Adult Obesity Clinical Guideline
Obesity refers to abnormal or excessive fat accumulation that may impair health .
Treatment should begin by making therapeutic lifestyle changes including diet modification , increased physical exercise as well as addressing any obesity related medical conditions detected during screening and evaluation .
Diagnosis : All adult patients should be screened for being overweight or obese . Measure body mass index ( BMI ) at each exam .
Underweight Healthy Weight Overweight Class I Obese Class II Obese Class III Obese
BMI < 18.5 |
BMI between 18.6 and 24.9 |
BMI between 25 and 29.9 |
BMI between 30 and 34.9 |
BMI between 35 and 39.9 |
BMI ≥40 |
Evaluation :
• A waist circumference measurement is recommended for patients with a BMI between 25 and 34.9 to provide additional information on risk .
• In patients with a BMI ≥25 and a waist circumference greater than ≥35 inches ( 88 cm ) ( women ) or ≥40 in ( 102 cm ) ( men ), an evaluation to determine the etiology of obesity and to estimate cardio metabolic and other risk is suggested .
• Assess patients for cardiovascular disease risk factors ( see Table 1 ) and other obesity-related medical conditions such as sleep apnea and type 2 diabetes mellitus .
• The evaluation should include a history and physical examination along with clinical and laboratory assessments including blood pressure , fasting blood glucose , fasting lipid panel , TSH , and liver enzymes .
• Intensive management of any CVD or obesity-related medical conditions should begin immediately . Treatment :
• It is important to set goals when discussing a weight loss program with a patient . An initial weight loss goal of 5 to 7 percent of body weight is realistic for most individuals within a six month period .
• The initial management of individuals who would benefit from weight loss is lifestyle intervention through a combination of diet , exercise , and behavior modification .
• Many types of diets produce modest weight loss . Options include low-calorie , low-fat , low-carbohydrate , and low glycemic index diets . Dietary adherence is an important predictor of weight loss , irrespective of the type of diet .
• Dietary counseling with a dietitian appears to facilitate weight loss , particularly during the first year of a weight loss program .
• For some patients who are unable to achieve weight loss goals with lifestyle intervention alone , adjunctive therapies ( pharmacologic therapy or bariatric surgery ) are an option .
• For individuals with a BMI ≥30 or a BMI of 27 to 29.9 with comorbidities and have failed to achieve weight loss goals through diet and exercise alone , pharmacologic therapy should be added to lifestyle intervention .
• For individuals with a BMI > 40 who have failed diet , exercise , and drug therapy , bariatric surgery is suggested . Individuals with a BMI > 35 with comorbidities may also be candidates for bariatric surgery , assuming the anticipated benefits outweigh the potential risks or side effects of the procedure .
Follow-up :
• A repeat BMI measurement and follow-up related to weight loss and / or weight maintenance should take place at least annually .
• Adhere to clinical guidelines related to follow-up for any other obesity-related medical conditions . Table 1 : Cardiovascular Disease Risk Factors
Modifiable : Non – Modifiable : Hypertension
Advanced age
Tobacco use Gender
Diabetes
Family history of CVD
Physical inactivity Unhealthy diet High cholesterol Overweight and obesity
Adult Obesity - 2