Obesity is a chronic disease. Positioning statement of the Diabetes, Obesity and Nutrition Workgroup of the Spanish Society of Internal Medicine (SEMI) for an approach centred on individuals with obesity

array:24 ["pii" => "S2254887421000631" "issn" => "22548874" "doi" => "10.1016/j.rceng.2020.06.013" "estado" => "S300" "fechaPublicacion" => "2021-11-01" "aid" => "1889" "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI)" "copyrightAnyo" => "2020" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Rev Clin Esp. 2021;221:509-16" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0014256520301806" "issn" => "00142565" "doi" => "10.1016/j.rce.2020.06.008" "estado" => "S300" "fechaPublicacion" => "2021-11-01" "aid" => "1889" "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI)" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Rev Clin Esp. 2021;221:509-16" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "Original" "titulo" => "La obesidad es una enfermedad crónica. Posicionamiento del grupo de trabajo de Diabetes, Obesidad y Nutrición de la Sociedad Española de Medicina Interna (SEMI) por un abordaje centrado en la persona con obesidad" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "509" "paginaFinal" => "516" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Obesity is a chronic disease. Positioning statement of the Diabetes, Obesity and Nutrition Workgroup of the Spanish Society of Internal Medicine (SEMI) for an approach centred on individuals with obesity" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figura 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 2010 "Ancho" => 2925 "Tamanyo" => 471641 ] ] "descripcion" => array:1 [ "es" => "Decálogo de posicionamiento de la SEMI para un abordaje de la obesidad centrado en la persona." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "J. Carretero Gómez, J. Ena, J.C. Arévalo Lorido, J.M. Seguí Ripoll, F.J. Carrasco-Sánchez, R. Gómez-Huelgas, M.I. Pérez Soto, J. Delgado Lista, P. Pérez Martínez" "autores" => array:10 [ 0 => array:2 [ "nombre" => "J." "apellidos" => "Carretero Gómez" ] 1 => array:2 [ "nombre" => "J." "apellidos" => "Ena" ] 2 => array:2 [ "nombre" => "J.C." "apellidos" => "Arévalo Lorido" ] 3 => array:2 [ "nombre" => "J.M." "apellidos" => "Seguí Ripoll" ] 4 => array:2 [ "nombre" => "F.J." "apellidos" => "Carrasco-Sánchez" ] 5 => array:2 [ "nombre" => "R." "apellidos" => "Gómez-Huelgas" ] 6 => array:2 [ "nombre" => "M.I." "apellidos" => "Pérez Soto" ] 7 => array:2 [ "nombre" => "J." "apellidos" => "Delgado Lista" ] 8 => array:2 [ "nombre" => "P." "apellidos" => "Pérez Martínez" ] 9 => array:1 [ "colaborador" => "en representación del grupo de trabajo de Diabetes, Obesidad y Nutrición de la Sociedad Española de Medicina Interna" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2254887421000631" "doi" => "10.1016/j.rceng.2020.06.013" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2254887421000631?idApp=WRCEE" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0014256520301806?idApp=WRCEE" "url" => "/00142565/0000022100000009/v2_202112250543/S0014256520301806/v2_202112250543/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2254887421000588" "issn" => "22548874" "doi" => "10.1016/j.rceng.2019.12.015" "estado" => "S300" "fechaPublicacion" => "2021-11-01" "aid" => "1806" "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI)" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Rev Clin Esp. 2021;221:517-28" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "Original article" "titulo" => "Use of antihyperglycaemic therapy with cardiovascular benefit in patients with type 2 diabetes who require hospitalisation: A cross-sectional study" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "517" "paginaFinal" => "528" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Uso de terapia antihiperglucemiante con beneficio cardiovascular en pacientes con diabetes tipo 2 que requieren hospitalización: un estudio transversal" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 974 "Ancho" => 1764 "Tamanyo" => 115054 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Flowchart of patients who received treatment with AR-GLP1." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "J. Ena, J. Carretero-Gómez, A. Zapatero-Gaviria, F.J. Carrasco-Sánchez, M. del Romero-Sánchez, C. González-Becerra, J.C. Blazquez-Encinar, M.J. Iguzquiza-Pellejero, B. de Escalante Yangüela, R. Gómez-Huelgas" "autores" => array:11 [ 0 => array:2 [ "nombre" => "J." "apellidos" => "Ena" ] 1 => array:2 [ "nombre" => "J." "apellidos" => "Carretero-Gómez" ] 2 => array:2 [ "nombre" => "A." "apellidos" => "Zapatero-Gaviria" ] 3 => array:2 [ "nombre" => "F.J." "apellidos" => "Carrasco-Sánchez" ] 4 => array:2 [ "nombre" => "M." "apellidos" => "del Romero-Sánchez" ] 5 => array:2 [ "nombre" => "C." "apellidos" => "González-Becerra" ] 6 => array:2 [ "nombre" => "J.C." "apellidos" => "Blazquez-Encinar" ] 7 => array:2 [ "nombre" => "M.J." "apellidos" => "Iguzquiza-Pellejero" ] 8 => array:2 [ "nombre" => "B." "apellidos" => "de Escalante Yangüela" ] 9 => array:2 [ "nombre" => "R." "apellidos" => "Gómez-Huelgas" ] 10 => array:1 [ "colaborador" => "on behalf of the Spanish Society for Internal Medicine Diabetes, Obesity, and Nutrition Workgroup" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S001425652030059X" "doi" => "10.1016/j.rce.2019.12.009" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S001425652030059X?idApp=WRCEE" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2254887421000588?idApp=WRCEE" "url" => "/22548874/0000022100000009/v3_202201140544/S2254887421000588/v3_202201140544/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S225488742100062X" "issn" => "22548874" "doi" => "10.1016/j.rceng.2020.04.013" "estado" => "S300" "fechaPublicacion" => "2021-11-01" "aid" => "1848" "copyright" => "Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI)" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Rev Clin Esp. 2021;221:497-508" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "Original article" "titulo" => "Assessment of the quality of antibiotics prescription in a regional health system" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "497" "paginaFinal" => "508" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Evaluación de la calidad de la prescripción de antibióticos en un sistema regional de salud" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0025" "etiqueta" => "Fig. 5" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr5.jpeg" "Alto" => 1760 "Ancho" => 2412 "Tamanyo" => 375827 ] ] "descripcion" => array:1 [ "en" => "Cost (€/DDD) per active ingredient and use (DID) by contribution groups. J01CA (penicillins): includes amoxicillin (J01CA04) and ampicillin (J01CA01). J01CR (combinations of penicillins): includes amoxicillin and beta-lactamase inhibitors (J01CR02). Prescription quality evaluation parameters: (<14.42%) dark green “very high”; (14.42–22.70%) light green “high”; (22.71–33.98%) yellow “low”; (>33.98%) red “very low”. J01MA (fluoroquinolones): includes ciprofloxacin (J01MA02), levofloxacin (J01MA12), moxifloxacin (J01MA14) and norfloxacin (J01MA06). Prescription quality evaluation parameters (<4.82%) dark green “very high”; (4.82–7.28%) light green “high”; (7.29–9.06%) yellow “low”; (>9.06%) red “very low”. J01FA (macrolides): includes azithromycin (J01FA10), clarithromycin (J01FA09), erythromycin (J01FA01) and spiramycin (J01FA02). J01DD (third generation cephalosporins): includes cefditoren (J01DD16) and cefixime (J01DD08). Prescription quality evaluation parameters (<0.04%) dark green “very high”; (0.04–0.51%) light green “high”; (0.52–1.88%) yellow “low”; (>1.88%) red “very low”. J01XX (others antibacterials): includes fosfomycin (J01XX01). *Significant differences compared to the other TSI groups with a significance level of p=0.020. **Significant differences compared to the other TSI groups with a significance level of p=0.051. ***Significant differences compared to the other TSI groups with a significance level of p=0.024. ****Significant differences compared to the other TSI groups with a significance level of p=0.053. Own draft based on Coenen et al.<a class="elsevierStyleCrossRef" href="#bib0250">11</a>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "P. Rojas García, F. Antoñanzas Villar" "autores" => array:2 [ 0 => array:2 [ "nombre" => "P." "apellidos" => "Rojas García" ] 1 => array:2 [ "nombre" => "F." "apellidos" => "Antoñanzas Villar" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0014256520301272" "doi" => "10.1016/j.rce.2020.04.015" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0014256520301272?idApp=WRCEE" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S225488742100062X?idApp=WRCEE" "url" => "/22548874/0000022100000009/v3_202201140544/S225488742100062X/v3_202201140544/en/main.assets" ] "en" => array:21 [ "idiomaDefecto" => true "cabecera" => "Original article" "titulo" => "Obesity is a chronic disease. Positioning statement of the Diabetes, Obesity and Nutrition Workgroup of the Spanish Society of Internal Medicine (SEMI) for an approach centred on individuals with obesity" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "509" "paginaFinal" => "516" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "J. Carretero Gómez, J. Ena, J.C. Arévalo Lorido, J.M. Seguí Ripoll, F.J. Carrasco-Sánchez, R. Gómez-Huelgas, M.I. Pérez Soto, J. Delgado Lista, P. Pérez Martínez" "autores" => array:10 [ 0 => array:4 [ "nombre" => "J." "apellidos" => "Carretero Gómez" "email" => array:1 [ 0 => "juanicarretero@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "J." "apellidos" => "Ena" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "J.C." "apellidos" => "Arévalo Lorido" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "J.M." "apellidos" => "Seguí Ripoll" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] ] ] 4 => array:3 [ "nombre" => "F.J." "apellidos" => "Carrasco-Sánchez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "d" "identificador" => "aff0020" ] ] ] 5 => array:3 [ "nombre" => "R." "apellidos" => "Gómez-Huelgas" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "e" "identificador" => "aff0025" ] ] ] 6 => array:3 [ "nombre" => "M.I." "apellidos" => "Pérez Soto" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "f" "identificador" => "aff0030" ] ] ] 7 => array:3 [ "nombre" => "J." "apellidos" => "Delgado Lista" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "g" "identificador" => "aff0035" ] ] ] 8 => array:3 [ "nombre" => "P." "apellidos" => "Pérez Martínez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "h" "identificador" => "aff0040" ] ] ] 9 => array:1 [ "colaborador" => "on behalf of the Diabetes, Obesity and Nutrition Workgroup of the Spanish Society of Internal Medicine" ] ] "afiliaciones" => array:8 [ 0 => array:3 [ "entidad" => "Servicio de Medicina Interna, Hospital de Zafra, Badajoz, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Medicina Interna, Hospital de la Marina Baixa, Alicante, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Medicina Interna, Hospital Universitario San Juan de Alicante, Alicante, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Servicio de Medicina Interna, Hospital Universitario Juan Ramón Jiménez, Huelva, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Servicio de Medicina Interna, Hospital Regional Universitario de Málaga, Málaga. Instituto de Investigación Biomédica de Málaga Institute of Biomedical (IBIMA), CIBER Physiopathology of Obesity and Nutrition – CIBERobn" "etiqueta" => "e" "identificador" => "aff0025" ] 5 => array:3 [ "entidad" => "Servicio de Medicina Interna, Hospital Universitario de Vinalopó, Elche, Alicante, Spain" "etiqueta" => "f" "identificador" => "aff0030" ] 6 => array:3 [ "entidad" => "Servicio de Medicina Interna, Hospital Universitario Reina Sofía/Universidad de Córdoba/Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain" "etiqueta" => "g" "identificador" => "aff0035" ] 7 => array:3 [ "entidad" => "Unidad de Lípidos y Arterioesclerosis, Hospital Universitario Reina Sofía/Universidad de Córdoba/Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba. CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain" "etiqueta" => "h" "identificador" => "aff0040" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "La obesidad es una enfermedad crónica. Posicionamiento del grupo de trabajo de Diabetes, Obesidad y Nutrición de la Sociedad Española de Medicina Interna (SEMI) por un abordaje centrado en la persona con obesidad" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1864 "Ancho" => 3333 "Tamanyo" => 328074 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Attitude towards anthropometric measurements. Pie chart of variable percentages: weight, BMI, AC, data included in the MH, obesity included in diagnoses, obesity classified in degrees. AC: abdominal circumference; BMI: body mass index; MH: medical history." ] ] ] "textoCompleto" => "IntroductionObesity is a chronic, complex, and multifactorial metabolic disease.<a class="elsevierStyleCrossRef" href="#bib0005">1</a> Its prevalence has tripled in recent decades, approaching 20% of the global population.<a class="elsevierStyleCrossRef" href="#bib0010">2</a> The rate in Spain is about 23%, similar to that seen in Internal Medicine departments (23.6%).<a class="elsevierStyleCrossRef" href="#bib0015">3</a>Most epidemiological studies use the body mass index (BMI) (weight/height2, kg/m2) to classify this entity;<a class="elsevierStyleCrossRef" href="#bib0015">3</a> individuals over the age of 18 years with a BMI ≥ 30 kg/m2 are considered to have obesity. However, obesity is also defined as an excess of body fat greater than 25% in men and 30% in women that is significant enough to cause increased morbidity and mortality.<a class="elsevierStyleCrossRef" href="#bib0005">1</a>The current trend is to conceive of obesity as a clinical condition associated with other pathologies rather than a disease in and of itself, which leads to it being under-diagnosed and under-treated. Likewise, obesity plays an essential role in the development of other noncommunicable chronic diseases such as type 2 diabetes mellitus (T2D), dyslipidaemia, high blood pressure (HTN), cardiovascular diseases (CVDs), and cancer.<a class="elsevierStyleCrossRef" href="#bib0020">4</a>All of the above, together with advances in knowledge, leads us to consider obesity a chronic disease that requires a comprehensive approach that is sustained over time.<a class="elsevierStyleCrossRefs" href="#bib0025">5,6</a> Nevertheless, as internists we encounter significant obstacles when dealing with this entity, including a lack of knowledge of the complexity and chronic and recurrent nature of obesity; lack of training and time; or prioritising the management of other associated comorbid conditions.<a class="elsevierStyleCrossRef" href="#bib0035">7</a>In this scenario, care for individuals with obesity needs to become an essential part of the comprehensive vision that internal medicine uses to view ill people. The aim of this document is to present the level of understanding and sensitivity of internists towards obesity and to draft a consensus document from the Spanish Society of Internal Medicine (SEMI) with recommendations based on the available scientific evidence and the opinions of its members.Material and methodsWith the aim of discovering the understanding and sensitivity of internists towards obesity, we drafted and distributed an online survey to SEMI members. After analysing the responses, a SWOT analysis was performed that was later discussed by a panel of expert internists. Lastly, recommendations were drafted in a third round.SurveyIn September 2019, an opinion survey with 31 close-ended questions was written. The survey was divided into 4 parts (see Appendix A Additional material): the first part was related to the sociodemographic data of the respondents; the second referred specifically to the availability of materials for evaluating obesity levels (scale, stadiometer, body tape measure) both in the clinic and ward; the third addressed the internists’ attitudes towards individuals with obesity and the role of internal medicine in managing obesity.Internist opinionsIn October 2019, the online survey was sent to SEMI members. After analysing the responses, a SWOT analysis was completed.Panel of expertsThe discussion process was held throughout January 2020. Fifteen expert internists from the SEMI Diabetes, Obesity, and Nutrition Workgroup were invited to participate. The 15 experts were selected for their interest and experience in the field of obesity, T2D, and vascular risk (VR), in an attempt to ensure a wide range representing the diverse fields and types of clinical practice.Seven expert internists accepted the offer to participate in the discussion; eight did not respond and did not express interest in participating in the process or allege any conflicts of interest or ethics. The panellists received the results of the survey and SWOT analysis in addition to the first version of the recommendations document.As a consensus method, in this case we used a “modified Delphi method” consensus tool known as the Nominal Group Technique (NGT) modified via the online discussion.<a class="elsevierStyleCrossRef" href="#bib0040">8</a> This modified process allows for both expression of personal opinion and interaction and debate among the panel members: it makes it possible to reach a consensus without forcing this and to identify areas of uncertainty with the goal of providing additional information on the regular clinical practice of each panellist in this clinical setting.<a class="elsevierStyleCrossRefs" href="#bib0045">9–11</a>Each expert received two documents: one document with the survey and SWOT analysis results, and a second document with ten main ideas based on the former for them to work on. In the second round, each expert sent their preferences (agree, unsure, or disagree) and an initial rough draft was created with the 13 recommendations. In a third discussion, each expert once again reviewed and provided their areas of agreement, uncertainty, and dissent. Lastly, the clinical recommendations were drafted with the panellists’ consensus.Statistical analysisThe quantitative variables are expressed in means and standard deviation. The qualitative variables are expressed in absolute numbers and percentages.The sample has been divided according to hospital size, and the differences between the analysed variables, all of which were qualitative, were analysed using the Chi-squared test. A p value of  < 0.05 was considered significant. The R statistical program version 3.6.1 (2019-07-05) was used - Action of the Toes (Copyright©2019. The R Foundation for Statistical Computing Platform).ResultsSurveyA total of 599 responses where obtained. Mean participant age was 44.4 (11) years; 52.1% were women, 151 (252%) were resident medical interns (MIR). The mean number of years practising medicine was 17.2 (11) years.Some 67.9% of survey respondents worked in first and second-level hospitals (30.4% and 37.5%, respectively). The preferred area of work was admissions (77.1%), followed by out-patient (20%) and cross-consultation services (2.8%). A total of 38.4% (n = 230) of the respondents had a specialized consultation unit: VR 74.3%, T2D 17.4%, and obesity 8.3%. A total of 92.8% of the respondents had a scale in their clinic, 85.6% a stadiometer, and 59.8% a body tape measure. <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a> details some results from the third part of the survey.<elsevierMultimedia ident="fig0005"></elsevierMultimedia>Once a diagnosis is made, the majority of internists (70.9%) provided instructions on lifestyle modifications. Of the rest, 3.6% did not take any specific measurements; 12% provided the patient with a standard diet; 3.6% sent the patients to an endocrinologist; and 9.6% to a dietitian. This attitude differed according to the respondent’s workplace (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>Some 91.8% of the respondents evaluated patients to rule out comorbidities associated with obesity, mainly those considered “metabolic”, such as: T2D (96.2%), CVD (88.9%), obesity hypoventilation syndrome (OHS) (73%), non-alcoholic fatty liver disease (65.3%), kidney disease via albumin/creatinine ratio (UAR) (65.3%), and others such as hypogonadism (6.9%).Lastly, in terms of the last part of the survey, 64.1% of the internists were aware of the drugs that are currently indicated for obesity treatment (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>) and 39.7% had used them at some point. A total of 74.9% were familiar with the indications for bariatric surgery (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>). Some 93.8% and 83% of the respondents considered obesity and overweight to be, respectively, a chronic disease. Some 88.7% thought that obesity is a disease proper to internists and they should play an active and leading role in treating it (85.3%).<elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia>With these results, a SWOT analysis was performed with the starting situation to draft our recommendations.Among the weaknesses (W), we must highlight the sparse knowledge and use of anti-obesity drugs and the indications for bariatric surgery; poor exclusive dedication (<20%) of internists to out-patient services and of these, only 50% to specialized consultation units; in the same manner, little interest in measuring abdominal circumference, or in referring to endocrinology or dietetics. In terms of hospitalised patients, it is worth highlighting the little interest in knowing their BMI, perhaps due to the limitations of mobilising patients admitted to internal medicine.In terms of threats (T), we must highlight the high risk of internist's space in the health system being occupied by other specialties that are more exclusively dedicated to out-patient services, particularly in hospitals offering first and second-level care.As part of our strengths (S), a large majority of those surveyed recognise obesity and overweight as a disease and can understand and rule out associated comorbidities. Of the responses, the larger proportion was from first and second-level hospitals, regional hospitals where internists play a central role in caring for admitted patients, and out-patient services. What’s more, as can be seen in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>, more attention is dedicated to promoting a healthy lifestyle in these hospitals.Lastly, regarding opportunities (O), we identified the perception of obesity as a chronic disease, which falls within the internist's fields of work, such as the care of people with chronic diseases. As previously mentioned, there was a large percentage of responses from first and second-level hospitals, a significant point when increasing the presence of specialized consultation units in these types of hospitals.Areas for improvement include the need for internists to receive patient-centred obesity training, nutrition recommendations, and the creation diets in first and second-level hospitals that lack dietitians/nutritionists and anti-obesity pharmacology.DiscussionThe consensus methods used in clinical research are aimed at problem-solving, idea generation, and the setting of priorities.<a class="elsevierStyleCrossRef" href="#bib0040">8</a> One of the strengths of these consensus methods is the balanced participation of group members, which controls and minimises the risk of one or some participants predominating over others.<a class="elsevierStyleCrossRef" href="#bib0060">12</a>Taking into consideration, on the one hand, the responses from the surveyed internists and, on the other, the points brought up through the expert discussion process, the SEMI Diabetes, Obesity, and Nutrition Workgroup drafted a list of ten points with no other aim than to provide a positioning statement for a patient-centred approach to obesity (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005">1Obesity is a complex chronic disease<a class="elsevierStyleCrossRef" href="#bib0065">13</a> that requires a multidisciplinary approach wherein internal medicine doctors play an important role.</li><li class="elsevierStyleListItem" id="lsti0010">2Obesity is a pressing problem for public health and addressing this issue transcends the health setting, requiring the involvement of political authorities and civil society. Fighting against social, economic, and cultural inequalities is key to a successful approach.<a class="elsevierStyleCrossRefs" href="#bib0070">14,15</a></li><li class="elsevierStyleListItem" id="lsti0015">3Each individual with obesity is different. Therefore, we need a holistic and individualised approach that is centred around the patient.<a class="elsevierStyleCrossRef" href="#bib0080">16</a></li><li class="elsevierStyleListItem" id="lsti0020">4Weighing, calculating body mass index (BMI), and measuring abdominal circumference (AC) of all patients seen in out-patient services is recommended; this is also recommended for hospitalised patients whenever possible (either directly or using alternative formulas to this end).<a class="elsevierStyleCrossRefs" href="#bib0085">17–19</a></li><li class="elsevierStyleListItem" id="lsti0025">5During patient diagnosis, it is necessary to include overweight and obesity in their different degrees according to the World Health Organization (WHO) classification.<a class="elsevierStyleCrossRef" href="#bib0100">20</a></li><li class="elsevierStyleListItem" id="lsti0030">6It is important to ensure early detection of the main comorbidities associated with overweight and obesity, both metabolic and non-metabolic, that negatively impact quality of life: type 2 diabetes, cardiovascular disease, sleep apnoea/hypopnea syndrome, chronic kidney disease/albuminuria, non-alcoholic fatty liver disease, osteoarthritis, infertility or hypogonadism, gastroesophageal reflux disease, and depression syndrome, among others.<a class="elsevierStyleCrossRefs" href="#bib0105">21–28</a></li><li class="elsevierStyleListItem" id="lsti0035">7Modifying eating habits and encouraging a healthy lifestyle that includes regular physical exercise should be the central pillar around which treatment for overweight and obesity revolves.<a class="elsevierStyleCrossRefs" href="#bib0145">29,30</a></li><li class="elsevierStyleListItem" id="lsti0040">8All patients diagnosed with overweight, particularly those with multiple cardiovascular or obesity risk factors, need to receive quality information about eating habit modification and healthy lifestyle, including professional nutrition counselling depending on their motivation and the available options in each health area, thereby establishing the necessary course of action for referral to a qualified professional.<a class="elsevierStyleCrossRef" href="#bib0155">31</a></li><li class="elsevierStyleListItem" id="lsti0045">9All internists, particularly those working in out-patient services and who treat patients with obesity, must be familiar with the drugs that are currently available for treating obesity and their indications, as well as the indication criteria for bariatric surgery or metabolic surgery. Additionally, they should provide patients with information about these therapeutic options when indicated<a class="elsevierStyleCrossRef" href="#bib0160">32</a> (<a class="elsevierStyleCrossRefs" href="#tbl0010">Tables 2 and 3</a>).</li><li class="elsevierStyleListItem" id="lsti0050">10Given the significance of obesity as one of the top health concerns, the SEMI believes that the pharmacological treatments currently authorised for use against this entity should be funded according to the instructions agreed on by the various scientific societies and the Ministry of Health, Consumer Affairs, and Social Welfare based on the available scientific evidence.</li></ul><elsevierMultimedia ident="fig0010"></elsevierMultimedia>ConclusionObesity is a chronic, complex, and multifactorial metabolic disease of epidemic scale around the globe. The perspective of obesity as a clinical condition associated with other comorbidities rather than being the actual cause leads it to be frequently underdiagnosed and undertreated. Obesity is the main risk factor for developing non-communicable diseases, which determines increased multimorbidity of individuals and a decline in quality of life.As a specialty with a comprehensive vision, Internal Medicine cannot be indifferent to this reality. The aim of this document is to present the level of understanding and sensitivity of internists towards obesity and to draft a consensus document from the SEMI with recommendations based on the available scientific evidence and the opinions of its members.Conflicts of interestThe content and recommendations in this document have been drafted according to the opinions of its authors and with the participation of a panel of experts without any intervention from the sponsoring institution, the Spanish Society for Internal Medicine (SEMI). Said entity has not participated in any of the phases of the design, decision-making, drafting of materials, analysis of the online survey for internists, selection of the panel members, dynamics, nor in the creation of the final consensus report." "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:3 [ "identificador" => "xres1646187" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1466589" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1646186" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1466590" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Material and methods" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Survey" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Internist opinions" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Panel of experts" ] 3 => array:2 [ "identificador" => "sec0030" "titulo" => "Statistical analysis" ] ] ] 6 => array:3 [ "identificador" => "sec0035" "titulo" => "Results" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0040" "titulo" => "Survey" ] ] ] 7 => array:2 [ "identificador" => "sec0045" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0050" "titulo" => "Conclusion" ] 9 => array:2 [ "identificador" => "sec0055" "titulo" => "Conflicts of interest" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2020-04-19" "fechaAceptado" => "2020-06-11" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1466589" "palabras" => array:4 [ 0 => "Obesity" 1 => "Internal medicine" 2 => "Chronic disease" 3 => "Comorbidities" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1466590" "palabras" => array:4 [ 0 => "Obesidad" 1 => "Medicina interna" 2 => "Enfermedad crónica" 3 => "Comorbilidades" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "BackgroundObesity is a chronic, complex and multifactorial metabolic disease involved in the development of chronic noncommunicable diseases such as type 2 diabetes mellitus, cardiovascular disease and cancer. The care of individuals with obesity is an essential part of the holistic approach provided by internal medicine to patients. Material and methodsBetween September 2019 and January 2020, we distributed an online survey to the members of the Spanish Society of Internal Medicine. We prepared a Strengths, Weaknesses, Opportunities, and Threats analysis using the responses and, using the nominal group technique, developed the recommendations. ResultsWe obtained 599 responses. The respondents mean age was 44.4 ± 11 years, and 52.1% were women. Some 91.8% of the internists evaluate their patients to rule out the comorbidities associated with obesity, mainly type 2 diabetes mellitus (96.2%), cardiovascular disease (88.9%) and obesity-associated hypoventilation syndrome (73%), among others. Some 79.9% provided indications on lifestyle changes. Some 64.1% and 74.9% of the respondents knew the indications for the drugs and bariatric surgery, respectively. Some 93.8% and 83% of the respondents considered obesity and excess weight a chronic disease, and 88.7% considered it a disease of specific interest to internists, who should take an active and leading role in its treatment (85.3%). ConclusionsThe objective of the present document is to determine the degree of understanding and sensitivity of internists regarding the management of obesity and to develop a consensus of recommendations for the Spanish Society of Internal Medicine based on the scientific evidence and the opinion of its members." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "IntroducciónLa obesidad es una enfermedad metabólica crónica, compleja y multifactorial, implicada en el desarrollo de enfermedades crónicas no transmisibles como la diabetes mellitus tipo 2, las enfermedades cardiovasculares y el cáncer. Es necesario que la atención a las personas con obesidad sea una parte esencial de la visión integral que la medicina interna aporta a la persona enferma. Material y métodosEntre septiembre de 2019 y enero de 2020 se difundió una encuesta en línea a los socios de la Sociedad Española de Medicina Interna; se elaboró un análisis DAFO con las respuestas y, mediante la técnica de Grupo Nominal, se elaboraron las recomendaciones. ResultadosObtuvimos 599 respuestas. Edad media 44,4 + 11 años, 52,1% mujeres. El 91,8% de los internistas evalúa a los pacientes para descartar las comorbilidades asociadas a la obesidad, principalmente la diabetes mellitus tipo 2 (96,2%), la enfermedad cardiovascular (88,9%) o el síndrome de hipoventilación asociada a obesidad (73%), entre otros. El 79,9% proporciona indicaciones sobre modificación del estilo de vida. El 64,1% y el 74,9% conoce las indicaciones de los fármacos y de la cirugía bariatrica respectivamente. El 93,8% y el 83% considera la obesidad y el sobrepeso una enfermedad crónica y el 88,7% una patología propia del internista, debiendo tener un papel activo y protagonista en su tratamiento (85,3%). ConclusionesEl objetivo del presente documento es dar a conocer el grado de conocimiento y de sensibilidad de los internistas frente al manejo de la obesidad y elaborar un consenso de recomendaciones de la Sociedad Española de Medicina Interna basadas en la evidencia científica y en la opinión de sus miembros." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Carretero Gómez J, Ena J, Arévalo Lorido JC, Seguí Ripoll JM, Carrasco-Sánchez FJ, Gómez-Huelgas R, et al. La obesidad es una enfermedad crónica. Posicionamiento del grupo de trabajo de Diabetes, Obesidad y Nutrición de la Sociedad Española de Medicina Interna (SEMI) por un abordaje centrado en la persona con obesidad. Rev Clin Esp. 2021;221:509–516." ] ] "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:1 [ 0 => array:4 [ "apendice" => "The following is Supplementary data to this article:<elsevierMultimedia ident="upi0005"></elsevierMultimedia>" "etiqueta" => "Appendix A" "titulo" => "Supplementary data" "identificador" => "sec0065" ] ] ] ] "multimedia" => array:6 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1864 "Ancho" => 3333 "Tamanyo" => 328074 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Attitude towards anthropometric measurements. Pie chart of variable percentages: weight, BMI, AC, data included in the MH, obesity included in diagnoses, obesity classified in degrees. AC: abdominal circumference; BMI: body mass index; MH: medical history." ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 2010 "Ancho" => 2925 "Tamanyo" => 471641 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "Ten points positioning statement from the SEMI for a patient-centred approach to obesity." ] ] 2 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "Result of the variables according to hospital size. Analysis performed using the Chi-squared test." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Hospital type \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">>1,000 beds \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">500−1,000 beds \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">200−500 beds \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><200 beds \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">N \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">56 (100%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">134 (100%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">222 (100%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">181 (100%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.0022 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Modification of habits \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">35 (62.5%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">93 (69.4%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">164 (73.9%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">128 (70.7%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.0022 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No specific action \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 (7.1%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9 (6.7%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 (3.1%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 (1.1%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.0022 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Standard diet indicated \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10 (17.9%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">23 (17.1%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">23 (10.4%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">17 (9.4%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.0022 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Referral to endocrinology \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 (5.3%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 (2.2%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11 (4.9%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 (2.8%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.0022 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Referral to dietitian \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 (7.1%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 (17.6%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">17 (7.6%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">29 (16%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.0022 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2802995.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Attitude towards obesity according to hospital type (p = 0.0022)." ] ] 3 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0020" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "Pharmacological treatment is indicated in patients with BMI ≥ 30 kg/m2 or ≥ 27 kg/m2 associated with major comorbidities (among others: high blood pressure, type 2 diabetes mellitus, obesity hypoventilation syndrome, non-alcoholic fatty liver disease).MEN: multiple endocrine neoplasia." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Drugs \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Formulation and maximum dose \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Weight loss (1 year) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Adverse events \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Safety precautions and contraindications \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Orlistat \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Oral60−120 mg/8 h \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.5−3.4 kg \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">→Abdominal pain, nausea, constipation, diarrhoea, faecal urgency→Headache→Malabsorption of fat-soluble vitamins (A, D, E, K)→Liver failure and kidney disease due to oxalates \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">→Chronic malabsorption syndromes→Cholestasis \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Liraglutide \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Subcutaneous3 mg/24 h \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5.8−5.9 kg \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">→Nausea, constipation, diarrhoea, vomiting \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">→History of medullary thyroid cancer or MEN-2→History of pancreatitis \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Bupropion/naltrexone \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Oral32/360 mg/24 h2 tablets/12 h \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.0−4.1 kg \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">→Nausea, constipation, vomiting→Headache→Insomnia, anxiety→Tachycardia, increased blood pressure \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">→Suicidal ideation→Uncontrolled depression syndrome→Use of barbiturates, benzodiazepines or anti-seizure drugs→Eating disorders→Poorly controlled arterial hypertension \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2802994.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Currently proven drugs for treating obesity." ] ] 4 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0025" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "Indications for bariatric surgery: BMI ≥ 40 kg/m2 or ≥ 35 kg/m2 with major comorbidities (among others: high blood pressure, type 2 diabetes mellitus, obesity hypoventilation syndrome, non-alcoholic fatty liver disease)." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Procedure \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Weight loss1 year/6 years \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Pros \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Contras \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Roux-en-Y gastric bypass \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">14−30%/13−14% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">→Significant and sustained weight loss→High rates of type 2 diabetes mellitus remission \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">→Complex procedure→Higher incidence of perioperative complications→Higher incidence of delayed complications: marginal ulcer, small bowel obstruction, dumping syndrome→Indefinite vitamin and mineral supplementation \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Vertical sleeve gastrectomy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">20–28%/22% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">→Significant and sustained weight loss→Less complex surgery→Option to reconvert into bypass→Lower risk of vitamin and mineral deficits \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">→Higher likelihood of regaining weight compared to bypass→Obstructive syndromes \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2802993.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Main bariatric surgery techniques." ] ] 5 => array:5 [ "identificador" => "upi0005" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "Ecomponente" => array:2 [ "fichero" => "mmc1.pdf" "ficheroTamanyo" => 90896 ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:32 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "American Association of Clinical Endocrinologists’ position statement on obesity and obesity medicine" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J.I. Mechanick" 1 => "A.J. Garber" 2 => "Y. Handelsman" 3 => "W.T. Garvey" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.4158/EP12160.PS" "Revista" => array:6 [ "tituloSerie" => "Endocr Pract." "fecha" => "2012" "volumen" => "18" "paginaInicial" => "642" "paginaFinal" => "648" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23047927" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Obesity Management Task Force of the European Association for the Study of Obesity. European guidelines for obesity management in adults" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "V. Yumuk" 1 => "C. Tsigos" 2 => "M. Fried" 3 => "K. Schindler" 4 => "L. Busetto" 5 => "D. Micic" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1159/000442721" "Revista" => array:6 [ "tituloSerie" => "Obesity Facts." "fecha" => "2015" "volumen" => "8" "paginaInicial" => "402" "paginaFinal" => "424" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26641646" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prevalence of obesity according to Edmonton staging in the Internal Medicine consultations. Results of the OBEMI study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J. Carretero Gómez" 1 => "J.C. Arévalo Lorido" 2 => "R. Gómez Huelgas" 3 => "M.T. Sánchez Vidal" 4 => "M. Suárez Tembra" 5 => "J.M. Varela Aguilar" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.rce.2016.11.003" "Revista" => array:6 [ "tituloSerie" => "Rev Clin Esp." "fecha" => "2017" "volumen" => "217" "paginaInicial" => "71" "paginaFinal" => "78" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27939027" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Association of BMI with overall and cause-specific mortality: a population-based cohort study of 3•6 million adults in the UK" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "K. Bhaskaran" 1 => "I. Dos-Santos-Silva" 2 => "D.A. Leon" 3 => "I.J. Douglas" 4 => "L. Smeeth" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S2213-8587(18)30288-2" "Revista" => array:6 [ "tituloSerie" => "Lancet Diabet Endocrinol." "fecha" => "2018" "volumen" => "6" "paginaInicial" => "944" "paginaFinal" => "953" "itemHostRev" => array:3 [ "pii" => "S1470204509701123" "estado" => "S300" "issn" => "14702045" ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "World obesity federation. Obesity: a chronic relapsing progressive disease process. A position statement of the world obesity federation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "G.A. Bray" 1 => "K.K. Kim" 2 => "J.P.H. Wilding" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/obr.12551" "Revista" => array:6 [ "tituloSerie" => "Obes Rev." "fecha" => "2017" "volumen" => "18" "paginaInicial" => "715" "paginaFinal" => "723" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28489290" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Management of obesity: improvement of healthcare training and systems for prevention and care" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "W.H. Dietz" 1 => "L.A. Baur" 2 => "K. Hall" 3 => "R.M. Puhl" 4 => "E.M. Taveras" 5 => "R. Uauy" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0140-6736(14)61748-7" "Revista" => array:6 [ "tituloSerie" => "Lancet." "fecha" => "2015" "volumen" => "385" "paginaInicial" => "2521" "paginaFinal" => "2533" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25703112" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Barriers to obesity management: a pilot study of primary care clinicians" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "V. Forman-Hoffman" 1 => "A. Little" 2 => "T. Wahls" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/1471-2296-7-35" "Revista" => array:5 [ "tituloSerie" => "BMC Fam Pract." "fecha" => "2006" "volumen" => "7" "paginaInicial" => "35" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16756673" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Consensus development methods: a review of best practice in creating clinical guidelines" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "N. Black" 1 => "M. Murphy" 2 => "D. Lamping" 3 => "M. McKee" 4 => "C. Sanderson" 5 => "J. Askham" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Health Serv Res Policy." "fecha" => "1999" "volumen" => "4" "paginaInicial" => "236" "paginaFinal" => "248" ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Using consensus group methods such as Delphi and Nominal Group in medical education research" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "S. Humphrey-Murto" 1 => "L. Varpio" 2 => "C. Gonsalves" 3 => "T.J. Wood" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1080/0142159X.2017.1245856" "Revista" => array:5 [ "tituloSerie" => "Med Teach." "fecha" => "2017" "volumen" => "39" "paginaInicial" => "14" "paginaFinal" => "19" ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0050" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Nominal group technique to select attributes for discrete choice experiments: an example for drug treatment choice in osteoporosis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Hiligsmann" 1 => "C. van Durme" 2 => "P. Geusens" 3 => "Bg Dellaert" 4 => "Cd Dirksen" 5 => "T. Van der Weijden" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2147/PPA.S38408" "Revista" => array:6 [ "tituloSerie" => "Patient Prefer Adherence." "fecha" => "2013" "volumen" => "7" "paginaInicial" => "133" "paginaFinal" => "139" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23412964" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0055" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "How to use the nominal group and Delphi techniques" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "S.S. McMillan" 1 => "M. King" 2 => "M.P. Tully" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s11096-016-0257-x" "Revista" => array:6 [ "tituloSerie" => "Int J Clin Pharm." "fecha" => "2016" "volumen" => "38" "paginaInicial" => "655" "paginaFinal" => "662" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26846316" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0060" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Building consensus in health care: a guide to using the nominal group technique" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J. Allen" 1 => "J. Dyas" 2 => "M. Jones" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.12968/bjcn.2004.9.3.12432" "Revista" => array:6 [ "tituloSerie" => "Br J Community Nurs." "fecha" => "2004" "volumen" => "9" "paginaInicial" => "110" "paginaFinal" => "114" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15028996" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0065" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Obesity as a disease: a white paper on evidence and arguments commissioned by the Council of the Obesity Society" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "D.B. Allison" 1 => "M. Downey" 2 => "R.L. Atkinson" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1038/oby.2008.231" "Revista" => array:6 [ "tituloSerie" => "Obesity." "fecha" => "2008" "volumen" => "16" "paginaInicial" => "1161" "paginaFinal" => "1177" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18464753" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0070" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The GBD 2015 Obesity Collaborators. Health effects ofoverweight and obesity in 195 countries over 25 years" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Afshin" 1 => "M.H. Forouzanfar" 2 => "M.B. Reitsma" 3 => "P. Sur" 4 => "K. Estep" 5 => "A. Lee" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMoa1614362" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med." "fecha" => "2017" "volumen" => "377" "paginaInicial" => "13" "paginaFinal" => "27" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28604169" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0075" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cause specific mortality, social position, and obesity among women who had never smoked: 28 year cohort study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "C.L. Hart" 1 => "L. Gruer" 2 => "G.C. Watt" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/bmj.d3785" "Revista" => array:4 [ "tituloSerie" => "BMJ." "fecha" => "2011" "volumen" => "342" "paginaInicial" => "d3785" ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0080" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A call to action to inform patient‐centred approaches to obesity management: Development of a disease‐illness model" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "J. Fastenau" 1 => "R.L. Kolotkin" 2 => "K. Fujioka" 3 => "M. Alba" 4 => "W. Canovatchel" 5 => "S. Traina" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:3 [ "tituloSerie" => "Clin Obes." "fecha" => "2019" "volumen" => "9" ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0085" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Scaling of adult body weight to height across sex and race/ethnic groups: relevance to BMI" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S.B. Heymseld" 1 => "C.M. Peterson" 2 => "D.M. Thomas" 3 => "H. Moonseong" 4 => "J.M. Schuna" 5 => "S. Hong" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Am J Clin Nutr." "fecha" => "2014" "volumen" => "100" "paginaInicial" => "1455" "paginaFinal" => "1461" ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0090" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "General and abdominal adiposity and risk of death in Europe" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "T. Pischon" 1 => "H. Boeing" 2 => "K. Hoffmann" 3 => "M. Bergmann" 4 => "M.B. Schulze" 5 => "K. Overvad" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMoa0801936" "Revista" => array:5 [ "tituloSerie" => "N Engl J Med." "fecha" => "2008" "volumen" => "359" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18650507" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0923753419404006" "estado" => "S300" "issn" => "09237534" ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0095" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Stature prediction equations for elderly non- Hipanic white, non-Hipanic black, and Mexican-American persons developed from NHANES III data" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "W.C. Chumlea" 1 => "S.S. Guo" 2 => "K. Wholihan" 3 => "D. Cockram" 4 => "R.J. Kuczmarski" 5 => "C.L. Johnson" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0002-8223(98)00036-4" "Revista" => array:7 [ "tituloSerie" => "J Am Diet Assoc." "fecha" => "1998" "volumen" => "98" "paginaInicial" => "137" "paginaFinal" => "142" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12515412" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0140673600020341" "estado" => "S300" "issn" => "01406736" ] ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0100" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Physical status: the use of anthropometry, report of WHO Expert Committee, WHO Technical Report. Series 854" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "WHO" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:3 [ "fecha" => "1995" "editorial" => "WHO" "editorialLocalizacion" => "Geneva" ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0105" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "European practical and patient-centred guidelines for adult obesity management in primary care" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "D. Durrer Schutz" 1 => "L. Busetto" 2 => "D. Dicker" 3 => "N. Farpour-Lambert" 4 => "R. Pryke" 5 => "H. Toplak" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1159/000496183" "Revista" => array:6 [ "tituloSerie" => "Obes Facts." "fecha" => "2019" "volumen" => "12" "paginaInicial" => "40" "paginaFinal" => "66" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30673677" "web" => "Medline" ] ] ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0110" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Comorbidity associated with obesity in a large population: The APNA study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "E. Martin-Rodriguez" 1 => "F. Guillen Grima" 2 => "A. Martí" 3 => "A. Brugos Larumbe" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.orcp.2015.04.003" "Revista" => array:6 [ "tituloSerie" => "Obes Res Clin Pract." "fecha" => "2015" "volumen" => "9" "paginaInicial" => "435" "paginaFinal" => "447" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25979684" "web" => "Medline" ] ] ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib0115" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Obesity and Type 2 diabetes: two diseases with a need for combined treatment strategies – EASO can lead the way" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "D.R. Leitner" 1 => "G. Fruhbeck" 2 => "V. Yumuk" 3 => "K. Schindler" 4 => "D. Micic" 5 => "E. Woodward" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1159/000480525" "Revista" => array:6 [ "tituloSerie" => "Obesity Facts." "fecha" => "2017" "volumen" => "10" "paginaInicial" => "483" "paginaFinal" => "492" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29020674" "web" => "Medline" ] ] ] ] ] ] ] ] 23 => array:3 [ "identificador" => "bib0120" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Obesity and the risk of myocardial infarction in 27,000 participants from 52 countries: a case-control study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S. Yusuf" 1 => "S. Hawken" 2 => "S. Ounpuu" 3 => "L. Bautista" 4 => "M.G. Franzosi" 5 => "P. Commerford" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S0140-6736(05)67663-5" "Revista" => array:6 [ "tituloSerie" => "Lancet." "fecha" => "2005" "volumen" => "366" "paginaInicial" => "1640" "paginaFinal" => "1649" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16271645" "web" => "Medline" ] ] ] ] ] ] ] ] 24 => array:3 [ "identificador" => "bib0125" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Interrelationships between obesity, obstructive sleep apnea syndrome and cardiovascular risk in obese adolescents" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:7 [ 0 => "D. Koren" 1 => "J.A. Chirinos" 2 => "L.E. Katz" 3 => "E.R. Mohler" 4 => "P.R. Gallagher" 5 => "G.F. Mitchell" 6 => "C.L. Marcus" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Int J Obes." "fecha" => "2015" "volumen" => "39" "paginaInicial" => "1086" "paginaFinal" => "1093" ] ] ] ] ] ] 25 => array:3 [ "identificador" => "bib0130" "etiqueta" => "26" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "EASL–EASD–EASO Clinical Practice Guidelines for the management of non-alcoholic fatty liver disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "European Association for the Study of the Liver (EASL)" 1 => "European Association for the Study of Diabetes (EASD)" 2 => "European Association for the Study of Obesity (EASO)" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00125-016-3902-y" "Revista" => array:6 [ "tituloSerie" => "Diabetologia." "fecha" => "2016" "volumen" => "59" "paginaInicial" => "1121" "paginaFinal" => "1140" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27053230" "web" => "Medline" ] ] ] ] ] ] ] ] 26 => array:3 [ "identificador" => "bib0135" "etiqueta" => "27" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "MOSH syndrome (male obesity secondary hypogonadism): clinical assessment and possible therapeutic approaches" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. De Lorenzo" 1 => "A. Noce" 2 => "E. Moriconi" 3 => "T. Rampello" 4 => "G. Marrone" 5 => "N. Di Daniele" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3390/nu10040474" "Revista" => array:5 [ "tituloSerie" => "Nutrients." "fecha" => "2018" "volumen" => "10" "paginaInicial" => "E474" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29649106" "web" => "Medline" ] ] ] ] ] ] ] ] 27 => array:3 [ "identificador" => "bib0140" "etiqueta" => "28" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The dual roles of obesity in chronic kidney disease: A review of the current literature" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "C.M. Rhee" 1 => "S.F. Ahmadi" 2 => "K. Kalantar-Zadeh" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/MNH.0000000000000212" "Revista" => array:6 [ "tituloSerie" => "Curr Opin Nephrol Hypertens." "fecha" => "2016" "volumen" => "25" "paginaInicial" => "208" "paginaFinal" => "216" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26999023" "web" => "Medline" ] ] ] ] ] ] ] ] 28 => array:3 [ "identificador" => "bib0145" "etiqueta" => "29" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "US Preventive Services Task Force. Behavioral weight loss interventions to prevent obesity-related morbidity and mortality in adults: US Preventive Services Task Force Recommendation Statement" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S.J. Curry" 1 => "A.H. Krist" 2 => "D.K. Owens" 3 => "M.J. Barry" 4 => "A.B. Caughey" 5 => "K.W. Davidson" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "JAMA." "fecha" => "2018" "volumen" => "320" "paginaInicial" => "1163" "paginaFinal" => "1171" ] ] ] ] ] ] 29 => array:3 [ "identificador" => "bib0150" "etiqueta" => "30" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Obesity Treatment, Beyond the Guidelines: Practical Suggestions for Clinical Practice" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "S. Kahan" 1 => "J.E. Manson" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "JAMA." "fecha" => "2019" "volumen" => "321" "paginaInicial" => "1349" "paginaFinal" => "1350" ] ] ] ] ] ] 30 => array:3 [ "identificador" => "bib0155" "etiqueta" => "31" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Lifestyle recommendations for the prevention and management of metabolic syndrome: an international panel recommendation" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "P. Pérez-Martínez" 1 => "D.P. Mikhailidis" 2 => "V.G. Athyros" 3 => "M. Bullo" 4 => "P. Couture" 5 => "M.I. Covas" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/nutrit/nux014" "Revista" => array:6 [ "tituloSerie" => "Nutr Rev." "fecha" => "2017" "volumen" => "75" "paginaInicial" => "307" "paginaFinal" => "326" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28521334" "web" => "Medline" ] ] ] ] ] ] ] ] 31 => array:3 [ "identificador" => "bib0160" "etiqueta" => "32" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Obesity: Pathophysiology and Management" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "K.M. Gadde" 1 => "C.K. Martin" 2 => "H.R. Berthoud" 3 => "S.B. Heymsfield" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jacc.2017.11.011" "Revista" => array:6 [ "tituloSerie" => "J Am Coll Cardiol." "fecha" => "2018" "volumen" => "71" "paginaInicial" => "69" "paginaFinal" => "84" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29301630" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/22548874/0000022100000009/v3_202201140544/S2254887421000631/v3_202201140544/en/main.assets" "Apartado" => array:4 [ "identificador" => "1901" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Original Articles" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/22548874/0000022100000009/v3_202201140544/S2254887421000631/v3_202201140544/en/main.pdf?idApp=WRCEE&text.app=https://revclinesp.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2254887421000631?idApp=WRCEE"]

Statistics

Original article

Obesity is a chronic disease. Positioning statement of the Diabetes, Obesity and Nutrition Workgroup of the Spanish Society of Internal Medicine (SEMI) for an approach centred on individuals with obesity

La obesidad es una enfermedad crónica. Posicionamiento del grupo de trabajo de Diabetes, Obesidad y Nutrición de la Sociedad Española de Medicina Interna (SEMI) por un abordaje centrado en la persona con obesidad

J. Carretero Gómeza,

Corresponding author

juanicarretero@gmail.com

Corresponding author.

, J. Enab, J.C. Arévalo Loridoa, J.M. Seguí Ripollc, F.J. Carrasco-Sánchezd, R. Gómez-Huelgase, M.I. Pérez Sotof, J. Delgado Listag, P. Pérez Martínezh, on behalf of the Diabetes, Obesity and Nutrition Workgroup of the Spanish Society of Internal Medicine

a Servicio de Medicina Interna, Hospital de Zafra, Badajoz, Spain

b Servicio de Medicina Interna, Hospital de la Marina Baixa, Alicante, Spain

c Servicio de Medicina Interna, Hospital Universitario San Juan de Alicante, Alicante, Spain

d Servicio de Medicina Interna, Hospital Universitario Juan Ramón Jiménez, Huelva, Spain

e Servicio de Medicina Interna, Hospital Regional Universitario de Málaga, Málaga. Instituto de Investigación Biomédica de Málaga Institute of Biomedical (IBIMA), CIBER Physiopathology of Obesity and Nutrition – CIBERobn

f Servicio de Medicina Interna, Hospital Universitario de Vinalopó, Elche, Alicante, Spain

g Servicio de Medicina Interna, Hospital Universitario Reina Sofía/Universidad de Córdoba/Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain

h Unidad de Lípidos y Arterioesclerosis, Hospital Universitario Reina Sofía/Universidad de Córdoba/Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba. CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain

Read

Times
was read the article

Total PDF

Total HTML

Share statistics

 array:24 [
  "pii" => "S2254887421000631"
  "issn" => "22548874"
  "doi" => "10.1016/j.rceng.2020.06.013"
  "estado" => "S300"
  "fechaPublicacion" => "2021-11-01"
  "aid" => "1889"
  "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46; and Sociedad Espa&#241;ola de Medicina Interna &#40;SEMI&#41;"
  "copyrightAnyo" => "2020"
  "documento" => "article"
  "crossmark" => 1
  "subdocumento" => "fla"
  "cita" => "Rev Clin Esp. 2021;221:509-16"
  "abierto" => array:3 [
    "ES" => false
    "ES2" => false
    "LATM" => false
  ]
  "gratuito" => false
  "lecturas" => array:1 [
    "total" => 0
  ]
  "Traduccion" => array:1 [
    "es" => array:19 [
      "pii" => "S0014256520301806"
      "issn" => "00142565"
      "doi" => "10.1016/j.rce.2020.06.008"
      "estado" => "S300"
      "fechaPublicacion" => "2021-11-01"
      "aid" => "1889"
      "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46; and Sociedad Espa&#241;ola de Medicina Interna &#40;SEMI&#41;"
      "documento" => "article"
      "crossmark" => 1
      "subdocumento" => "fla"
      "cita" => "Rev Clin Esp. 2021;221:509-16"
      "abierto" => array:3 [
        "ES" => false
        "ES2" => false
        "LATM" => false
      ]
      "gratuito" => false
      "lecturas" => array:1 [
        "total" => 0
      ]
      "es" => array:13 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Original</span>"
        "titulo" => "La obesidad es una enfermedad cr&#243;nica&#46; Posicionamiento del grupo de trabajo de Diabetes&#44; Obesidad y Nutrici&#243;n de la Sociedad Espa&#241;ola de Medicina Interna &#40;SEMI&#41; por un abordaje centrado en la persona con obesidad"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "tieneResumen" => array:2 [
          0 => "es"
          1 => "en"
        ]
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "509"
            "paginaFinal" => "516"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Obesity is a chronic disease&#46; Positioning statement of the Diabetes&#44; Obesity and Nutrition Workgroup of the Spanish Society of Internal Medicine &#40;SEMI&#41; for an approach centred on individuals with obesity"
          ]
        ]
        "contieneResumen" => array:2 [
          "es" => true
          "en" => true
        ]
        "contieneTextoCompleto" => array:1 [
          "es" => true
        ]
        "contienePdf" => array:1 [
          "es" => true
        ]
        "resumenGrafico" => array:2 [
          "original" => 0
          "multimedia" => array:7 [
            "identificador" => "fig0010"
            "etiqueta" => "Figura 2"
            "tipo" => "MULTIMEDIAFIGURA"
            "mostrarFloat" => true
            "mostrarDisplay" => false
            "figura" => array:1 [
              0 => array:4 [
                "imagen" => "gr2.jpeg"
                "Alto" => 2010
                "Ancho" => 2925
                "Tamanyo" => 471641
              ]
            ]
            "descripcion" => array:1 [
              "es" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Dec&#225;logo de posicionamiento de la SEMI para un abordaje de la obesidad centrado en la persona&#46;</p>"
            ]
          ]
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "J&#46; Carretero G&#243;mez, J&#46; Ena, J&#46;C&#46; Ar&#233;valo Lorido, J&#46;M&#46; Segu&#237; Ripoll, F&#46;J&#46; Carrasco-S&#225;nchez, R&#46; G&#243;mez-Huelgas, M&#46;I&#46; P&#233;rez Soto, J&#46; Delgado Lista, P&#46; P&#233;rez Mart&#237;nez"
            "autores" => array:10 [
              0 => array:2 [
                "nombre" => "J&#46;"
                "apellidos" => "Carretero G&#243;mez"
              ]
              1 => array:2 [
                "nombre" => "J&#46;"
                "apellidos" => "Ena"
              ]
              2 => array:2 [
                "nombre" => "J&#46;C&#46;"
                "apellidos" => "Ar&#233;valo Lorido"
              ]
              3 => array:2 [
                "nombre" => "J&#46;M&#46;"
                "apellidos" => "Segu&#237; Ripoll"
              ]
              4 => array:2 [
                "nombre" => "F&#46;J&#46;"
                "apellidos" => "Carrasco-S&#225;nchez"
              ]
              5 => array:2 [
                "nombre" => "R&#46;"
                "apellidos" => "G&#243;mez-Huelgas"
              ]
              6 => array:2 [
                "nombre" => "M&#46;I&#46;"
                "apellidos" => "P&#233;rez Soto"
              ]
              7 => array:2 [
                "nombre" => "J&#46;"
                "apellidos" => "Delgado Lista"
              ]
              8 => array:2 [
                "nombre" => "P&#46;"
                "apellidos" => "P&#233;rez Mart&#237;nez"
              ]
              9 => array:1 [
                "colaborador" => "en representaci&#243;n del grupo de trabajo de Diabetes&#44; Obesidad y Nutrici&#243;n de la Sociedad Espa&#241;ola de Medicina Interna"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S2254887421000631"
          "doi" => "10.1016/j.rceng.2020.06.013"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => false
            "ES2" => false
            "LATM" => false
          ]
          "gratuito" => false
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2254887421000631?idApp=WRCEE"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0014256520301806?idApp=WRCEE"
      "url" => "/00142565/0000022100000009/v2_202112250543/S0014256520301806/v2_202112250543/es/main.assets"
    ]
  ]
  "itemSiguiente" => array:19 [
    "pii" => "S2254887421000588"
    "issn" => "22548874"
    "doi" => "10.1016/j.rceng.2019.12.015"
    "estado" => "S300"
    "fechaPublicacion" => "2021-11-01"
    "aid" => "1806"
    "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46; and Sociedad Espa&#241;ola de Medicina Interna &#40;SEMI&#41;"
    "documento" => "article"
    "crossmark" => 1
    "subdocumento" => "fla"
    "cita" => "Rev Clin Esp. 2021;221:517-28"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:1 [
      "total" => 0
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>"
      "titulo" => "Use of antihyperglycaemic therapy with cardiovascular benefit in patients with type 2 diabetes who require hospitalisation&#58; A cross-sectional study"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "517"
          "paginaFinal" => "528"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Uso de terapia antihiperglucemiante con beneficio cardiovascular en pacientes con diabetes tipo 2 que requieren hospitalizaci&#243;n&#58; un estudio transversal"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:8 [
          "identificador" => "fig0010"
          "etiqueta" => "Figure 2"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr2.jpeg"
              "Alto" => 974
              "Ancho" => 1764
              "Tamanyo" => 115054
            ]
          ]
          "detalles" => array:1 [
            0 => array:3 [
              "identificador" => "at0010"
              "detalle" => "Figure "
              "rol" => "short"
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Flowchart of patients who received treatment with AR-GLP1&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "J&#46; Ena, J&#46; Carretero-G&#243;mez, A&#46; Zapatero-Gaviria, F&#46;J&#46; Carrasco-S&#225;nchez, M&#46; del Romero-S&#225;nchez, C&#46; Gonz&#225;lez-Becerra, J&#46;C&#46; Blazquez-Encinar, M&#46;J&#46; Iguzquiza-Pellejero, B&#46; de Escalante Yang&#252;ela, R&#46; G&#243;mez-Huelgas"
          "autores" => array:11 [
            0 => array:2 [
              "nombre" => "J&#46;"
              "apellidos" => "Ena"
            ]
            1 => array:2 [
              "nombre" => "J&#46;"
              "apellidos" => "Carretero-G&#243;mez"
            ]
            2 => array:2 [
              "nombre" => "A&#46;"
              "apellidos" => "Zapatero-Gaviria"
            ]
            3 => array:2 [
              "nombre" => "F&#46;J&#46;"
              "apellidos" => "Carrasco-S&#225;nchez"
            ]
            4 => array:2 [
              "nombre" => "M&#46;"
              "apellidos" => "del Romero-S&#225;nchez"
            ]
            5 => array:2 [
              "nombre" => "C&#46;"
              "apellidos" => "Gonz&#225;lez-Becerra"
            ]
            6 => array:2 [
              "nombre" => "J&#46;C&#46;"
              "apellidos" => "Blazquez-Encinar"
            ]
            7 => array:2 [
              "nombre" => "M&#46;J&#46;"
              "apellidos" => "Iguzquiza-Pellejero"
            ]
            8 => array:2 [
              "nombre" => "B&#46;"
              "apellidos" => "de Escalante Yang&#252;ela"
            ]
            9 => array:2 [
              "nombre" => "R&#46;"
              "apellidos" => "G&#243;mez-Huelgas"
            ]
            10 => array:1 [
              "colaborador" => "on behalf of the Spanish Society for Internal Medicine Diabetes&#44; Obesity&#44; and Nutrition Workgroup"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S001425652030059X"
        "doi" => "10.1016/j.rce.2019.12.009"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => false
          "ES2" => false
          "LATM" => false
        ]
        "gratuito" => false
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S001425652030059X?idApp=WRCEE"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2254887421000588?idApp=WRCEE"
    "url" => "/22548874/0000022100000009/v3_202201140544/S2254887421000588/v3_202201140544/en/main.assets"
  ]
  "itemAnterior" => array:19 [
    "pii" => "S225488742100062X"
    "issn" => "22548874"
    "doi" => "10.1016/j.rceng.2020.04.013"
    "estado" => "S300"
    "fechaPublicacion" => "2021-11-01"
    "aid" => "1848"
    "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46; and Sociedad Espa&#241;ola de Medicina Interna &#40;SEMI&#41;"
    "documento" => "article"
    "crossmark" => 1
    "subdocumento" => "fla"
    "cita" => "Rev Clin Esp. 2021;221:497-508"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:1 [
      "total" => 0
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>"
      "titulo" => "Assessment of the quality of antibiotics prescription in a regional health system"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "497"
          "paginaFinal" => "508"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Evaluaci&#243;n de la calidad de la prescripci&#243;n de antibi&#243;ticos en un sistema regional de salud"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0025"
          "etiqueta" => "Fig&#46; 5"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr5.jpeg"
              "Alto" => 1760
              "Ancho" => 2412
              "Tamanyo" => 375827
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">Cost &#40;&#8364;&#47;DDD&#41; per active ingredient and use &#40;DID&#41; by contribution groups&#46;</p> <p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">J01CA &#40;penicillins&#41;&#58; includes amoxicillin &#40;J01CA04&#41; and ampicillin &#40;J01CA01&#41;&#46; J01CR &#40;combinations of penicillins&#41;&#58; includes amoxicillin and beta-lactamase inhibitors &#40;J01CR02&#41;&#46; Prescription quality evaluation parameters&#58; &#40;&#60;14&#46;42&#37;&#41; dark green &#8220;very high&#8221;&#59; &#40;14&#46;42&#8211;22&#46;70&#37;&#41; light green &#8220;high&#8221;&#59; &#40;22&#46;71&#8211;33&#46;98&#37;&#41; yellow &#8220;low&#8221;&#59; &#40;&#62;33&#46;98&#37;&#41; red &#8220;very low&#8221;&#46;</p> <p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">J01MA &#40;fluoroquinolones&#41;&#58; includes ciprofloxacin &#40;J01MA02&#41;&#44; levofloxacin &#40;J01MA12&#41;&#44; moxifloxacin &#40;J01MA14&#41; and norfloxacin &#40;J01MA06&#41;&#46; Prescription quality evaluation parameters &#40;&#60;4&#46;82&#37;&#41; dark green &#8220;very high&#8221;&#59; &#40;4&#46;82&#8211;7&#46;28&#37;&#41; light green &#8220;high&#8221;&#59; &#40;7&#46;29&#8211;9&#46;06&#37;&#41; yellow &#8220;low&#8221;&#59; &#40;&#62;9&#46;06&#37;&#41; red &#8220;very low&#8221;&#46; J01FA &#40;macrolides&#41;&#58; includes azithromycin &#40;J01FA10&#41;&#44; clarithromycin &#40;J01FA09&#41;&#44; erythromycin &#40;J01FA01&#41; and spiramycin &#40;J01FA02&#41;&#46;</p> <p id="spar0105" class="elsevierStyleSimplePara elsevierViewall">J01DD &#40;third generation cephalosporins&#41;&#58; includes cefditoren &#40;J01DD16&#41; and cefixime &#40;J01DD08&#41;&#46; Prescription quality evaluation parameters &#40;&#60;0&#46;04&#37;&#41; dark green &#8220;very high&#8221;&#59; &#40;0&#46;04&#8211;0&#46;51&#37;&#41; light green &#8220;high&#8221;&#59; &#40;0&#46;52&#8211;1&#46;88&#37;&#41; yellow &#8220;low&#8221;&#59; &#40;&#62;1&#46;88&#37;&#41; red &#8220;very low&#8221;&#46;</p> <p id="spar0110" class="elsevierStyleSimplePara elsevierViewall">J01XX &#40;others antibacterials&#41;&#58; includes fosfomycin &#40;J01XX01&#41;&#46;</p> <p id="spar0115" class="elsevierStyleSimplePara elsevierViewall">&#42;Significant differences compared to the other TSI groups with a significance level of <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;020&#46;</p> <p id="spar0120" class="elsevierStyleSimplePara elsevierViewall">&#42;&#42;Significant differences compared to the other TSI groups with a significance level of <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;051&#46;</p> <p id="spar0125" class="elsevierStyleSimplePara elsevierViewall">&#42;&#42;&#42;Significant differences compared to the other TSI groups with a significance level of <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;024&#46;</p> <p id="spar0130" class="elsevierStyleSimplePara elsevierViewall">&#42;&#42;&#42;&#42;Significant differences compared to the other TSI groups with a significance level of <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;053&#46;</p> <p id="spar0135" class="elsevierStyleSimplePara elsevierViewall">Own draft based on Coenen et al&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">11</span></a></p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "P&#46; Rojas Garc&#237;a, F&#46; Anto&#241;anzas Villar"
          "autores" => array:2 [
            0 => array:2 [
              "nombre" => "P&#46;"
              "apellidos" => "Rojas Garc&#237;a"
            ]
            1 => array:2 [
              "nombre" => "F&#46;"
              "apellidos" => "Anto&#241;anzas Villar"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S0014256520301272"
        "doi" => "10.1016/j.rce.2020.04.015"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => false
          "ES2" => false
          "LATM" => false
        ]
        "gratuito" => false
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0014256520301272?idApp=WRCEE"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S225488742100062X?idApp=WRCEE"
    "url" => "/22548874/0000022100000009/v3_202201140544/S225488742100062X/v3_202201140544/en/main.assets"
  ]
  "en" => array:21 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn"><span class="elsevierStyleSup">Original article</span></span>"
    "titulo" => "Obesity is a chronic disease&#46; Positioning statement of the Diabetes&#44; Obesity and Nutrition Workgroup of the Spanish Society of Internal Medicine &#40;SEMI&#41; for an approach centred on individuals with obesity"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "509"
        "paginaFinal" => "516"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "J&#46; Carretero G&#243;mez, J&#46; Ena, J&#46;C&#46; Ar&#233;valo Lorido, J&#46;M&#46; Segu&#237; Ripoll, F&#46;J&#46; Carrasco-S&#225;nchez, R&#46; G&#243;mez-Huelgas, M&#46;I&#46; P&#233;rez Soto, J&#46; Delgado Lista, P&#46; P&#233;rez Mart&#237;nez"
        "autores" => array:10 [
          0 => array:4 [
            "nombre" => "J&#46;"
            "apellidos" => "Carretero G&#243;mez"
            "email" => array:1 [
              0 => "juanicarretero@gmail.com"
            ]
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "&#42;"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "J&#46;"
            "apellidos" => "Ena"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "J&#46;C&#46;"
            "apellidos" => "Ar&#233;valo Lorido"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          3 => array:3 [
            "nombre" => "J&#46;M&#46;"
            "apellidos" => "Segu&#237; Ripoll"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "aff0015"
              ]
            ]
          ]
          4 => array:3 [
            "nombre" => "F&#46;J&#46;"
            "apellidos" => "Carrasco-S&#225;nchez"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">d</span>"
                "identificador" => "aff0020"
              ]
            ]
          ]
          5 => array:3 [
            "nombre" => "R&#46;"
            "apellidos" => "G&#243;mez-Huelgas"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">e</span>"
                "identificador" => "aff0025"
              ]
            ]
          ]
          6 => array:3 [
            "nombre" => "M&#46;I&#46;"
            "apellidos" => "P&#233;rez Soto"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">f</span>"
                "identificador" => "aff0030"
              ]
            ]
          ]
          7 => array:3 [
            "nombre" => "J&#46;"
            "apellidos" => "Delgado Lista"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">g</span>"
                "identificador" => "aff0035"
              ]
            ]
          ]
          8 => array:3 [
            "nombre" => "P&#46;"
            "apellidos" => "P&#233;rez Mart&#237;nez"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">h</span>"
                "identificador" => "aff0040"
              ]
            ]
          ]
          9 => array:1 [
            "colaborador" => "on behalf of the Diabetes&#44; Obesity and Nutrition Workgroup of the Spanish Society of Internal Medicine"
          ]
        ]
        "afiliaciones" => array:8 [
          0 => array:3 [
            "entidad" => "Servicio de Medicina Interna&#44; Hospital de Zafra&#44; Badajoz&#44; Spain"
            "etiqueta" => "a"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Servicio de Medicina Interna&#44; Hospital de la Marina Baixa&#44; Alicante&#44; Spain"
            "etiqueta" => "b"
            "identificador" => "aff0010"
          ]
          2 => array:3 [
            "entidad" => "Servicio de Medicina Interna&#44; Hospital Universitario San Juan de Alicante&#44; Alicante&#44; Spain"
            "etiqueta" => "c"
            "identificador" => "aff0015"
          ]
          3 => array:3 [
            "entidad" => "Servicio de Medicina Interna&#44; Hospital Universitario Juan Ram&#243;n Jim&#233;nez&#44; Huelva&#44; Spain"
            "etiqueta" => "d"
            "identificador" => "aff0020"
          ]
          4 => array:3 [
            "entidad" => "Servicio de Medicina Interna&#44; Hospital Regional Universitario de M&#225;laga&#44; M&#225;laga&#46; Instituto de Investigaci&#243;n Biom&#233;dica de M&#225;laga Institute of Biomedical &#40;IBIMA&#41;&#44; CIBER Physiopathology of Obesity and Nutrition &#8211; CIBERobn"
            "etiqueta" => "e"
            "identificador" => "aff0025"
          ]
          5 => array:3 [
            "entidad" => "Servicio de Medicina Interna&#44; Hospital Universitario de Vinalop&#243;&#44; Elche&#44; Alicante&#44; Spain"
            "etiqueta" => "f"
            "identificador" => "aff0030"
          ]
          6 => array:3 [
            "entidad" => "Servicio de Medicina Interna&#44; Hospital Universitario Reina Sof&#237;a&#47;Universidad de C&#243;rdoba&#47;Instituto Maim&#243;nides de Investigaci&#243;n Biom&#233;dica de C&#243;rdoba &#40;IMIBIC&#41;&#44; C&#243;rdoba&#44; CIBER Fisiopatolog&#237;a de la Obesidad y Nutrici&#243;n &#40;CIBEROBN&#41;&#44; Instituto de Salud Carlos III&#44; Madrid&#44; Spain"
            "etiqueta" => "g"
            "identificador" => "aff0035"
          ]
          7 => array:3 [
            "entidad" => "Unidad de L&#237;pidos y Arterioesclerosis&#44; Hospital Universitario Reina Sof&#237;a&#47;Universidad de C&#243;rdoba&#47;Instituto Maim&#243;nides de Investigaci&#243;n Biom&#233;dica de C&#243;rdoba &#40;IMIBIC&#41;&#44; C&#243;rdoba&#46; CIBER Fisiopatolog&#237;a de la Obesidad y Nutrici&#243;n &#40;CIBEROBN&#41;&#44; Instituto de Salud Carlos III&#44; Madrid&#44; Spain"
            "etiqueta" => "h"
            "identificador" => "aff0040"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "La obesidad es una enfermedad cr&#243;nica&#46; Posicionamiento del grupo de trabajo de Diabetes&#44; Obesidad y Nutrici&#243;n de la Sociedad Espa&#241;ola de Medicina Interna &#40;SEMI&#41; por un abordaje centrado en la persona con obesidad"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:8 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1864
            "Ancho" => 3333
            "Tamanyo" => 328074
          ]
        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0005"
            "detalle" => "Figure "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Attitude towards anthropometric measurements&#46; Pie chart of variable percentages&#58; weight&#44; BMI&#44; AC&#44; data included in the MH&#44; obesity included in diagnoses&#44; obesity classified in degrees&#46;</p> <p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">AC&#58; abdominal circumference&#59; BMI&#58; body mass index&#59; MH&#58; medical history&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Obesity is a chronic&#44; complex&#44; and multifactorial metabolic disease&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Its prevalence has tripled in recent decades&#44; approaching 20&#37; of the global population&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> The rate in Spain is about 23&#37;&#44; similar to that seen in Internal Medicine departments &#40;23&#46;6&#37;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Most epidemiological studies use the body mass index &#40;BMI&#41; &#40;weight&#47;height<span class="elsevierStyleSup">2</span>&#44; kg&#47;m<span class="elsevierStyleSup">2</span>&#41; to classify this entity&#59;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> individuals over the age of 18&#8239;years with a BMI&#8239;&#8805;&#8239;30&#8239;kg&#47;m<span class="elsevierStyleSup">2</span> are considered to have obesity&#46; However&#44; obesity is also defined as an excess of body fat greater than 25&#37; in men and 30&#37; in women that is significant enough to cause increased morbidity and mortality&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The current trend is to conceive of obesity as a clinical condition associated with other pathologies rather than a disease in and of itself&#44; which leads to it being under-diagnosed and under-treated&#46; Likewise&#44; obesity plays an essential role in the development of other noncommunicable chronic diseases such as type 2 diabetes mellitus &#40;T2D&#41;&#44; dyslipidaemia&#44; high blood pressure &#40;HTN&#41;&#44; cardiovascular diseases &#40;CVDs&#41;&#44; and cancer&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">All of the above&#44; together with advances in knowledge&#44; leads us to consider obesity a chronic disease that requires a comprehensive approach that is sustained over time&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;6</span></a> Nevertheless&#44; as internists we encounter significant obstacles when dealing with this entity&#44; including a lack of knowledge of the complexity and chronic and recurrent nature of obesity&#59; lack of training and time&#59; or prioritising the management of other associated comorbid conditions&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">In this scenario&#44; care for individuals with obesity needs to become an essential part of the comprehensive vision that internal medicine uses to view ill people&#46; The aim of this document is to present the level of understanding and sensitivity of internists towards obesity and to draft a consensus document from the Spanish Society of Internal Medicine &#40;SEMI&#41; with recommendations based on the available scientific evidence and the opinions of its members&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material and methods</span><p id="par0030" class="elsevierStylePara elsevierViewall">With the aim of discovering the understanding and sensitivity of internists towards obesity&#44; we drafted and distributed an online survey to SEMI members&#46; After analysing the responses&#44; a SWOT analysis was performed that was later discussed by a panel of expert internists&#46; Lastly&#44; recommendations were drafted in a third round&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Survey</span><p id="par0035" class="elsevierStylePara elsevierViewall">In September 2019&#44; an opinion survey with 31 close-ended questions was written&#46; The survey was divided into 4 parts &#40;see Appendix A Additional material&#41;&#58; the first part was related to the sociodemographic data of the respondents&#59; the second referred specifically to the availability of materials for evaluating obesity levels &#40;scale&#44; stadiometer&#44; body tape measure&#41; both in the clinic and ward&#59; the third addressed the internists&#8217; attitudes towards individuals with obesity and the role of internal medicine in managing obesity&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Internist opinions</span><p id="par0040" class="elsevierStylePara elsevierViewall">In October 2019&#44; the online survey was sent to SEMI members&#46; After analysing the responses&#44; a SWOT analysis was completed&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Panel of experts</span><p id="par0045" class="elsevierStylePara elsevierViewall">The discussion process was held throughout January 2020&#46; Fifteen expert internists from the SEMI Diabetes&#44; Obesity&#44; and Nutrition Workgroup were invited to participate&#46; The 15 experts were selected for their interest and experience in the field of obesity&#44; T2D&#44; and vascular risk &#40;VR&#41;&#44; in an attempt to ensure a wide range representing the diverse fields and types of clinical practice&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Seven expert internists accepted the offer to participate in the discussion&#59; eight did not respond and did not express interest in participating in the process or allege any conflicts of interest or ethics&#46; The panellists received the results of the survey and SWOT analysis in addition to the first version of the recommendations document&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">As a consensus method&#44; in this case we used a &#8220;modified Delphi method&#8221; consensus tool known as the Nominal Group Technique &#40;NGT&#41; modified via the online discussion&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> This modified process allows for both expression of personal opinion and interaction and debate among the panel members&#58; it makes it possible to reach a consensus without forcing this and to identify areas of uncertainty with the goal of providing additional information on the regular clinical practice of each panellist in this clinical setting&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9&#8211;11</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">Each expert received two documents&#58; one document with the survey and SWOT analysis results&#44; and a second document with ten main ideas based on the former for them to work on&#46; In the second round&#44; each expert sent their preferences &#40;agree&#44; unsure&#44; or disagree&#41; and an initial rough draft was created with the 13 recommendations&#46; In a third discussion&#44; each expert once again reviewed and provided their areas of agreement&#44; uncertainty&#44; and dissent&#46; Lastly&#44; the clinical recommendations were drafted with the panellists&#8217; consensus&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Statistical analysis</span><p id="par0065" class="elsevierStylePara elsevierViewall">The quantitative variables are expressed in means and standard deviation&#46; The qualitative variables are expressed in absolute numbers and percentages&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">The sample has been divided according to hospital size&#44; and the differences between the analysed variables&#44; all of which were qualitative&#44; were analysed using the Chi-squared test&#46; A <span class="elsevierStyleItalic">p</span> value of &#8239;&#60;&#8239;0&#46;05 was considered significant&#46; The R statistical program version 3&#46;6&#46;1 &#40;2019-07-05&#41; was used - Action of the Toes &#40;Copyright&#169;2019&#46; The R Foundation for Statistical Computing Platform&#41;&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Results</span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Survey</span><p id="par0075" class="elsevierStylePara elsevierViewall">A total of 599 responses where obtained&#46; Mean participant age was 44&#46;4 &#40;11&#41; years&#59; 52&#46;1&#37; were women&#44; 151 &#40;252&#37;&#41; were resident medical interns &#40;MIR&#41;&#46; The mean number of years practising medicine was 17&#46;2 &#40;11&#41; years&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Some 67&#46;9&#37; of survey respondents worked in first and second-level hospitals &#40;30&#46;4&#37; and 37&#46;5&#37;&#44; respectively&#41;&#46; The preferred area of work was admissions &#40;77&#46;1&#37;&#41;&#44; followed by out-patient &#40;20&#37;&#41; and cross-consultation services &#40;2&#46;8&#37;&#41;&#46; A total of 38&#46;4&#37; &#40;n&#8239;&#61;&#8239;230&#41; of the respondents had a specialized consultation unit&#58; VR 74&#46;3&#37;&#44; T2D 17&#46;4&#37;&#44; and obesity 8&#46;3&#37;&#46; A total of 92&#46;8&#37; of the respondents had a scale in their clinic&#44; 85&#46;6&#37; a stadiometer&#44; and 59&#46;8&#37; a body tape measure&#46; <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a> details some results from the third part of the survey&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">Once a diagnosis is made&#44; the majority of internists &#40;70&#46;9&#37;&#41; provided instructions on lifestyle modifications&#46; Of the rest&#44; 3&#46;6&#37; did not take any specific measurements&#59; 12&#37; provided the patient with a standard diet&#59; 3&#46;6&#37; sent the patients to an endocrinologist&#59; and 9&#46;6&#37; to a dietitian&#46; This attitude differed according to the respondent&#8217;s workplace &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0090" class="elsevierStylePara elsevierViewall">Some 91&#46;8&#37; of the respondents evaluated patients to rule out comorbidities associated with obesity&#44; mainly those considered &#8220;metabolic&#8221;&#44; such as&#58; T2D &#40;96&#46;2&#37;&#41;&#44; CVD &#40;88&#46;9&#37;&#41;&#44; obesity hypoventilation syndrome &#40;OHS&#41; &#40;73&#37;&#41;&#44; non-alcoholic fatty liver disease &#40;65&#46;3&#37;&#41;&#44; kidney disease via albumin&#47;creatinine ratio &#40;UAR&#41; &#40;65&#46;3&#37;&#41;&#44; and others such as hypogonadism &#40;6&#46;9&#37;&#41;&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Lastly&#44; in terms of the last part of the survey&#44; 64&#46;1&#37; of the internists were aware of the drugs that are currently indicated for obesity treatment &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41; and 39&#46;7&#37; had used them at some point&#46; A total of 74&#46;9&#37; were familiar with the indications for bariatric surgery &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46; Some 93&#46;8&#37; and 83&#37; of the respondents considered obesity and overweight to be&#44; respectively&#44; a chronic disease&#46; Some 88&#46;7&#37; thought that obesity is a disease proper to internists and they should play an active and leading role in treating it &#40;85&#46;3&#37;&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall">With these results&#44; a SWOT analysis was performed with the starting situation to draft our recommendations&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Among the weaknesses &#40;W&#41;&#44; we must highlight the sparse knowledge and use of anti-obesity drugs and the indications for bariatric surgery&#59; poor exclusive dedication &#40;&#60;20&#37;&#41; of internists to out-patient services and of these&#44; only 50&#37; to specialized consultation units&#59; in the same manner&#44; little interest in measuring abdominal circumference&#44; or in referring to endocrinology or dietetics&#46; In terms of hospitalised patients&#44; it is worth highlighting the little interest in knowing their BMI&#44; perhaps due to the limitations of mobilising patients admitted to internal medicine&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">In terms of threats &#40;T&#41;&#44; we must highlight the high risk of internist&#39;s space in the health system being occupied by other specialties that are more exclusively dedicated to out-patient services&#44; particularly in hospitals offering first and second-level care&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">As part of our strengths &#40;S&#41;&#44; a large majority of those surveyed recognise obesity and overweight as a disease and can understand and rule out associated comorbidities&#46; Of the responses&#44; the larger proportion was from first and second-level hospitals&#44; regional hospitals where internists play a central role in caring for admitted patients&#44; and out-patient services&#46; What&#8217;s more&#44; as can be seen in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#44; more attention is dedicated to promoting a healthy lifestyle in these hospitals&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Lastly&#44; regarding opportunities &#40;O&#41;&#44; we identified the perception of obesity as a chronic disease&#44; which falls within the internist&#39;s fields of work&#44; such as the care of people with chronic diseases&#46; As previously mentioned&#44; there was a large percentage of responses from first and second-level hospitals&#44; a significant point when increasing the presence of specialized consultation units in these types of hospitals&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Areas for improvement include the need for internists to receive patient-centred obesity training&#44; nutrition recommendations&#44; and the creation diets in first and second-level hospitals that lack dietitians&#47;nutritionists and anti-obesity pharmacology&#46;</p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Discussion</span><p id="par0130" class="elsevierStylePara elsevierViewall">The consensus methods used in clinical research are aimed at problem-solving&#44; idea generation&#44; and the setting of priorities&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> One of the strengths of these consensus methods is the balanced participation of group members&#44; which controls and minimises the risk of one or some participants predominating over others&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a></p><p id="par0135" class="elsevierStylePara elsevierViewall">Taking into consideration&#44; on the one hand&#44; the responses from the surveyed internists and&#44; on the other&#44; the points brought up through the expert discussion process&#44; the SEMI Diabetes&#44; Obesity&#44; and Nutrition Workgroup drafted a list of ten points with no other aim than to provide a positioning statement for a patient-centred approach to obesity &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">1</span><p id="par0140" class="elsevierStylePara elsevierViewall">Obesity is a complex chronic disease<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> that requires a multidisciplinary approach wherein internal medicine doctors play an important role&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">2</span><p id="par0145" class="elsevierStylePara elsevierViewall">Obesity is a pressing problem for public health and addressing this issue transcends the health setting&#44; requiring the involvement of political authorities and civil society&#46; Fighting against social&#44; economic&#44; and cultural inequalities is key to a successful approach&#46;<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">14&#44;15</span></a></p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">3</span><p id="par0150" class="elsevierStylePara elsevierViewall">Each individual with obesity is different&#46; Therefore&#44; we need a holistic and individualised approach that is centred around the patient&#46;<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a></p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">4</span><p id="par0155" class="elsevierStylePara elsevierViewall">Weighing&#44; calculating body mass index &#40;BMI&#41;&#44; and measuring abdominal circumference &#40;AC&#41; of all patients seen in out-patient services is recommended&#59; this is also recommended for hospitalised patients whenever possible &#40;either directly or using alternative formulas to this end&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">17&#8211;19</span></a></p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">5</span><p id="par0160" class="elsevierStylePara elsevierViewall">During patient diagnosis&#44; it is necessary to include overweight and obesity in their different degrees according to the World Health Organization &#40;WHO&#41; classification&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a></p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">6</span><p id="par0165" class="elsevierStylePara elsevierViewall">It is important to ensure early detection of the main comorbidities associated with overweight and obesity&#44; both metabolic and non-metabolic&#44; that negatively impact quality of life&#58; type 2 diabetes&#44; cardiovascular disease&#44; sleep apnoea&#47;hypopnea syndrome&#44; chronic kidney disease&#47;albuminuria&#44; non-alcoholic fatty liver disease&#44; osteoarthritis&#44; infertility or hypogonadism&#44; gastroesophageal reflux disease&#44; and depression syndrome&#44; among others&#46;<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">21&#8211;28</span></a></p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">7</span><p id="par0170" class="elsevierStylePara elsevierViewall">Modifying eating habits and encouraging a healthy lifestyle that includes regular physical exercise should be the central pillar around which treatment for overweight and obesity revolves&#46;<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">29&#44;30</span></a></p></li><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">8</span><p id="par0175" class="elsevierStylePara elsevierViewall">All patients diagnosed with overweight&#44; particularly those with multiple cardiovascular or obesity risk factors&#44; need to receive quality information about eating habit modification and healthy lifestyle&#44; including professional nutrition counselling depending on their motivation and the available options in each health area&#44; thereby establishing the necessary course of action for referral to a qualified professional&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">31</span></a></p></li><li class="elsevierStyleListItem" id="lsti0045"><span class="elsevierStyleLabel">9</span><p id="par0180" class="elsevierStylePara elsevierViewall">All internists&#44; particularly those working in out-patient services and who treat patients with obesity&#44; must be familiar with the drugs that are currently available for treating obesity and their indications&#44; as well as the indication criteria for bariatric surgery or metabolic surgery&#46; Additionally&#44; they should provide patients with information about these therapeutic options when indicated<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">32</span></a> &#40;<a class="elsevierStyleCrossRefs" href="#tbl0010">Tables 2 and 3</a>&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0050"><span class="elsevierStyleLabel">10</span><p id="par0185" class="elsevierStylePara elsevierViewall">Given the significance of obesity as one of the top health concerns&#44; the SEMI believes that the pharmacological treatments currently authorised for use against this entity should be funded according to the instructions agreed on by the various scientific societies and the Ministry of Health&#44; Consumer Affairs&#44; and Social Welfare based on the available scientific evidence&#46;</p></li></ul></p><elsevierMultimedia ident="fig0010"></elsevierMultimedia></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Conclusion</span><p id="par0190" class="elsevierStylePara elsevierViewall">Obesity is a chronic&#44; complex&#44; and multifactorial metabolic disease of epidemic scale around the globe&#46; The perspective of obesity as a clinical condition associated with other comorbidities rather than being the actual cause leads it to be frequently underdiagnosed and undertreated&#46; Obesity is the main risk factor for developing non-communicable diseases&#44; which determines increased multimorbidity of individuals and a decline in quality of life&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall">As a specialty with a comprehensive vision&#44; Internal Medicine cannot be indifferent to this reality&#46; The aim of this document is to present the level of understanding and sensitivity of internists towards obesity and to draft a consensus document from the SEMI with recommendations based on the available scientific evidence and the opinions of its members&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Conflicts of interest</span><p id="par0200" class="elsevierStylePara elsevierViewall">The content and recommendations in this document have been drafted according to the opinions of its authors and with the participation of a panel of experts without any intervention from the sponsoring institution&#44; the Spanish Society for Internal Medicine &#40;SEMI&#41;&#46; Said entity has not participated in any of the phases of the design&#44; decision-making&#44; drafting of materials&#44; analysis of the online survey for internists&#44; selection of the panel members&#44; dynamics&#44; nor in the creation of the final consensus report&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:11 [
        0 => array:3 [
          "identificador" => "xres1646187"
          "titulo" => "Abstract"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "abst0005"
              "titulo" => "Background"
            ]
            1 => array:2 [
              "identificador" => "abst0010"
              "titulo" => "Material and methods"
            ]
            2 => array:2 [
              "identificador" => "abst0015"
              "titulo" => "Results"
            ]
            3 => array:2 [
              "identificador" => "abst0020"
              "titulo" => "Conclusions"
            ]
          ]
        ]
        1 => array:2 [
          "identificador" => "xpalclavsec1466589"
          "titulo" => "Keywords"
        ]
        2 => array:3 [
          "identificador" => "xres1646186"
          "titulo" => "Resumen"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "abst0025"
              "titulo" => "Introducci&#243;n"
            ]
            1 => array:2 [
              "identificador" => "abst0030"
              "titulo" => "Material y m&#233;todos"
            ]
            2 => array:2 [
              "identificador" => "abst0035"
              "titulo" => "Resultados"
            ]
            3 => array:2 [
              "identificador" => "abst0040"
              "titulo" => "Conclusiones"
            ]
          ]
        ]
        3 => array:2 [
          "identificador" => "xpalclavsec1466590"
          "titulo" => "Palabras clave"
        ]
        4 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introduction"
        ]
        5 => array:3 [
          "identificador" => "sec0010"
          "titulo" => "Material and methods"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "sec0015"
              "titulo" => "Survey"
            ]
            1 => array:2 [
              "identificador" => "sec0020"
              "titulo" => "Internist opinions"
            ]
            2 => array:2 [
              "identificador" => "sec0025"
              "titulo" => "Panel of experts"
            ]
            3 => array:2 [
              "identificador" => "sec0030"
              "titulo" => "Statistical analysis"
            ]
          ]
        ]
        6 => array:3 [
          "identificador" => "sec0035"
          "titulo" => "Results"
          "secciones" => array:1 [
            0 => array:2 [
              "identificador" => "sec0040"
              "titulo" => "Survey"
            ]
          ]
        ]
        7 => array:2 [
          "identificador" => "sec0045"
          "titulo" => "Discussion"
        ]
        8 => array:2 [
          "identificador" => "sec0050"
          "titulo" => "Conclusion"
        ]
        9 => array:2 [
          "identificador" => "sec0055"
          "titulo" => "Conflicts of interest"
        ]
        10 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2020-04-19"
    "fechaAceptado" => "2020-06-11"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec1466589"
          "palabras" => array:4 [
            0 => "Obesity"
            1 => "Internal medicine"
            2 => "Chronic disease"
            3 => "Comorbidities"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec1466590"
          "palabras" => array:4 [
            0 => "Obesidad"
            1 => "Medicina interna"
            2 => "Enfermedad cr&#243;nica"
            3 => "Comorbilidades"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Obesity is a chronic&#44; complex and multifactorial metabolic disease involved in the development of chronic noncommunicable diseases such as type 2 diabetes mellitus&#44; cardiovascular disease and cancer&#46; The care of individuals with obesity is an essential part of the holistic approach provided by internal medicine to patients&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material and methods</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Between September 2019 and January 2020&#44; we distributed an online survey to the members of the Spanish Society of Internal Medicine&#46; We prepared a Strengths&#44; Weaknesses&#44; Opportunities&#44; and Threats analysis using the responses and&#44; using the nominal group technique&#44; developed the recommendations&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">We obtained 599 responses&#46; The respondents mean age was 44&#46;4&#8239;&#177;&#8239;11 years&#44; and 52&#46;1&#37; were women&#46; Some 91&#46;8&#37; of the internists evaluate their patients to rule out the comorbidities associated with obesity&#44; mainly type 2 diabetes mellitus &#40;96&#46;2&#37;&#41;&#44; cardiovascular disease &#40;88&#46;9&#37;&#41; and obesity-associated hypoventilation syndrome &#40;73&#37;&#41;&#44; among others&#46; Some 79&#46;9&#37; provided indications on lifestyle changes&#46; Some 64&#46;1&#37; and 74&#46;9&#37; of the respondents knew the indications for the drugs and bariatric surgery&#44; respectively&#46; Some 93&#46;8&#37; and 83&#37; of the respondents considered obesity and excess weight a chronic disease&#44; and 88&#46;7&#37; considered it a disease of specific interest to internists&#44; who should take an active and leading role in its treatment &#40;85&#46;3&#37;&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">The objective of the present document is to determine the degree of understanding and sensitivity of internists regarding the management of obesity and to develop a consensus of recommendations for the Spanish Society of Internal Medicine based on the scientific evidence and the opinion of its members&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Background"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Material and methods"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
          ]
          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Conclusions"
          ]
        ]
      ]
      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducci&#243;n</span><p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">La obesidad es una enfermedad metab&#243;lica cr&#243;nica&#44; compleja y multifactorial&#44; implicada en el desarrollo de enfermedades cr&#243;nicas no transmisibles como la diabetes mellitus tipo 2&#44; las enfermedades cardiovasculares y el c&#225;ncer&#46; Es necesario que la atenci&#243;n a las personas con obesidad sea una parte esencial de la visi&#243;n integral que la medicina interna aporta a la persona enferma&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material y m&#233;todos</span><p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Entre septiembre de 2019 y enero de 2020 se difundi&#243; una encuesta en l&#237;nea a los socios de la Sociedad Espa&#241;ola de Medicina Interna&#59; se elabor&#243; un an&#225;lisis DAFO con las respuestas y&#44; mediante la t&#233;cnica de Grupo Nominal&#44; se elaboraron las recomendaciones&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">Obtuvimos 599 respuestas&#46; Edad media 44&#44;4&#8239;&#43;&#8239;11 a&#241;os&#44; 52&#44;1&#37; mujeres&#46; El 91&#44;8&#37; de los internistas eval&#250;a a los pacientes para descartar las comorbilidades asociadas a la obesidad&#44; principalmente la diabetes mellitus tipo 2 &#40;96&#44;2&#37;&#41;&#44; la enfermedad cardiovascular &#40;88&#44;9&#37;&#41; o el s&#237;ndrome de hipoventilaci&#243;n asociada a obesidad &#40;73&#37;&#41;&#44; entre otros&#46; El 79&#44;9&#37; proporciona indicaciones sobre modificaci&#243;n del estilo de vida&#46; El 64&#44;1&#37; y el 74&#44;9&#37; conoce las indicaciones de los f&#225;rmacos y de la cirug&#237;a bariatrica respectivamente&#46; El 93&#44;8&#37; y el 83&#37; considera la obesidad y el sobrepeso una enfermedad cr&#243;nica y el 88&#44;7&#37; una patolog&#237;a propia del internista&#44; debiendo tener un papel activo y protagonista en su tratamiento &#40;85&#44;3&#37;&#41;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">El objetivo del presente documento es dar a conocer el grado de conocimiento y de sensibilidad de los internistas frente al manejo de la obesidad y elaborar un consenso de recomendaciones de la Sociedad Espa&#241;ola de Medicina Interna basadas en la evidencia cient&#237;fica y en la opini&#243;n de sus miembros&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Introducci&#243;n"
          ]
          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "Material y m&#233;todos"
          ]
          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclusiones"
          ]
        ]
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Carretero G&#243;mez J&#44; Ena J&#44; Ar&#233;valo Lorido JC&#44; Segu&#237; Ripoll JM&#44; Carrasco-S&#225;nchez FJ&#44; G&#243;mez-Huelgas R&#44; et al&#46; La obesidad es una enfermedad cr&#243;nica&#46; Posicionamiento del grupo de trabajo de Diabetes&#44; Obesidad y Nutrici&#243;n de la Sociedad Espa&#241;ola de Medicina Interna &#40;SEMI&#41; por un abordaje centrado en la persona con obesidad&#46; Rev Clin Esp&#46; 2021&#59;221&#58;509&#8211;516&#46;</p>"
      ]
    ]
    "apendice" => array:1 [
      0 => array:1 [
        "seccion" => array:1 [
          0 => array:4 [
            "apendice" => "<p id="par0210" class="elsevierStylePara elsevierViewall">The following is Supplementary data to this article&#58;<elsevierMultimedia ident="upi0005"></elsevierMultimedia></p>"
            "etiqueta" => "Appendix A"
            "titulo" => "Supplementary data"
            "identificador" => "sec0065"
          ]
        ]
      ]
    ]
    "multimedia" => array:6 [
      0 => array:8 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1864
            "Ancho" => 3333
            "Tamanyo" => 328074
          ]
        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0005"
            "detalle" => "Figure "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Attitude towards anthropometric measurements&#46; Pie chart of variable percentages&#58; weight&#44; BMI&#44; AC&#44; data included in the MH&#44; obesity included in diagnoses&#44; obesity classified in degrees&#46;</p> <p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">AC&#58; abdominal circumference&#59; BMI&#58; body mass index&#59; MH&#58; medical history&#46;</p>"
        ]
      ]
      1 => array:8 [
        "identificador" => "fig0010"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 2010
            "Ancho" => 2925
            "Tamanyo" => 471641
          ]
        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0010"
            "detalle" => "Figure "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Ten points positioning statement from the SEMI for a patient-centred approach to obesity&#46;</p>"
        ]
      ]
      2 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0015"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Result of the variables according to hospital size&#46; Analysis performed using the Chi-squared test&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Hospital type&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#62;1&#44;000 beds&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">500&#8722;1&#44;000 beds&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">200&#8722;500 beds&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#60;200 beds&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">N&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">56 &#40;100&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">134 &#40;100&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">222 &#40;100&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">181 &#40;100&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;0022&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Modification of habits&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">35 &#40;62&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">93 &#40;69&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">164 &#40;73&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">128 &#40;70&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;0022&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">No specific action&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;7&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9 &#40;6&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 &#40;3&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;1&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;0022&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Standard diet indicated&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10 &#40;17&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23 &#40;17&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23 &#40;10&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17 &#40;9&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;0022&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Referral to endocrinology&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;5&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;2&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11 &#40;4&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 &#40;2&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;0022&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Referral to dietitian&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;7&#46;1&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 &#40;17&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17 &#40;7&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29 &#40;16&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;0022&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2802995.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Attitude towards obesity according to hospital type &#40;<span class="elsevierStyleItalic">p</span>&#8239;&#61;&#8239;0&#46;0022&#41;&#46;</p>"
        ]
      ]
      3 => array:8 [
        "identificador" => "tbl0010"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0020"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Pharmacological treatment is indicated in patients with BMI&#8239;&#8805;&#8239;30&#8239;kg&#47;m<span class="elsevierStyleSup">2</span> or &#8805;&#8239;27&#8239;kg&#47;m<span class="elsevierStyleSup">2</span> associated with major comorbidities &#40;among others&#58; high blood pressure&#44; type 2 diabetes mellitus&#44; obesity hypoventilation syndrome&#44; non-alcoholic fatty liver disease&#41;&#46;</p><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">MEN&#58; multiple endocrine neoplasia&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Drugs&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Formulation and maximum dose&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Weight loss &#40;1&#8239;year&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Adverse events&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Safety precautions and contraindications&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Orlistat&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Oral60&#8722;120&#8239;mg&#47;8&#8239;h&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;5&#8722;3&#46;4&#8239;kg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8594;Abdominal pain&#44; nausea&#44; constipation&#44; diarrhoea&#44; faecal urgency&#8594;Headache&#8594;Malabsorption of fat-soluble vitamins &#40;A&#44; D&#44; E&#44; K&#41;&#8594;Liver failure and kidney disease due to oxalates&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8594;Chronic malabsorption syndromes&#8594;Cholestasis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Liraglutide&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Subcutaneous3&#8239;mg&#47;24&#8239;h&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#46;8&#8722;5&#46;9&#8239;kg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8594;Nausea&#44; constipation&#44; diarrhoea&#44; vomiting&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8594;History of medullary thyroid cancer or MEN-2&#8594;History of pancreatitis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Bupropion&#47;naltrexone&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Oral32&#47;360&#8239;mg&#47;24&#8239;h2&#8239;tablets&#47;12&#8239;h&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;0&#8722;4&#46;1&#8239;kg&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8594;Nausea&#44; constipation&#44; vomiting&#8594;Headache&#8594;Insomnia&#44; anxiety&#8594;Tachycardia&#44; increased blood pressure&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8594;Suicidal ideation&#8594;Uncontrolled depression syndrome&#8594;Use of barbiturates&#44; benzodiazepines or anti-seizure drugs&#8594;Eating disorders&#8594;Poorly controlled arterial hypertension&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2802994.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Currently proven drugs for treating obesity&#46;</p>"
        ]
      ]
      4 => array:8 [
        "identificador" => "tbl0015"
        "etiqueta" => "Table 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0025"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Indications for bariatric surgery&#58; BMI&#8239;&#8805;&#8239;40&#8239;kg&#47;m<span class="elsevierStyleSup">2</span> or &#8805;&#8239;35&#8239;kg&#47;m<span class="elsevierStyleSup">2</span> with major comorbidities &#40;among others&#58; high blood pressure&#44; type 2 diabetes mellitus&#44; obesity hypoventilation syndrome&#44; non-alcoholic fatty liver disease&#41;&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Procedure&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Weight loss1&#8239;year&#47;6&#8239;years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Pros&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Contras&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Roux-en-Y gastric bypass&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14&#8722;30&#37;&#47;13&#8722;14&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8594;Significant and sustained weight loss&#8594;High rates of type 2 diabetes mellitus remission&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8594;Complex procedure&#8594;Higher incidence of perioperative complications&#8594;Higher incidence of delayed complications&#58; marginal ulcer&#44; small bowel obstruction&#44; dumping syndrome&#8594;Indefinite vitamin and mineral supplementation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Vertical sleeve gastrectomy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&#8211;28&#37;&#47;22&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8594;Significant and sustained weight loss&#8594;Less complex surgery&#8594;Option to reconvert into bypass&#8594;Lower risk of vitamin and mineral deficits&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8594;Higher likelihood of regaining weight compared to bypass&#8594;Obstructive syndromes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2802993.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Main bariatric surgery techniques&#46;</p>"
        ]
      ]
      5 => array:5 [
        "identificador" => "upi0005"
        "tipo" => "MULTIMEDIAECOMPONENTE"
        "mostrarFloat" => false
        "mostrarDisplay" => true
        "Ecomponente" => array:2 [
          "fichero" => "mmc1.pdf"
          "ficheroTamanyo" => 90896
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:32 [
            0 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "American Association of Clinical Endocrinologists&#8217; position statement on obesity and obesity medicine"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "J&#46;I&#46; Mechanick"
                            1 => "A&#46;J&#46; Garber"
                            2 => "Y&#46; Handelsman"
                            3 => "W&#46;T&#46; Garvey"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.4158/EP12160.PS"
                      "Revista" => array:6 [
                        "tituloSerie" => "Endocr Pract&#46;"
                        "fecha" => "2012"
                        "volumen" => "18"
                        "paginaInicial" => "642"
                        "paginaFinal" => "648"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23047927"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Obesity Management Task Force of the European Association for the Study of Obesity&#46; European guidelines for obesity management in adults"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "V&#46; Yumuk"
                            1 => "C&#46; Tsigos"
                            2 => "M&#46; Fried"
                            3 => "K&#46; Schindler"
                            4 => "L&#46; Busetto"
                            5 => "D&#46; Micic"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1159/000442721"
                      "Revista" => array:6 [
                        "tituloSerie" => "Obesity Facts&#46;"
                        "fecha" => "2015"
                        "volumen" => "8"
                        "paginaInicial" => "402"
                        "paginaFinal" => "424"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26641646"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prevalence of obesity according to Edmonton staging in the Internal Medicine consultations&#46; Results of the OBEMI study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46; Carretero G&#243;mez"
                            1 => "J&#46;C&#46; Ar&#233;valo Lorido"
                            2 => "R&#46; G&#243;mez Huelgas"
                            3 => "M&#46;T&#46; S&#225;nchez Vidal"
                            4 => "M&#46; Su&#225;rez Tembra"
                            5 => "J&#46;M&#46; Varela Aguilar"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.rce.2016.11.003"
                      "Revista" => array:6 [
                        "tituloSerie" => "Rev Clin Esp&#46;"
                        "fecha" => "2017"
                        "volumen" => "217"
                        "paginaInicial" => "71"
                        "paginaFinal" => "78"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27939027"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0020"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Association of BMI with overall and cause-specific mortality&#58; a population-based cohort study of 3&#8226;6 million adults in the UK"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "K&#46; Bhaskaran"
                            1 => "I&#46; Dos-Santos-Silva"
                            2 => "D&#46;A&#46; Leon"
                            3 => "I&#46;J&#46; Douglas"
                            4 => "L&#46; Smeeth"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/S2213-8587(18)30288-2"
                      "Revista" => array:6 [
                        "tituloSerie" => "Lancet Diabet Endocrinol&#46;"
                        "fecha" => "2018"
                        "volumen" => "6"
                        "paginaInicial" => "944"
                        "paginaFinal" => "953"
                        "itemHostRev" => array:3 [
                          "pii" => "S1470204509701123"
                          "estado" => "S300"
                          "issn" => "14702045"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0025"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "World obesity federation&#46; Obesity&#58; a chronic relapsing progressive disease process&#46; A position statement of the world obesity federation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "G&#46;A&#46; Bray"
                            1 => "K&#46;K&#46; Kim"
                            2 => "J&#46;P&#46;H&#46; Wilding"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/obr.12551"
                      "Revista" => array:6 [
                        "tituloSerie" => "Obes Rev&#46;"
                        "fecha" => "2017"
                        "volumen" => "18"
                        "paginaInicial" => "715"
                        "paginaFinal" => "723"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28489290"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0030"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Management of obesity&#58; improvement of healthcare training and systems for prevention and care"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "W&#46;H&#46; Dietz"
                            1 => "L&#46;A&#46; Baur"
                            2 => "K&#46; Hall"
                            3 => "R&#46;M&#46; Puhl"
                            4 => "E&#46;M&#46; Taveras"
                            5 => "R&#46; Uauy"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/S0140-6736(14)61748-7"
                      "Revista" => array:6 [
                        "tituloSerie" => "Lancet&#46;"
                        "fecha" => "2015"
                        "volumen" => "385"
                        "paginaInicial" => "2521"
                        "paginaFinal" => "2533"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25703112"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0035"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Barriers to obesity management&#58; a pilot study of primary care clinicians"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "V&#46; Forman-Hoffman"
                            1 => "A&#46; Little"
                            2 => "T&#46; Wahls"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1186/1471-2296-7-35"
                      "Revista" => array:5 [
                        "tituloSerie" => "BMC Fam Pract&#46;"
                        "fecha" => "2006"
                        "volumen" => "7"
                        "paginaInicial" => "35"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16756673"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0040"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Consensus development methods&#58; a review of best practice in creating clinical guidelines"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "N&#46; Black"
                            1 => "M&#46; Murphy"
                            2 => "D&#46; Lamping"
                            3 => "M&#46; McKee"
                            4 => "C&#46; Sanderson"
                            5 => "J&#46; Askham"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Health Serv Res Policy&#46;"
                        "fecha" => "1999"
                        "volumen" => "4"
                        "paginaInicial" => "236"
                        "paginaFinal" => "248"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0045"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Using consensus group methods such as Delphi and Nominal Group in medical education research"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "S&#46; Humphrey-Murto"
                            1 => "L&#46; Varpio"
                            2 => "C&#46; Gonsalves"
                            3 => "T&#46;J&#46; Wood"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1080/0142159X.2017.1245856"
                      "Revista" => array:5 [
                        "tituloSerie" => "Med Teach&#46;"
                        "fecha" => "2017"
                        "volumen" => "39"
                        "paginaInicial" => "14"
                        "paginaFinal" => "19"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0050"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Nominal group technique to select attributes for discrete choice experiments&#58; an example for drug treatment choice in osteoporosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; Hiligsmann"
                            1 => "C&#46; van Durme"
                            2 => "P&#46; Geusens"
                            3 => "Bg Dellaert"
                            4 => "Cd Dirksen"
                            5 => "T&#46; Van der Weijden"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.2147/PPA.S38408"
                      "Revista" => array:6 [
                        "tituloSerie" => "Patient Prefer Adherence&#46;"
                        "fecha" => "2013"
                        "volumen" => "7"
                        "paginaInicial" => "133"
                        "paginaFinal" => "139"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23412964"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "How to use the nominal group and Delphi techniques"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "S&#46;S&#46; McMillan"
                            1 => "M&#46; King"
                            2 => "M&#46;P&#46; Tully"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s11096-016-0257-x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Int J Clin Pharm&#46;"
                        "fecha" => "2016"
                        "volumen" => "38"
                        "paginaInicial" => "655"
                        "paginaFinal" => "662"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26846316"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Building consensus in health care&#58; a guide to using the nominal group technique"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "J&#46; Allen"
                            1 => "J&#46; Dyas"
                            2 => "M&#46; Jones"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.12968/bjcn.2004.9.3.12432"
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Community Nurs&#46;"
                        "fecha" => "2004"
                        "volumen" => "9"
                        "paginaInicial" => "110"
                        "paginaFinal" => "114"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15028996"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0065"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Obesity as a disease&#58; a white paper on evidence and arguments commissioned by the Council of the Obesity Society"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "D&#46;B&#46; Allison"
                            1 => "M&#46; Downey"
                            2 => "R&#46;L&#46; Atkinson"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1038/oby.2008.231"
                      "Revista" => array:6 [
                        "tituloSerie" => "Obesity&#46;"
                        "fecha" => "2008"
                        "volumen" => "16"
                        "paginaInicial" => "1161"
                        "paginaFinal" => "1177"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18464753"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0070"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The GBD 2015 Obesity Collaborators&#46; Health effects ofoverweight and obesity in 195 countries over 25 years"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46; Afshin"
                            1 => "M&#46;H&#46; Forouzanfar"
                            2 => "M&#46;B&#46; Reitsma"
                            3 => "P&#46; Sur"
                            4 => "K&#46; Estep"
                            5 => "A&#46; Lee"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJMoa1614362"
                      "Revista" => array:6 [
                        "tituloSerie" => "N Engl J Med&#46;"
                        "fecha" => "2017"
                        "volumen" => "377"
                        "paginaInicial" => "13"
                        "paginaFinal" => "27"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28604169"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0075"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cause specific mortality&#44; social position&#44; and obesity among women who had never smoked&#58; 28 year cohort study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "C&#46;L&#46; Hart"
                            1 => "L&#46; Gruer"
                            2 => "G&#46;C&#46; Watt"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/bmj.d3785"
                      "Revista" => array:4 [
                        "tituloSerie" => "BMJ&#46;"
                        "fecha" => "2011"
                        "volumen" => "342"
                        "paginaInicial" => "d3785"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0080"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A call to action to inform patient&#8208;centred approaches to obesity management&#58; Development of a disease&#8208;illness model"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "J&#46; Fastenau"
                            1 => "R&#46;L&#46; Kolotkin"
                            2 => "K&#46; Fujioka"
                            3 => "M&#46; Alba"
                            4 => "W&#46; Canovatchel"
                            5 => "S&#46; Traina"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:3 [
                        "tituloSerie" => "Clin Obes&#46;"
                        "fecha" => "2019"
                        "volumen" => "9"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0085"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Scaling of adult body weight to height across sex and race&#47;ethnic groups&#58; relevance to BMI"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46;B&#46; Heymseld"
                            1 => "C&#46;M&#46; Peterson"
                            2 => "D&#46;M&#46; Thomas"
                            3 => "H&#46; Moonseong"
                            4 => "J&#46;M&#46; Schuna"
                            5 => "S&#46; Hong"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Am J Clin Nutr&#46;"
                        "fecha" => "2014"
                        "volumen" => "100"
                        "paginaInicial" => "1455"
                        "paginaFinal" => "1461"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0090"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "General and abdominal adiposity and risk of death in Europe"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "T&#46; Pischon"
                            1 => "H&#46; Boeing"
                            2 => "K&#46; Hoffmann"
                            3 => "M&#46; Bergmann"
                            4 => "M&#46;B&#46; Schulze"
                            5 => "K&#46; Overvad"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJMoa0801936"
                      "Revista" => array:5 [
                        "tituloSerie" => "N Engl J Med&#46;"
                        "fecha" => "2008"
                        "volumen" => "359"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18650507"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0923753419404006"
                          "estado" => "S300"
                          "issn" => "09237534"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0095"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Stature prediction equations for elderly non- Hipanic white&#44; non-Hipanic black&#44; and Mexican-American persons developed from NHANES III data"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "W&#46;C&#46; Chumlea"
                            1 => "S&#46;S&#46; Guo"
                            2 => "K&#46; Wholihan"
                            3 => "D&#46; Cockram"
                            4 => "R&#46;J&#46; Kuczmarski"
                            5 => "C&#46;L&#46; Johnson"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/S0002-8223(98)00036-4"
                      "Revista" => array:7 [
                        "tituloSerie" => "J Am Diet Assoc&#46;"
                        "fecha" => "1998"
                        "volumen" => "98"
                        "paginaInicial" => "137"
                        "paginaFinal" => "142"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12515412"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0140673600020341"
                          "estado" => "S300"
                          "issn" => "01406736"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib0100"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Physical status&#58; the use of anthropometry&#44; report of WHO Expert Committee&#44; WHO Technical Report&#46; Series 854"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "WHO"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:3 [
                        "fecha" => "1995"
                        "editorial" => "WHO"
                        "editorialLocalizacion" => "Geneva"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib0105"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "European practical and patient-centred guidelines for adult obesity management in primary care"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "D&#46; Durrer Schutz"
                            1 => "L&#46; Busetto"
                            2 => "D&#46; Dicker"
                            3 => "N&#46; Farpour-Lambert"
                            4 => "R&#46; Pryke"
                            5 => "H&#46; Toplak"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1159/000496183"
                      "Revista" => array:6 [
                        "tituloSerie" => "Obes Facts&#46;"
                        "fecha" => "2019"
                        "volumen" => "12"
                        "paginaInicial" => "40"
                        "paginaFinal" => "66"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30673677"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib0110"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Comorbidity associated with obesity in a large population&#58; The APNA study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "E&#46; Martin-Rodriguez"
                            1 => "F&#46; Guillen Grima"
                            2 => "A&#46; Marti&#769;"
                            3 => "A&#46; Brugos Larumbe"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.orcp.2015.04.003"
                      "Revista" => array:6 [
                        "tituloSerie" => "Obes Res Clin Pract&#46;"
                        "fecha" => "2015"
                        "volumen" => "9"
                        "paginaInicial" => "435"
                        "paginaFinal" => "447"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25979684"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib0115"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Obesity and Type 2 diabetes&#58; two diseases with a need for combined treatment strategies &#8211; EASO can lead the way"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "D&#46;R&#46; Leitner"
                            1 => "G&#46; Fruhbeck"
                            2 => "V&#46; Yumuk"
                            3 => "K&#46; Schindler"
                            4 => "D&#46; Micic"
                            5 => "E&#46; Woodward"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1159/000480525"
                      "Revista" => array:6 [
                        "tituloSerie" => "Obesity Facts&#46;"
                        "fecha" => "2017"
                        "volumen" => "10"
                        "paginaInicial" => "483"
                        "paginaFinal" => "492"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29020674"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib0120"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Obesity and the risk of myocardial infarction in 27&#44;000 participants from 52 countries&#58; a case-control study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46; Yusuf"
                            1 => "S&#46; Hawken"
                            2 => "S&#46; Ounpuu"
                            3 => "L&#46; Bautista"
                            4 => "M&#46;G&#46; Franzosi"
                            5 => "P&#46; Commerford"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/S0140-6736(05)67663-5"
                      "Revista" => array:6 [
                        "tituloSerie" => "Lancet&#46;"
                        "fecha" => "2005"
                        "volumen" => "366"
                        "paginaInicial" => "1640"
                        "paginaFinal" => "1649"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16271645"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib0125"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Interrelationships between obesity&#44; obstructive sleep apnea syndrome and cardiovascular risk in obese adolescents"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:7 [
                            0 => "D&#46; Koren"
                            1 => "J&#46;A&#46; Chirinos"
                            2 => "L&#46;E&#46; Katz"
                            3 => "E&#46;R&#46; Mohler"
                            4 => "P&#46;R&#46; Gallagher"
                            5 => "G&#46;F&#46; Mitchell"
                            6 => "C&#46;L&#46; Marcus"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Int J Obes&#46;"
                        "fecha" => "2015"
                        "volumen" => "39"
                        "paginaInicial" => "1086"
                        "paginaFinal" => "1093"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib0130"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "EASL&#8211;EASD&#8211;EASO Clinical Practice Guidelines for the management of non-alcoholic fatty liver disease"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "European Association for the Study of the Liver &#40;EASL&#41;"
                            1 => "European Association for the Study of Diabetes &#40;EASD&#41;"
                            2 => "European Association for the Study of Obesity &#40;EASO&#41;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00125-016-3902-y"
                      "Revista" => array:6 [
                        "tituloSerie" => "Diabetologia&#46;"
                        "fecha" => "2016"
                        "volumen" => "59"
                        "paginaInicial" => "1121"
                        "paginaFinal" => "1140"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27053230"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib0135"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "MOSH syndrome &#40;male obesity secondary hypogonadism&#41;&#58; clinical assessment and possible therapeutic approaches"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46; De Lorenzo"
                            1 => "A&#46; Noce"
                            2 => "E&#46; Moriconi"
                            3 => "T&#46; Rampello"
                            4 => "G&#46; Marrone"
                            5 => "N&#46; Di Daniele"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3390/nu10040474"
                      "Revista" => array:5 [
                        "tituloSerie" => "Nutrients&#46;"
                        "fecha" => "2018"
                        "volumen" => "10"
                        "paginaInicial" => "E474"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29649106"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            27 => array:3 [
              "identificador" => "bib0140"
              "etiqueta" => "28"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The dual roles of obesity in chronic kidney disease&#58; A review of the current literature"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "C&#46;M&#46; Rhee"
                            1 => "S&#46;F&#46; Ahmadi"
                            2 => "K&#46; Kalantar-Zadeh"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/MNH.0000000000000212"
                      "Revista" => array:6 [
                        "tituloSerie" => "Curr Opin Nephrol Hypertens&#46;"
                        "fecha" => "2016"
                        "volumen" => "25"
                        "paginaInicial" => "208"
                        "paginaFinal" => "216"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26999023"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            28 => array:3 [
              "identificador" => "bib0145"
              "etiqueta" => "29"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "US Preventive Services Task Force&#46; Behavioral weight loss interventions to prevent obesity-related morbidity and mortality in adults&#58; US Preventive Services Task Force Recommendation Statement"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46;J&#46; Curry"
                            1 => "A&#46;H&#46; Krist"
                            2 => "D&#46;K&#46; Owens"
                            3 => "M&#46;J&#46; Barry"
                            4 => "A&#46;B&#46; Caughey"
                            5 => "K&#46;W&#46; Davidson"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "JAMA&#46;"
                        "fecha" => "2018"
                        "volumen" => "320"
                        "paginaInicial" => "1163"
                        "paginaFinal" => "1171"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            29 => array:3 [
              "identificador" => "bib0150"
              "etiqueta" => "30"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Obesity Treatment&#44; Beyond the Guidelines&#58; Practical Suggestions for Clinical Practice"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "S&#46; Kahan"
                            1 => "J&#46;E&#46; Manson"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "JAMA&#46;"
                        "fecha" => "2019"
                        "volumen" => "321"
                        "paginaInicial" => "1349"
                        "paginaFinal" => "1350"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            30 => array:3 [
              "identificador" => "bib0155"
              "etiqueta" => "31"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Lifestyle recommendations for the prevention and management of metabolic syndrome&#58; an international panel recommendation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "P&#46; P&#233;rez-Mart&#237;nez"
                            1 => "D&#46;P&#46; Mikhailidis"
                            2 => "V&#46;G&#46; Athyros"
                            3 => "M&#46; Bullo"
                            4 => "P&#46; Couture"
                            5 => "M&#46;I&#46; Covas"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/nutrit/nux014"
                      "Revista" => array:6 [
                        "tituloSerie" => "Nutr Rev&#46;"
                        "fecha" => "2017"
                        "volumen" => "75"
                        "paginaInicial" => "307"
                        "paginaFinal" => "326"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28521334"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            31 => array:3 [
              "identificador" => "bib0160"
              "etiqueta" => "32"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Obesity&#58; Pathophysiology and Management"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "K&#46;M&#46; Gadde"
                            1 => "C&#46;K&#46; Martin"
                            2 => "H&#46;R&#46; Berthoud"
                            3 => "S&#46;B&#46; Heymsfield"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jacc.2017.11.011"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Coll Cardiol&#46;"
                        "fecha" => "2018"
                        "volumen" => "71"
                        "paginaInicial" => "69"
                        "paginaFinal" => "84"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29301630"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/22548874/0000022100000009/v3_202201140544/S2254887421000631/v3_202201140544/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "1901"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Original Articles"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/22548874/0000022100000009/v3_202201140544/S2254887421000631/v3_202201140544/en/main.pdf?idApp=WRCEE&text.app=https://revclinesp.es/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2254887421000631?idApp=WRCEE"
]

Article information

ISSN: 22548874
Original language: English

DOI:10.1016/j.rceng.2020.06.013

The statistics are updated each day

Year/Month	Html	Pdf	Total

2023 March	8	3	11
2021 June	1	0	1

Indexed in:

Follow us:

Subscribe:

Statistics

Indexed in:

Follow us:

Subscribe:

Statistics

Subscribe to our newsletter