From Obesity to Healthy Longevity: A Consensus-Based Clinical Framework for Diagnosis, Staging, and Treatment

Obesity is a complex, multifaceted condition that affects individuals of all ages and backgrounds. Characterized by excess or dysfunctional adiposity, it impairs health and contributes to various complications, including multimorbidity, disability, and reduced life expectancy. In light of these challenges, contemporary international frameworks have shifted towards disease-based diagnostic models that integrate adiposity, complications, and functional status. Given the high prevalence of obesity in Croatia, alongside limited healthcare resources and reimbursement constraints for modern pharmacotherapy, there is a pressing need for nationally adapted clinical guidance. The development of this position statement was informed by a modified Delphi consensus process involving 23 multidisciplinary experts from academic and clinical institutions across Croatia. This expert panel drew upon contemporary international guidelines, randomized controlled trials, and meta-analyses to establish a comprehensive framework for the diagnosis, staging, and management of obesity in Croatia. The resulting document provides a clinically relevant and evidence-based approach to addressing this complex disease. A key component of this framework is the integration of anthropometric measures with metabolic, mechanical, psychological, and functional domains to confirm excess adiposity and assess clinical risk or dysfunction. This comprehensive assessment enables healthcare providers to diagnose obesity accurately and stage treatment intensity according to disease severity. The proposed staging system aligns with established frameworks such as those published by the European Association for the Study of Obesity (EASO) and The Lancet. Treatment is guided by 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 the 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. By integrating disease staging, individualized therapy, and long-term care, this framework supports precision treatment across the lifespan and emphasizes obesity management as a key strategy for preventing complications, reducing disability, and promoting healthy longevity.