Supplementary Material for: The Spanish GIRO guideline: a paradigm shift in the management of obesity in adults.

Introduction: Current obesogenic environments, along with intrinsic factors, contribute to the obesity pandemic, which impacts the quality of life and healthcare for individuals with obesity. In addition, discrimination and stigma related to obesity remain widespread in our society. In this scenario, the Spanish Society for the Study of Obesity (SEEDO), in collaboration with 38 recognized scientific societies and 12 patients’ organisation, have elaborated the Spanish guideline for obesity management in adults, referred to as the GIRO guideline. GIRO aims to drive a shift in obesity management and serve as a guide for healthcare professionals (HCPs) to address this chronic and multifactorial disease. Methods: A comprehensive systematic review was conducted and completed with experts’ contribution, with a particular focus on Spanish society. The quality of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system. Experts selected the recommendations and determined their strength through consensus. Results: A total of 121 recommendations were proposed, including 32 adopted from the Canadian Adult Obesity Clinical Practice Guidelines and 89 specific recommendations created for the Spanish context, distributed across five areas of application: 1) Recognition of obesity as a chronic disease; 2) Obesity assessment; 3) Multidisciplinary approach to obesity treatment; 4) Recommendations for obesity management in special populations; and 5) Implementation of the GIRO guideline and future challenges. Conclusion: The GIRO recommendations are intended to serve as a useful and interactive tool for HCPs, policymakers and other stakeholders to ensure access to and quality of healthcare for individuals living with obesity.

引言：当前的致肥胖环境与内在危险因素共同推动了肥胖大流行，该流行病会对肥胖人群的生活质量与医疗保健体验造成负面影响。此外，与肥胖相关的歧视与污名化现象在社会中仍广泛存在。在此背景下，西班牙肥胖研究学会（Spanish Society for the Study of Obesity, SEEDO）联合38家知名科学学会与12个患者组织，制定了成人肥胖管理西班牙指南，即GIRO指南。GIRO指南旨在推动肥胖管理范式的转变，并作为医疗专业人员（healthcare professionals, HCPs）应对这一慢性多因素疾病的指导性文件。
方法：本研究开展了全面的系统综述，并结合专家共识意见完成撰写，研究重点特别聚焦于西班牙本土情境。证据质量采用推荐分级、评估、制定与评价（Grading of Recommendations, Assessment, Development and Evaluation, GRADE）系统进行评定。专家团队通过共识流程遴选推荐意见并确定其强度等级。
结果：最终共提出121项推荐意见，其中32项引自《加拿大成人肥胖临床实践指南》，89项为针对西班牙本土情境定制的专属推荐意见，涵盖五大应用领域：1）将肥胖认定为慢性疾病；2）肥胖评估；3）肥胖治疗的多学科诊疗模式；4）特殊人群肥胖管理推荐意见；5）GIRO指南的实施与未来挑战。
结论：GIRO指南推荐意见旨在成为医疗专业人员、政策制定者及其他利益相关方的实用且兼具交互性的工具，以保障肥胖人群能够获得可及且优质的医疗保健服务。