From obesity to healthy longevity: a consensus-based clinical framework for diagnosis, staging, and treatment

Obesity is a chronic, progressive, relapsing disease characterized by excess or dysfunctional adiposity that impairs health and contributes to multimorbidity, disability, and reduced life expectancy. Contemporary international frameworks recommend moving beyond BMI-only definitions toward disease-based diagnostic models that integrate adiposity, complications, and functional status. Croatia faces a high prevalence of obesity alongside constrained healthcare resources and limited reimbursement for modern pharmacotherapy, highlighting the need for nationally adapted clinical guidance.

This position statement was developed using a modified Delphi consensus process involving 23 multidisciplinary experts from academic and clinical institutions across Croatia. Consensus statements were derived from contemporary international guidelines, randomized controlled trials, and meta-analyses. Evidence quality and recommendation strength were graded using an adapted GRADE-based framework.

The document establishes a Croatia-specific framework for the diagnosis, staging, and management of obesity. Diagnosis requires confirmation of excess adiposity with evidence of clinical risk or dysfunction and integrates anthropometric measures with metabolic, mechanical, psychological, and functional domains. A staging system aligned with EASO and Lancet frameworks guides treatment intensity according to disease severity. Management is based on four pillars: lifestyle therapy, psychological support, pharmacotherapy, and metabolic/bariatric surgery. Pharmacological treatment is stage-based and comorbidity-driven, prioritizing agents with proven organ-protective effects. Special considerations are provided for older adults, emphasizing preservation of muscle mass, functional capacity, independence, and quality of life. Long-term structured follow-up is recommended for all patients, reflecting the chronic disease model of obesity.

This position statement provides an evidence-based, nationally adapted clinical framework that aligns obesity management with modern chronic disease standards. By integrating disease staging, individualized therapy, and long-term care, it supports precision treatment across the lifespan and emphasizes obesity management as a key strategy for preventing complications, reducing disability, and promoting healthy longevity.