Medical Management

The National Institutes of Health have published guidelines for the prevention and treatment of overweight and obesity.* The guide includes recommendations for the selection of appropriate therapies depending upon BMI and comorbidities.

Guide to Selecting Overweight and Obesity Treatment in Adults
Treatment by BMI Category  
Diet, physical activity and behavioral therapy
with comorbidities
regardless of comorbidities
with comorbidities
regardless of comorbidities

BMI ≥35 kg/m2
or the prescence at least one
severe comorbidity

  • Prevention of weight gain with lifestyle therapy is indicated in any patient with a BMI ≥ 25 kg/m2, even without comorbidities, while weight loss is not necessarily recommended for those with a BMI of 25–29.9 kg/m2 or a high waist circumference, unless they have two or more comorbidities.
  • Combined therapy with a low-calorie diet (LCD), increased physical activity, and behavior therapy can be a successful intervention for weight loss and weight maintenance.
  • Consider pharmacotherapy if a patient has not lost 1 pound per week after 6 months of combined diet and lifestyle therapy.
  • Pregnant patients require specialized assessment prior to diet or lifestyle changes.

Safe, sustained weight loss is usually the primary medical goal for overweight and obese patients. Even small amounts of weight loss can improve physical condition and reduce the effects of some comorbidities. However, the recommended initial weight loss target is usually about 10% of of body weight achieved over 6 months. The rate of weight loss should be 1 to 2 pounds each week. Greater rates of weight loss do not achieve better long-term results. After the first 6 months of weight loss therapy, the priority should be weight maintenance achieved through combined changes in diet, physical activity, and behavior. Further weight loss may be considered after a period of weight maintenance.

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