A combination of treatment options are needed to help people with obesity lose weight and improve their health1,2

Healthy eating and physical activity must be part of any weight-loss intervention, but are not always sufficient to maintain weight loss.1
 

Clinical management of obesity: AHA/ACC/TOS guideline1

Clinical management of obesity guideline
Clinical management of obesity guideline


Adapted from Jensen MD, Ryan DH, Apovian CM, et al; American College of Cardiology/American Heart Association Task Force on Practice Guidelines; Obesity Society. 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society. J Am Coll Cardiol. 2014;63(25 pt B):2985-3023.

AHA=American Heart Association.
ACC=American College of Cardiology.
TOS=The Obesity Society.

aYes alone indicates that the treatment is indicated regardless of the presence or absence of comorbidities. The solid arrow indicates the point at which treatment may be initiated.


Managing obesity requires a stepwise approach, based on your patient's BMI 

  • All patients for whom weight loss is recommended should be offered comprehensive lifestyle intervention.Key lifestyle changes include healthy eating, behavior modification, and physical activity1
  • For patients with BMI≥27 kg/m2 with more than 1 comorbidity associated with obesity or with BMI≥30 kg/m2, pharmacotherapy can be considered in conjunction with comprehensive lifestyle intervention1
  • For patients with BMI≥35 kg/m2 with comorbidities associated with obesity or with BMI≥40 kg/m2 who have not achieved health goals with lifestyle intervention with or without pharmacotherapy, bariatric surgery may be an appropriate option1

There are two main types of pharmacological treatments

Short-term treatments3

  • These medications are usually taken for up to 12 weeks

Long-term treatments4,5

  • These medications may be taken for at least 1 year to help patients support a healthier weight and treat the chronic disease of obesity
  • Pharmacological management may help with a patient’s ability to maintain lifestyle changes that lead to healthier weight

Pharmacological medications may help the patient to lower appetite or decrease the amount of fat the body absorbs.3,6

Pharmacological therapy and surgery should be considered an adjunct to healthy eating, physical activity, and behavioral therapy.1

Bariatric surgeries

Weight loss surgery may be an option for your patients if:1,3

  • Their BMI ranges from 35-39.9 kg/mand they have an obesity-related comorbidity, or
  • Their BMI is ≥40 kg/m2

Studies show that bariatric surgery is associated with a 30%-50% lower risk of death in patients at 7-15 years compared with those not having surgery.7

 

Also in The Science of Obesity:

   

Related Information


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Useful links and obesity treatment guidelines

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References:

  1. Jensen MD, Ryan DH, Apovian CM, et al; American College of Cardiology/American Heart Association Task Force on Practice Guidelines; Obesity Society. 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society. J Am Coll Cardiol. 2014;63(25 pt B):2985-3023.

  2. Ferguson C, David S, Divine L, et al; George Washington University, School of Public Health and Health Services, Department of Health Policy. Obesity Drug Outcome Measures: A Consensus Report of Considerations Regarding Pharmacologic Intervention. https://publichealth.gwu.edu/pdf/obesitydrugmeasures.pdf. Accessed March 11, 2015.

  3. The American College of Obstetricians and Gynecologists. ACOG obesity toolkit. https://www.acog.org/About-ACOG/ACOG-Departments/Toolkits-for-Health-Care-Providers/Obesity-Toolkit. Accessed March 22, 2018. 
  4. Yanovski SZ, Yanovski JA. Long-term drug treatment for obesity: a systematic and clinical review. JAMA. 2014;311(1):74-86. 
  5. Khera R, Murad MH, Chandar AK, et al. Association of pharmacological treatments for obesity with weight loss and adverse events: a systematic review and meta-analysis. JAMA. 2016;315(22):2424-2434.
  6. Kim GW, Lin JE, Blomain ES, Waldman SA. Anti-obesity pharmacotherapy: new drugs and emerging targets. Clin Pharmacol Ther. 2014;95(1):53-66.
  7. Schroeder R, Harrison TD, McGraw SL. Treatment of adult obesity with bariatric surgery. Am Fam Physician. 2016;93(1):31-37.