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Samuel's BMI is 40

How to treat obesity

Obesity is a chronic disease, where treatment should target both weight-related complications and adiposity to improve overall health and quality of life. 1 It can be managed effectively through a variety of available treatment options, depending on the individual patient characteristics and the severity of the disease. The principal goals in obesity management are to prevent complications by trying to keep the patient metabolically healthy (if possible), to prevent or to treat complications if they are already present, to reduce stigmatisation and to restore well-being, positive body image and self-esteem. 2

There are multiple guidelines available for obesity management, which include recommendations on the below three categories of intervention. Each category can offer different levels of weight loss: 1

Weight loss expectations by treatment category:

Obesity treatment options




Lifestyle therapy
– In various studies, lifestyle modifications, including low calorie diets, have shown to reduce weight by between 5-8%. 3 However, these interventions are not always sufficient to maintain weight loss.4,5





 

Pharmacotherapy – Pharmacological options have different mode of actions and across the different classes they can provide 3-9% weight loss. 6





 

Bariatric surgery – There are a number of different types of weight loss surgery, with each option providing different weight loss efficacies ranging between 14-43%. 7

 

Lifestyle modification



 

Lifestyle therapy modifications are the cornerstone of all obesity treatment and should be the first line intervention in all individuals with a BMI ≥25 kg/m2. Importantly, lifestyle modifications must be included as part of any weight loss intervention. Many obesity management guidelines recommend that lifestyle therapy for obesity should include the following three components; meal plan, physical activity and behavioural modification. 1 However, these interventions are not always sufficient to maintain weight loss. 4,5
 

Click here to download a handout for your patients, which you can use to help guide discussions around healthier eating and increased physical activity.

For more guidance on Lifestyle Therapy Modifications see page 91: AACE/ACE Guidelines 2016.
Available at: https://journals.aace.com/doi/pdf/10.4158/EP161365.GL


Pharmacotherapy tx



 

Pharmacological treatment should be considered as part of a comprehensive strategy of disease management. 8 Pharmacotherapy can help patients to maintain compliance, reduce obesity-related health risks and improve quality of life. It can also help to prevent the development of obesity complications (e.g. type 2 diabetes). 8 Pharmacotherapy can be considered in patients with a BMI of ≥30 kg/m2, or ≥27 kg/m2 with obesity-related complications if lifestyle therapy does not provide sufficient clinical benefit for individuals. 1


Anti-obesity medications can act directly on the central nervous system, inducing weight loss by reducing appetite, or act peripherally and induce weight loss by interfering with fat absorption from the gastrointestinal tract. 9

 

There is also a role for pharmacotherapy post bariatric surgery. 10-20% of all patients will regain the weight lost through bariatric surgery. 10 In these cases, pharmacotherapy is recommended by the European Association for the Study of Obesity for patients with a partial weight loss response or who have experienced weight regain after bariatric surgery. 11
 

For more guidance on Lifestyle Therapy Modifications see page 91: AACE/ACE Guidelines 2016.
Available at:
https://journals.aace.com/doi/pdf/10.4158/EP161365.GL


Bariatric



 

Bariatric surgery is the third-line and most efficient intervention for obesity management. In patients with a BMI ≥ 40, more than 45kg overweight or with a BMI ≥ 35 and at least one or more obesity-related co-morbidities (such as type 2 diabetes, hypertension, sleep apnoea and other respiratory disorders, non-alcoholic fatty liver disease, osteoarthritis, lipid abnormalities, gastrointestinal disorders, or heart disease), 12 it is intended to manage excess weight that is severe and/or associated with severe weight-related complications. 1

 

Bariatric surgery can be malabsorptive or restrictive, with each type requiring different lifestyle changes. 7


For more guidance on Lifestyle Therapy Modifications see page 91: AACE/ACE Guidelines 2016.
Available at:
https://journals.aace.com/doi/pdf/10.4158/EP161365.GL


Short and long-term objectives of obesity treatment

After having discussed and decided the most appropriate treatment plan with your patient, you can align on their short and long-term goals and objectives for their obesity management.
 
The first objective of treatment is to stabilise body weight. 2

 

  • During the first few months, guidelines recommend to monitor weight loss and waist circumference every 1-2 weeks to evaluate the efficiency of the treatment plan chosen with your patient and to progress step by step and review treatment where required.
  • After six months, monitoring once a month may be sufficient.2 Guidelines recommend that you should ask your patient how frequently they want consultations.
  • Long-term weight management may be more successful if it involves a self-management approach, continuing contact with your patient and behavioural strategies for maintaining motivation.2

Click here for more information on best practice for working with your patients with obesity to achieve successful weight management outcomes.