Prioritizing Clinically Relevant Criteria for Longitudinal Obesity Management: A Systemic Framework to Support Decision-Making

Obesity is a multifactorial chronic condition characterised by the interplay of biological, behavioural, psychological, and environmental factors, as well as barriers that influence treatment adherence. This study aimed to identify, organise, and prioritise criteria for obesity management by proposing a systemic framework to support clinical decision-making. To this end, a systematic literature review was conducted to identify criteria related to obesity etiology, its consequences, barriers, and motivations for treatment. These criteria were then evaluated by an expert panel. Expert judgements were translated into linguistic scales within a fuzzy environment, and consensus was validated using the Fuzzy Delphi method. The Fuzzy TOPSIS method was then applied to calculate proximity coefficients and rank the criteria across two dimensions: importance and applicability. These dimensions were subsequently unified to generate a consolidated prioritisation for data collection. The results highlight the centrality of dietary, emotional, and treatment-adherence factors, reinforcing the need to approach obesity from a multifactorial, non-reductionist perspective. The proposed framework supports planning clinical, surgical, and public health interventions, as well as the development of decision-support systems for longitudinal obesity management. Importantly, the framework does not diminish the relevance of endocrine and genetic mechanisms in obesity but prioritises criteria that are operationally feasible for routine clinical decision support systems, particularly in real-world and multidisciplinary obesity care settings. • A systemic framework operationalizes obesity as a multifactorial condition. • Adherence and continuity emerged as central drivers in obesity management. • Clinically relevant obesity criteria were validated and prioritized by experts. • A multicriteria approach structured and prioritized the obesity management criteria.