A panel of 23 medical experts in Croatia has published a national clinical framework for diagnosing and treating obesity as a chronic, progressive disease, moving away from the use of body mass index alone as the basis for diagnosis and care, according to a study published in Frontiers in Aging on August 14.
The position statement was developed using a modified Delphi consensus process, drawing on international clinical guidelines, randomized controlled trials, and meta-analyses. Experts came from academic and clinical institutions across Croatia and graded their recommendations using an adapted GRADE-based framework, a standard method for evaluating the strength and quality of medical evidence.
The document defines obesity as a chronic, progressive, relapsing disease characterized by excess or dysfunctional adiposity that impairs health and contributes to multimorbidity, disability, and reduced life expectancy. Under the new framework, a diagnosis requires confirmation of excess body fat alongside evidence of clinical risk or physical dysfunction. That assessment integrates metabolic, mechanical, psychological, and functional factors rather than relying on BMI alone.
The framework introduces a staging system aligned with guidelines from the European Association for the Study of Obesity and The Lancet Commission on Obesity. Treatment intensity is tied to disease severity. The four pillars of management under the framework are lifestyle therapy, psychological support, pharmacotherapy, and metabolic or bariatric surgery.
Pharmacological treatment is described as stage-based and guided by existing conditions, with priority given to medications that have demonstrated organ-protective effects. The document also addresses older adults specifically, emphasizing preservation of muscle mass, functional capacity, independence, and quality of life as treatment goals for that population.
Croatia was identified in the document as facing a high prevalence of obesity alongside constrained healthcare resources and limited insurance reimbursement for modern pharmacological treatments. The authors framed the national framework as a response to those conditions, designed to align Croatian clinical practice with international chronic disease standards while accounting for local limitations.
Long-term structured follow-up is recommended for all patients under the framework, reflecting the view that obesity requires ongoing management rather than short-term intervention. The document positions obesity treatment as a central strategy for reducing complications, preventing disability, and supporting what the authors call healthy longevity across a patient's lifespan.
