What are the recommended approaches for obesity management?

Comprehensive Approach to Obesity Management

Obesity management requires a multifactorial lifestyle program for at least 6-12 months, including individualized dietary intervention, increased physical activity, and behavioral modification strategies, to achieve a weight loss of 5-15% over 6 months. 1

Diagnosis and Assessment

• Use BMI as a routine diagnostic measure with country-specific cut points: ≥30 kg/m² indicating obesity and ≥25 kg/m² indicating overweight in Western countries, and ≥23 kg/m² indicating overweight in many Asian countries 1
• Measure waist circumference to assess abdominal adiposity: ≥88 cm for women and ≥102 cm for men in Western countries; ≥80 cm for women and ≥90 cm for men in Asian countries 1
• Conduct comprehensive clinical assessment to identify obesity-related complications including diabetes, hypertension, dyslipidemia, sleep apnea, and cardiovascular disease 1

First-Line Treatment: Lifestyle Modification

Dietary Intervention

• Reduce caloric intake by at least 500 kcal/day while ensuring sufficient protein, vitamins, and minerals 1
• Aim for approximately 55% of calories from carbohydrates, 10% from proteins, and 30% from fats (with ≤10% from saturated fats) 1
• Eliminate sugar-sweetened beverages to reduce daily caloric intake 2
• Focus on whole grains and reduce intake of fast food and energy-dense items 2

Physical Activity

• Recommend 150-300 minutes/week of moderate-intensity activity 1
• Implement gradual increases in activity levels based on individual fitness and capabilities 1
• For teenagers, promote 60 minutes of moderate to vigorous physical activity daily 2

Behavioral Therapy

• Implement self-monitoring, mindful eating, stimulus control, and stress management techniques 1
• Consider motivational interviewing techniques and technology-based tools to support adherence 1
• For teenagers, use a family-centered approach with the adolescent as the change agent 2

Second-Line Treatments

Pharmacotherapy

• Consider anti-obesity medications when lifestyle interventions alone are insufficient 1
• FDA-approved options include orlistat, naltrexone/bupropion, liraglutide, and other GLP-1 receptor agonists 1, 3
• Orlistat is indicated for weight loss in overweight adults (18 years and older) when used along with a reduced-calorie and low-fat diet 4
• Take orlistat as 1 capsule with each meal containing fat, not exceeding 3 capsules daily 4
• Take a multivitamin once daily at bedtime when using orlistat 4
• For adolescents with severe obesity, consider orlistat under care of an experienced clinician 2

Bariatric Surgery

• Consider for patients with BMI ≥35 kg/m² when non-surgical interventions have failed 1
• Surgical options include gastric banding, sleeve gastrectomy, and Roux-en-Y gastric bypass 1
• Bariatric surgery achieves approximately 25-30% weight loss and significant improvements in obesity-related comorbidities 1
• For adolescents with BMI far above 35 and comorbidities unresponsive to lifestyle therapy for 1 year, consider bariatric surgery 2

Treatment Goals and Monitoring

• Set realistic weight loss targets of 5-15% over 6 months, followed by long-term weight maintenance 1
• Regularly assess progress and adjust treatment approach as needed 1
• For growing teenagers, focus on weight maintenance rather than weight loss, allowing BMI to gradually decrease as height increases 2
• Tailor treatment intensity based on obesity severity and related complications 1

Important Considerations and Pitfalls

• Recognize obesity as a chronic disease requiring ongoing support, not a temporary condition 1
• Focus on overall health improvements rather than solely on weight 1
• Continue behavioral support even when using pharmacotherapy or after bariatric surgery 1
• Use respectful, non-stigmatizing language in all patient interactions 1, 2
• Weight regain is common after weight loss; long-term support is essential 2, 5
• For teenagers, avoid approaches that might induce unhealthy slimming practices or lead to eating disorders 2
• Energy restriction must be carefully monitored in adolescents to avoid compromising normal growth and development 2