Metabesity guideline: a pakistan perspective

Pakistan is among the top ten countries in terms of obesity, with individuals at a higher risk of metabolic disorders or metabesity. Metabesity is a combination of obesity with metabolic disorders such as diabetes, which also increases the risk of cardiovascular and neurovascular disorders, and accelerated ageing. There is a complex interplay of genetic, behavioural and metabolic influences in metabesity, which necessitates the need for comprehensive guidelines for its management, especially in the Pakistani population. For this purpose, rigorous literary evidence was gathered, and standardised guidelines such as the American Association of Clinical Endocrinology (AACE) were explored. The prepared guidelines for metabesity suggest screening tests for hyperglycaemia, dyslipidaemia and coronary disorders at regular intervals, and following a standard diagnostic criteria for metabesity. This involves measurement of waist circumference (Asian-based cut off >90cm in men and >80cm in women), lipid profile (HDL <40mg/dl in men and < 50mg/dl in women), blood pressure (>135/85mmHg), and fasting blood glucose (>99mg/dl) to determine the risk. Treatment protocol involves lifestyle changes including 500-750kcal reduction in diet per day along with 150 minutes of weekly physical activity. Pharmacotherapy is advised for weight loss, hypertension, hyperglycaemia, and dyslipidaemia, along with management of other comorbid conditions if any. In patients with a body mass index (BMI) above 35, surgical options such as bariatric surgery can be considered. Metabesity impacts other comorbid conditions and has individual risks for each age group. A more personalised approach for management should be preferred in persons with polycystic ovary syndrome (PCOS), neurologic disorders, Alzheimer's, stroke and infections, due to significant impact of the disease.