Italy’s top health experts have created new guidelines to help doctors treat obesity more effectively. These guidelines recommend using multiple measurements beyond just weight to understand health risks, combining diet and exercise with behavioral support as the first step, and considering medications or surgery when lifestyle changes alone aren’t enough. The guidelines emphasize that losing just 10% of body weight can significantly improve quality of life and reduce depression risk. These evidence-based recommendations are now the official standard for obesity treatment in Italy and provide clear guidance for healthcare professionals.

The Quick Take

  • What they studied: What are the best ways to diagnose and treat obesity based on the strongest available scientific evidence?
  • Who participated: This wasn’t a traditional study with patients. Instead, expert doctors reviewed all existing research to create official treatment guidelines for Italy.
  • Key finding: Doctors should use multiple body measurements (not just BMI), combine diet and exercise with mental health support, and add medications or surgery only when lifestyle changes don’t work well enough.
  • What it means for you: If you’re struggling with weight, expect your doctor to measure your health in multiple ways and start with a structured program combining nutrition, exercise, and behavioral support before considering medications or surgery.

The Research Details

This guideline document represents a systematic review of scientific evidence conducted by a panel of obesity experts in Italy. Rather than conducting a new experiment, the experts examined all high-quality research published on obesity diagnosis and treatment. They organized their findings into four main areas: how to diagnose obesity, nutrition-based treatment, medications and surgery, and other important topics.

The experts used a method called GRADE (Grading of Recommendations, Assessment, Development and Evaluation), which is the gold standard for creating medical guidelines. This method ensures that recommendations are based on the strongest evidence available and are clearly labeled by how confident experts are in each recommendation.

The panel reviewed evidence on 13 specific clinical questions that doctors commonly face when treating patients with obesity. This systematic approach ensures the guidelines reflect current science rather than individual opinions.

Using a structured, evidence-based approach to create guidelines ensures that doctors across Italy follow the same proven methods rather than using different approaches. This consistency improves patient outcomes and ensures everyone receives care based on the best available science. The GRADE method is internationally recognized as the most rigorous way to create medical guidelines.

These guidelines carry significant authority because they were endorsed by Italy’s National Institute of Health, the country’s top public health authority. The expert panel included specialists in obesity treatment, nutrition, and related fields. The use of the GRADE methodology ensures transparency about which recommendations have strong evidence versus those with weaker evidence. However, as a guideline document rather than a new research study, it synthesizes existing evidence rather than generating new data.

What the Results Show

The guidelines recommend that doctors should not rely on BMI (body mass index) alone when assessing obesity risk. Instead, they should use additional measurements that specifically look at belly fat distribution, which is a better predictor of health problems. This is important because two people with the same BMI can have very different health risks depending on where their body stores fat.

For all patients with obesity, the first treatment should be a structured lifestyle program that combines three elements: medical nutrition therapy (working with a nutritionist on diet), physical activity, and cognitive-behavioral therapy (mental health support to change eating habits). This comprehensive approach should be offered to everyone before considering medications or surgery.

Medications should be considered for people with a BMI over 27 who have other health conditions like diabetes or heart disease, or for people with a BMI of 30-39.9 based on individual goals. Surgery may be considered when medications don’t work or for people with a BMI over 40 kg/m², where surgery might be the preferred first option.

A key finding is that losing just 10% of initial body weight produces meaningful improvements in quality of life and reduces the risk of developing depression.

The guidelines emphasize that obesity should be treated as a chronic disease that requires ongoing management, similar to diabetes or high blood pressure. This means treatment isn’t a one-time event but rather a long-term commitment. The guidelines also stress the importance of individualized treatment plans based on each person’s specific health conditions, goals, and circumstances rather than using a one-size-fits-all approach.

These Italian guidelines align with international obesity treatment standards from organizations like the American Medical Association and European obesity societies. They represent an update to previous guidance, incorporating newer evidence about medications and the importance of measuring abdominal fat distribution. The emphasis on behavioral support alongside diet and exercise reflects growing scientific understanding that successful weight management requires addressing both physical and psychological factors.

As a guideline document based on reviewing existing research, this doesn’t present new experimental data. The strength of recommendations varies depending on the quality of underlying research—some recommendations have very strong evidence while others are based on moderate evidence. Guidelines also may not apply equally to all populations, as most obesity research has been conducted in specific demographic groups. Individual doctors may need to adapt recommendations based on their patients’ unique circumstances, cultural backgrounds, and preferences.

The Bottom Line

If you have obesity, ask your doctor to measure your health using multiple methods beyond just weight. Work with your healthcare team to develop a structured program combining nutrition counseling, regular physical activity, and behavioral support (strong recommendation—high confidence). If lifestyle changes alone don’t achieve your goals after a reasonable time period, discuss medications with your doctor, especially if you have other health conditions (moderate recommendation). Surgery may be appropriate in specific cases, particularly if you have a very high BMI or if other treatments haven’t worked (moderate recommendation).

These guidelines are primarily for healthcare professionals treating patients with obesity in Italy and internationally. Patients with obesity or those concerned about their weight should discuss these recommendations with their doctors. The guidelines may be less applicable to people with obesity due to specific medical conditions (like thyroid disease) that require specialized treatment. Pregnant women and children have different obesity management approaches not fully covered in these adult-focused guidelines.

Expect to see improvements in quality of life and mood within 3-6 months of consistent lifestyle changes. Significant health benefits from 10% weight loss typically appear within 6-12 months. If medications are added, effects usually become noticeable within 8-12 weeks. Long-term success requires ongoing commitment—this is a marathon, not a sprint.

Want to Apply This Research?

  • Track weekly weight, waist circumference measurements, physical activity minutes, and mood/quality of life scores using a simple 1-10 scale. This multi-metric approach aligns with the guideline’s recommendation to look beyond BMI alone.
  • Set a specific, achievable goal: commit to one structured meal plan from a nutritionist, schedule three weekly exercise sessions, and complete one behavioral support session (virtual or in-person) per week. Log completion of each element daily.
  • Create a monthly dashboard showing trends in weight, waist circumference, activity levels, and quality of life scores. Share this with your healthcare provider quarterly to assess whether your current treatment plan is working or needs adjustment.

These guidelines represent expert recommendations based on scientific evidence, but they are not a substitute for personalized medical advice from your healthcare provider. Obesity treatment should be individualized based on your specific health conditions, medications, and personal circumstances. Always consult with your doctor before starting any weight loss program, taking medications, or considering surgery. If you have other medical conditions, mental health concerns, or are taking medications, inform your healthcare team as these may affect treatment recommendations. Results vary significantly between individuals, and what works for one person may not work for another.