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(Adnkronos Salute) - Bmi addio, o quasi. Non basterà più l'indice di massa corporea per stabilire se una persona soffre di obesità e per decidere come curarla. La definizione attuale, che considera un paziente 'obeso' se ha un Bmi uguale o superiore a 30, "esclude molte persone che potrebbero beneficiare del trattamento". L'Easo, Associazione europea per lo studio dell'obesità, detta quindi "un nuovo schema per la diagnosi, la stadiazione e la gestione dell'obesità negli adulti". Pubblicato su 'Nature Medicine', permetterà di "modernizzare la diagnosi e il trattamento" della patologia "tenendo conto di tutti gli ultimi sviluppi nel campo, compresa la nuova generazione di farmaci per l'obesità". Medicinali la cui somministrazione potrà essere valutata anche quando l'indice di massa corporea è inferiore a 30, pari a 25 o maggiore. "Nonostante l'ampio riconoscimento dell'obesità come una malattia multifattoriale, cronica, recidivante e non trasmissibile, caratterizzata da un accumulo anormale e/o eccessivo di grasso corporeo, la diagnosi di obesità è ancora in molti contesti basata esclusivamente sui valori di soglia del Bmi e non riflette il ruolo della distribuzione e della funzione del tessuto adiposo nella gravità della malattia", spiega l'Easo in una comunicazione che riporta in calce anche il nome dell'italiano Luca Busetto, professore associato del Dipartimento di Medicina dell'università di Padova, vice-president della società scientifica per la regione Sud. Una delle novità chiave dei criteri redatti dal gruppo di lavoro Easo, composto da esperti fra cui i presidenti presenti e passati dell'associazione, riguarda dunque "la componente antropometrica della diagnosi di obesità". E mette nero su bianco che "il solo Bmi è insufficiente come criterio diagnostico" e che "la distribuzione del grasso corporeo ha un effetto sostanziale sulla salute". Nel mirino il girovita: "L'accumulo di grasso addominale è associato a un aumento del rischio di sviluppare complicazioni cardiometaboliche", ammoniscono gli specialisti, e rappresenta quindi "un determinante più forte dello sviluppo della malattia rispetto all'indice di massa corporea, anche in soggetti con un Bmi inferiore alla soglia standard (30) per la diagnosi di obesità". Il grasso addominale o viscerale, avverte l'Easo, "è un importante fattore di rischio per il deterioramento della salute anche in persone con Bmi basso e senza manifestazioni cliniche evidenti". Pertanto le nuove indicazioni europee considerano obesi anche "soggetti con Bmi più basso" di 30, "compreso tra 25 e 30, ma accumulo di grasso addominale aumentato e presenza di eventuali compromissioni mediche, funzionali o psicologiche". Così "riducendo il rischio di sottotrattamento in questo particolare gruppo di pazienti, rispetto all'attuale definizione di obesità basata sul Bmi".Gli autori chiariscono che nelle loro raccomandazioni i "pilastri del trattamento" anti-obesità "aderiscono sostanzialmente alle linee guida attualmente disponibili: le modifiche comportamentali, inclusa la terapia nutrizionale, l'attività fisica, la riduzione dello stress e il miglioramento del sonno sono stati concordati come i principali capisaldi della gestione" della patologia, "con la possibile aggiunta di terapia psicologica, farmaci per l'obesità e procedure metaboliche o bariatriche (chirurgiche ed endoscopiche)".Relativamente alle ultime due opzioni, precisa l'Easo, "il comitato direttivo ha discusso il fatto che le attuali linee guida si basano su evidenze derivanti da studi clinici i cui criteri di inclusione erano per lo più fondati su valori soglia antropometrici, piuttosto che su una valutazione clinica completa". Perciò, "nella pratica attuale, l'applicazione rigorosa di questi criteri preclude l'uso di farmaci anti-obesità o procedure metaboliche/bariatriche in pazienti con un sostanziale carico di malattia da obesità, ma valori di Bmi bassi".Ora si cambia: "L'utilizzo dei farmaci - raccomandano gli esperti - dovrebbe essere considerato in pazienti con Bmi pari a 25 o maggiore, un rapporto vita-altezza superiore a 0,5 e la presenza di compromissioni o complicazioni mediche, funzionali o psicologiche, indipendentemente dai valori soglia attuali dell'indice di massa corporea". Per gli autori dei nuovi criteri, "questa dichiarazione può anche essere vista come un appello alle aziende farmaceutiche e alle autorità regolatorie, ad adottare criteri di inclusione più aderenti alla stadiazione clinica dell'obesità e meno" legate "ai tradizionali cut-off di Bmi quando si progettano futuri studi clinici con farmaci per l'obesità". L'obiettivo dell'Easo è "avvicinare la gestione dell'obesità a quella di altre malattie croniche non trasmissibili", per le quali si punta "non a risultati intermedi a breve termine, ma a benefici per la salute a lungo termine"."Definire obiettivi terapeutici personalizzati a lungo termine": questo, secondo gli specialisti, dovrebbe guidare "la discussione con i pazienti dall'inizio del trattamento, considerando lo stadio e la gravità della malattia, le opzioni terapeutiche disponibili e i possibili effetti collaterali e rischi concomitanti, le preferenze del paziente, i fattori individuali che determinano l'obesità e i possibili ostacoli al trattamento. Si sottolinea la necessità - concludono gli autori delle nuove indicazioni - di un piano di trattamento globale a lungo termine o per tutta la vita, piuttosto che di una riduzione del peso corporeo a breve termine". di Adnkronos   05-07-2024 - 17:45 Link copiato Commenti Leggi la Netiquette

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