment should be offered in addition to MNT when MNT is unable to reach clinical goals. In particular, pharmacological treatment should be considered as the preferred option for subjects with BMI > 27 kg/m<sup>2</sup> with comorbidities, and for those with BMI 30-39.9 kg/m<sup>2</sup>, based on individual therapeutic goals and needs, adopting surgical treatment in selected cases or in case of OMM failure to reach clinical goals. For subjects with a BMI > 40 kg/m<sup>2</sup>, surgical treatment may be considered conversely as a preferable option. Reduction of at least 10% of the initial body weight is associated with a better quality of life and a reduced risk of incident depression. The current guideline is endorsed by the Italian National Institute of Health, providing the new, updated clinical and legal reference for professionals involved in the management of subjects living with obesity in Italy.

Eating and Weight Disorders - Studies on Anorexia Bulimia and ObesityVol. 31(1)
University of Messina (IT), University of Rome Tor Vergata (IT), University of Verona (IT), University of Padua (IT), University of Trieste (IT), University of Campania "Luigi Vanvitelli" (IT), University of Pavia (IT), Policlinico Umberto I (IT), Società Italiana di Fisica (IT), Regione Campania (IT), Magna Graecia University (IT), Azienda Ospedaliera Citta' della Salute e della Scienza di Torino (IT), Ospedale Maggiore (IT), Società Italiana di Cardiologia (IT), Ospedale Maggiore Carlo Alberto Pizzardi (IT), Ospedale San Carlo (IT), Italian Society of Physiotherapy (IT), Casa di Cura Villa Garda (IT), Department of Medical Sciences (RU), Azienda Ospedaliero-Universitaria Careggi (IT), Federico II University Hospital (IT), Azienda USL di Bologna (IT), Azienda Ospedaliera Universitaria Senese (IT), Associazione Italiana Vulvodinia Onlus (IT), Società Italiana di Medicina Generale (IT), Ospedale Santa Maria Goretti (IT), Ospedale Regina Apostolorum (IT), Campus Bio Medico University Hospital (IT), Ospedale Policlinico San Martino (IT), Ospedale Santa Maria della Misericordia di Rovigo (IT), Ospedale Sant'Anna (IT), Policlinico San Matteo Fondazione (IT), Istituto di Sessuologia Clinica (IT), University of Florence (IT), University of Bari Aldo Moro (IT), University of Naples Federico II (IT), Sapienza University of Rome (IT), University of Palermo (IT), University of Bologna (IT)
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Openalex Percentile: Top 89%
Bariatric Surgery and Outcomes
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