2025 Brazilian evidence-based guideline on the management of obesity and prevention of cardiovascular disease and obesity-associated complications: a position statement by five medical societies

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BACKGROUND: Obesity, which currently affects over one billion individuals, is widely recognised as a global condition. It is strongly associated with an increased incidence of cardiovascular disease (CVD), which accounts for 26.8% of all deaths worldwide. The emergence of new anti-obesity medications that can provide greater weight loss and more significant clinical benefits has underscored the urgent need for structured guidelines that integrate obesity treatment into CVD prevention strategies. This article, developed through a collaboration among five leading Brazilian medical societies (Brazilian Association for the Study of Obesity and Metabolic Syndrome, Brazilian Diabetes Society, Brazilian Society of Endocrinology and Metabolism, Brazilian Cardiology Society, and Brazilian Sleep Academy), aims to structure obesity treatment within the context of CVD prevention, considering both cardiovascular risk and obesity stage. METHODS: The Delphi method was used to develop the guideline by engaging a panel of twenty experts who formulated 25 evidence-based recommendations through multiple rounds of structured voting. Each recommendation was designed to address specific clinical scenarios and assigned a recommendation grade based on statistical analysis consensus levels. RESULTS: Following cardiovascular risk assessment using the Predicting Risk of CVD Events risk score, individuals with obesity or overweight will be stratified according to their 10-year risk of developing atherosclerotic disease (low, moderate, or high) and heart failure (high-risk). Anti-obesity treatment will then be guided by the best evidence-based recommendations designed to address excess adiposity and reduce associated complications. CONCLUSION: This guideline offers a practical, evidence-based framework for the treatment of obesity, primarily focusing on the prevention of obesity-related complications, particularly CVD. By applying these recommendations, healthcare professionals can tailor therapeutic strategies to the specific needs of individuals living with obesity. We hope that the widespread implementation of this guideline will contribute to reducing the adverse health burden of obesity and CVD, improving public health outcomes in Brazil.

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