Management of overweight and obese patients without noncommunicable diseases in primary care facilities. Guidelines

These guidelines outline modern approaches to the diagnosis and management of overweight and obese patients without noncommunicable diseases in health centers, including scripts for patient interviews, algorithms of individualized nutrition programs, and methods necessary for assessing patients' condition. Key attention is paid to dynamic follow-up, and the key criteria for monitoring treatment effectiveness are presented to reduce the risk of complications and improve the overall quality and life expectancy of patients. The algorithmization and structuring of modern clinical guidelines and standards in relation to dynamic follow-up make the guide relevant, practiceoriented, and useful for healthcare professionals. The inclusion of scientific data ensures the high effectiveness of the proposed approaches and their application in everyday health practice.

The guidelines can be used by health professionals, heads of primary care facilities, and their departments.

1. Muromtseva GA, Kontsevaya AV, Konstantinov VV, et al. The prevalence of noninfectious diseases risk factors in Russian population in 2012-2013 years. The results of ECVD-RF. Cardiovascular Therapy and Prevention. 2014;13(6):4-11. (In Russ.) doi:10.15829/1728-8800-2014-6-4-11.

2. Balanova YuA, Drapkina OM, Kutsenko VA, et al. Obesity in the Russian population during the COVID-19 pandemic and associated factors. Data from the ESSE-RF3 study. Cardiovascular Therapy and Prevention. 2023;22(8S):3793. (In Russ.) doi:10.15829/1728-8800-2023-3793.

3. Okunogbe A, Nugent R, Spencer G, Powis J, Ralston J, Wilding J. Economic impacts of overweight and obesity: current and future estimates for 161 countries. BMJ Glob Health. 2022;7(9):e009773. doi:10.1136/bmjgh-2022-009773.

4. Bastien M, Poirier P, Lemieux I, Després J-P. Overview of epidemiology and contribution of obesity to cardiovascular disease. Progress in Cardiovascular Diseases. 2014;56(4):369-81. doi:10.1016/j.pcad.2013.10.016.

5. Kontsevaya AV, Mukaneeva DK, Myrzamatova AO, et al. Economic damage of risk factors associated with morbidity and mortality from major chronic noncommunicable diseases in Russia in 2016. Cardiovascular Therapy and Prevention. 2020;19(1):48-55. (In Russ.) doi:10.15829/1728-8800-2020-1-2396.

6. Dedov II, Shestakova MV, Melnichenko GA, et al. Interdisciplinary clinical guidelines "Treatment of obesity and comorbid diseases". Obesity and metabolism. 2021; 18(1):5-99. (In Russ.)

7. Drapkina OM, Kontsevaya AV, Kalinina AM, et al. Comorbidity of patients with noncommunicable diseases in general practice. Eurasian guidelines. Cardiovascular Therapy and Prevention. 2024;23(3):3996. (In Russ.) doi:10.15829/1728-8800-2024-3996. EDN: AVZLPJ

8. Drapkina OM, Karamnova NS, Kontsevaya AV, et al. Russian Society for the Prevention of Noncommunicable Diseases (ROPNIZ). Alimentary-dependent risk factors for chronic non-communicable diseases and eating habits: dietary correction within the framework of preventive counseling. Methodological Guidelines. Cardiovascular Therapy and Prevention. 2021;20(5):2952. (In Russ.) doi:10.15829/1728-8800-2021-2952.

9. Schutz D, Busetto L, Dicker D, et al. European Practical and Patient-Centred Guidelines for Adult Obesity Management in Primary Care. Obes Facts. 2019;12(1): 40-66. doi:10.1159/000496183

10. Volkova LYu, Eliashevich SO, Shepel RN, et al. A structured approach to changing the nutritional model in adult obese patients in primary health care. Preventive medicine. 2023;26(2):94-9. (In Russ.).

11. Drapkina OM, Drozdova LYu, Kontsevaya AV, et al. Providing medical care to patients with risk factors for developing chronic noncommunicable diseases in adult health centers. Methodological recommendations. M.: ROPNIZ, LLC "SILICEA-POLYGRAPH" 2025. 164 p. (In Russ.) ISBN: 978-5-6053845-8-8. doi:10.15829/ROPNIZ-d108-2025. EDN: HKMNQW.

12. Drapkina OM, Kontsevaya AV, Kalinina AM, et al. 2022 Prevention of chronic noncommunicable diseases in the Russian Federation. National guidelines. Cardiovascular Therapy and Prevention. 2022;21(4):3235. (In Russ.) doi:10.15829/1728-8800-2022-3235.

13. Drapkina OM, Drozdova LYu, Kalinina AM, et al. Organization of preventive medical examination and medical examination of certain groups of the adult population. Methodological recommendations. Edition 2-E. M.: Federal State Budgetary Institution "NMITS TPM" of the Ministry of Health of the Russian Federation. 2020. (In Russ.) ISBN: 978-5-6043991-1-8.

14. Drapkina OM, Demko VV, Kalinina AM, Shepel RN. Preventive counseling of patients with risk factors for noncommunicable diseases in clinical practice. Analytical review. Cardiovascular Therapy and Prevention. 2024;23(12):4154. (In Russ.) doi:10.15829/1728-8800-2024-4154. EDN: RNDDQO.

15. Dyachenkov EV, Vasilyeva EYu, et al. Communication with the patient: models, training, evaluation. Specialist in medical simulation training: a textbook. 2nd ed., ispr. and add. Moscow: ROSOMED, 2021. pp. 176-211. (In Russ.) EDN: SCCDSD.

16. Kulikova MS, Gorny BE, Kontsevaya AV, et al. The effectiveness of remote technologies in the control and self-monitoring of overweight and obesity in primary care patients. Preventive medicine. 2021;24(10):24-31. (In Russ.) doi:10.17116/profmed20212410124.

17. Kulikova MS, Kalinina AM, Kontseva AV, et al. Remote monitoring of the process of reducing excess body weight using the mobile application "Doctor PM": the opinion of patients and medical professionals. Preventive medicine. 2022;25(10):35-43. (In Russ.) doi:10.17116/profmed20222510135.

18. Kulikova MS, Kalinina AM. Interaction between doctor and patient in the control of overweight in the era of digital healthcare (literature review). Preventive medicine. 2022;25(9):97-102. (In Russ.) doi:10.17116/profmed20222509197.

19. Kulikova MS, Kalinina AM, Yeganyan RA, et al. The use of mobile healthcare tools in the control of overweight and eating habits: results of a Russian multicenter randomized trial. Preventive medicine. 2022;25(12):46-54. (In Russ.) doi:10.17116/profmed20222512146.

20. Karamnova NS, Izmailova OV, Kalinina AM, et al. Methodical manual on the quantitative assessment of food consumed "Atlas of portions of food and dishes". Polygraphy for Business LLC, 2018. p. 110. (In Russ.) ISBN: 978-5-600-02141-9.

21. Ard JD, Lewis KH, Cohen SS, et al. Differences in treatment response to a total diet replacement intervention versus a food-based intervention: A secondary analysis of the OPTIWIN trial. Obes Sci Pract. 2020:1-10. doi:10.1002/osp4.444.

22. Ard J, Lewis K, Rothberg A, et al. Effectiveness of a total meal replacement program on weight loss: Results from the OPTIWIN study. Obesity. 2018;27:22-9. doi:10.1002/oby.22303.

23. Steven S, Hollingsworth KG, Al-Mrabeh A, et al., Very Low-Calorie Diet and 6 Months of Weight Stability in Type 2 Diabetes: Pathophysiological Changes in Responders and Nonresponders. Diabetes Care. 2016;39(5):808-15. doi:10.2337/dc15-1942.

24. Colles SL, Dixon JB, Marks P, et al. Preoperative weight loss with a very-low-energy diet: quantitation of changes in liver and abdominal fat by serial imaging. Am J Clin Nutr. 2006;84(2):304-11. doi:10.1093/ajcn/84.1.304.

25. Bischoff SC, Damms-Machado A, Betz C, et al., Multicenter evaluation of an interdisciplinary 52-week weight loss program for obesity with regard to body weight, comorbidities and quality of life--a prospective study. International Journal of Obesity. 2012;36(4):614-24. doi:10.1038/ijo.2011.107.

26. Roesler A, Marshall S, Rahimi-Ardabili H, et al. Choosing and following a very low calorie diet program in Australia: A quasi-mixed methods study to understand experiences, barriers, and facilitators in a self-initiated environment. Nutr Diet. 2020:1-16. doi:10.1111/1747-0080.12645.