Endocrine Abstracts

Background: Obesity represents a threatening worldwide epidemic but, beyond the guidelines recommendations, its modalities of treatment in the medical community appear as variable and not clearly defined. Aim of our survey was to assess the present real-world approach to obesity management in Italy.

Methods: Online anonymous survey among the 2248 members of the Italian Association of Clinical Endocrinologists (AME). The survey included 8 questions about demographics and 26 questions about obesity management.

Results: Response rate was 23.7% (534/2248 endocrinologists). The survey sample was representative of the Italian endocrinologist population, because sex, age, regional distribution, and professional experience of respondents were not different from the overall figures of the AME members. 38.0% of respondents worked in a hospital setting and 31.0% in private practice only. Obesity was managed by dedicated professionals in half of professional settings. 76.0% of patients seeking an endocrine consultation resulted affected by obesity as the main reason for referral or as a coexisting clinical condition. 47.0% of endocrinologists referred their obese patients to specialists with specific experience, while 39.0% of respondents directly managed their patients. Pharmacologic treatments were directly employed in addition to lifestyle modifications by 58.0%, 33.0% and 10.0% of respondents in patients with first-, second-, and third-degree obesity, respectively. Metformin, orlistat, naltrexone/bupropion, and liraglutide were employed by 36.0%, 6.5%, 4.8%, and 20.0% of respondents, respectively. Over half of respondents claimed that the drugs cost was the main factor that limited the use of anti-obesity drugs and that this factor impacted unfavorably on the adherence to long-term treatment. Metabolic surgery was considered for obese patients resistant to medical treatment in 9.0%, 20.0%, and 37.0% of first-, second-, and third-degree cases, respectively. According to 34% of respondents, psychological support should be offered to all obese patients. Finally, 44% of respondents stated that the availability of new drugs with greater efficacy, lower cost and less side-effects would increase the number of obese patients eligible for anti-obesity medical treatment and would improve their adherence to therapy.

Conclusions: The results of this large-scale, obese-centered, survey demonstrate that obesity is widely impacting on the clinical activity of Italian endocrinologists. The use of pharmacologic treatment is considered as an appropriate therapeutic support in 10.0–58.0% of cases, and metformin and liraglutide appear as the most used drugs. The availability of drugs with greater efficacy and lower side-effects could markedly improve the clinical approach to these patients and their long-term management.