obesity
OBESITY
Treatment Guideline Chart
Obesity is a chronic, progressive and relapsing medical condition characterized by the accumulation of abnormal or excessive body fat that impairs health.
Causes of obesity are multifactorial with complex interactions.
Treatment goals include addressing the principal cause of weight gain and focusing management on both weight loss and patient-centered health outcomes.
A multidisciplinary approach, that is a combination of dietary change, physical activity and behavioral modification, is recommended.

Obesity References

  1. Cosentino G, Conrad AO, Uwaifo GI. Phentermine and topiramate for the management of obesity: a review. Drug Des Devel Ther. 2011 Apr;7:267-278. http://www.ncbi.nlm.nih.gov/. Accessed 31 Jul 2013. PMID: 23630412
  2. Arterburn D, Hilton L, Li Z, et al. Meta-Analysis: pharmacologic treatment of obesity. Ann Intern Med. 2005 Apr;142(7):532-546. PMID: 15809465
  3. Bray GA. Medical therapy for obesity--current status and future hopes. Med Clin North Am. 2007 Nov;91(6):1225-1253. PMID: 17964918
  4. Lau DC, Douketis JD, Morrison KM, et al; Obesity Canada Clinical Practice Guidelines Expert Panel. 2006 Canadian clinical practice guidelines on the management and prevention of obesity in adults and children [summary]. CMAJ. 2007 Apr;176(8):S1-13. PMID: 17420481
  5. James WP, Astrup A, Finer N. Effect of sibutramine on weight maintenance after weight loss: a randomised trial. STORM Study Group. Sibutramine Trial of Obesity Reduction and Maintenance. Lancet. 2000 Dec;356(9248):2119-2125. PMID: 11191537
  6. Dickerson LM, Carek PJ. Pharmacotherapy for the obese patient. Prim Care. 2009 Jun;36(2):407-415. PMID: 19501251
  7. Mechanick JI, Garber AJ, Handelsman Y, Garvey WT. American Association of Clinical Endocrinologists' position statement on obesity and obesity medicine. Endocr Pract. 2012 Sep;18(5):642-648. PMID: 23047927
  8. Moyer VA; U.S. Preventive Services Task Force. Screening for and management of obesity in adults: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2012 Sep;157(5):373-378. PMID: 22733087
  9. Padwal R, Li S, Lau D. Long-term pharmacotherapy for obesity and overweight. Cochrane Database Syst Rev. 2004;3:CD004094. PMID: 15266516
  10. Shewmake RA, Huntington MK. Nutritional treatment of obesity. Prim Care. 2009 Jun;36(2):357-377. PMID: 19501248
  11. Torgerson JS, Hauptman J, Boldrin MN, et al. XENical in the prevention of diabetes in obese subjects (XENDOS) study: a randomized study of orlistat as an adjunct to lifestyle changes for the prevention of type 2 diabetes in obese patients. Diabetes Care. 2004 Jan;27(1):155-161. PMID: 14693982
  12. Snow V, Barry P, Fitterman N, Qaseem A, et al; Clinical Efficacy Assessment Subcommittee of the American College of Physicians. Pharmacologic and surgical management of obesity in primary care: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2005 Apr;142(7):525-531. PMID: 15809464
  13. WHO Expert Consultation. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet. 2004 Jan 10;363(9403):157-163. doi: 10.1016/S0140-6736(03)15268-3. PMID: 14726171
  14. Yanovski SZ, Yanovski JA. Obesity. N Engl J Med. 2002 Feb;346(8):591-602. doi: 10.1056/NEJMra012586. PMID: 11856799
  15. Tsigos C, Hainer V, Basdevant A, et al; Obesity Management Task Force of the European Association of the Study of Obesity. Management of obesity in adults: European clinical practice guidelines. Obes Facts. 2008;1(2):106-116. PMID: 20054170
  16. MedWormhttp://www.medworm.com/rss/index.php/Endocrinology/15/http://www.medworm.com/rss/medicalfeeds/specialities/Endocrinology.xml
  17. MedWormhttp://www.medworm.com/rss/index.php/Pediatrics/33/http://www.medworm.com/rss/medicalfeeds/specialities/Pediatrics.xml
  18. International Diabetes Federation. The IDF consensus worldwide definition of the metabolic syndrome. International Diabetes Federation. http://www.idf.org/. Apr 2005.
  19. U.S. Food and Drug Administration. Medication guide: Qsymia. US FDA. http://www.fda.gov/. 2012. Accessed 31 Jul 2013.
  20. National Institutes of Health, National Heart, Lung and Blood Institute, North American Association for the Study of Obesity. Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults. NHLBI. http://www.ncbi.nlm.gov/. 01 Oct 2000.
  21. Academy of Medicine of Malaysia, Malaysian Association for the Study of Obesity, Malaysian Endocrine and Metabolic Society, and The Ministry of Health, Malaysia. Clinical practice guidelines on the management of obesity. MOH (Malaysia). www.moh.gov.my/. 2004.
  22. Ministry of Health Malaysia, Academy of Medicine, Malaysian Association for the Study of Obesity, Malaysian Endocrine and Metabolic Society. Management of obesity. MEMS. http://www.mems.my/. 2004.
  23. Ministry of Health Singapore, Singapore Association for the Survey of Obesity. MOH clinical practice guidelines. Obesity. http://www.moh.gov.sg/. May 2004.
  24. World Health Organization. Obesity and overweight. WHO. http://www.who.int. Accessed 11 Jun 2010.
  25. Inoue S, Zimmet P, Caterson I, et al. The Asia-Pacific perspective: redefining obesity and its treatment. http://www.obesityasiapacific.com/. Feb 2000.
  26. Institute for Clinical Systems Improvement (ICSI). Prevention and management of obesity (mature adolescents and adults). http://www.icsi.org. Jan 2009. Accessed 10 Jun 2010.
  27. National Institute for Health and Care Excellence. Obesity: guidance on the prevention, identification, assessment and management of overweight and obesity in adults and children. NICE. http://www.nice.org.uk/. Dec 2006. Accessed 11 Jun 2010.
  28. Institute for Clinical Systems Improvement (ICSI). Prevention and management of obesity (mature adolescents and adults). http://www.icsi.org. Apr 2011.
  29. Apovian CM, Aronne LJ, Bessesen DH, et al. Pharmacological management of obesity: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2015 Feb;100(2):342-362. doi: 10.1210/jc.2014- 3415 . Accessed 6 Oct 2015. PMID: 25590212
  30. Jensen MD, Ryan DH, Apovian CM, et al. 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. Circulation. 2014 Jun;129(25)(Suppl 2):S102-S138. doi: 10.1161/01.cir.0000437739.71477.ee. Accessed 6 Oct 2015. PMID: 24222017
  31. Gonzalez-Campoy JM, St Jeor ST, Castorino K, et al. Clinical practice guidelines for healthy eating for the prevention and treatment of metabolic and endocrine diseases in adults: cosponsored by the American Association of Clinical Endocrinologists/the American College of Endocrinology and the Obesity Society. Endocr Pract. 2013 Sep;19(Suppl 3):1-82. doi: 10.4158/EP13155.GL. Accessed 07 Apr 2014. PMID: 24129260
  32. Guerrero AE, Gonzalez-Santos LE, Caole-Ang IV, et al. 2015 Updated clinical practice guidelines for the management of dyslipidemia in the Philippines. Philippine Society of Endocrinology, Diabetes and Metabolism. http://endo-society.org.ph. 2015. Accessed 03 Aug 2016.
  33. Bray GA, Frühbeck G, Ryan DH, et al. Management of obesity. Lancet. 2016 May 7;387(10031):1947-1956. doi: 10.1016/S0140-6736(16)00271-3. PMID: 26868660
  34. Garvey WT, Mechanick JI, Brett EM, et al; Reviewer of the AACE/ACE Obesity Clinical Practice Guidelines. American Association of Clinical Endocrinologists and American College of Endocrinology comprehensive clinical practice guidelines for medical care of patients with obesity. Endocr Pract. 2016 Jul;22(Suppl 3):1-203. doi: 10.4158/EP161365.GL. Accessed 24 Aug 2017. PMID: 27219496
  35. Gadde KM, Martin CK, Berthoud HR, et al. Obesity: pathophysiology and management. J Am Coll Cardiol. 2018 Jan 2;71(1):69-84. doi: 10.1016/j.jacc.2017.11.011. Accessed 16 Apr 2018. PMID: 29301630
  36. Kasama K, Mui W, Lee WJ, et al. IFSO-APC consensus statements 2011. Obes Surg. 2012 May;22(5):677-684. doi: 10.1007/s11695-012-0610-7. PMID: 22367008
  37. Health Promotion Board, Singapore. Obesity. HPB-MOH clinical practice guidelines 1/2016. Ministry of Health Singapore. https://www.moh.gov.sg. 2016.
  38. Durrer Schutz D, Busetto L, Dicker D, et al. European practical and patient-centred guidelines for adult obesity management in primary care. Obes Facts. 2019 Jan;12(1):40-66. doi: 10.1159/000496183. PMID: 30673677
  39. Lim RB. Bariatric procedures for the management of severe obesity. UpToDate. https://www.uptodate.com. Sep 2018. Accessed 20 Mar 2019.
  40. Perreault L. Obesity in adults: behavioral therapy. UpToDate. https://www.uptodate.com. Oct 2018. Accessed 20 Mar 2019.
  41. Perreault L. Obesity in adults: drug therapy. UpToDate. https://www.uptodate.com. Feb 2019. Accessed 20 Mar 2019.
  42. Ministry of Health of Singapore Health Promotion Board. Obesity clinical practice guidelines 1/2016. MOH Singapore. http://www.moh.gov.sg/. Jun 2016.
  43. Wharton S, Lau DCW, Vallis M, et al. Obesity in adults: a clinical practice guideline. CMAJ. 2020 Aug 04;192(31):E875-891. doi: 10.1503/cmaj.191707.
  44. American Diabetes Association. 8. Obesity management for the treatment of type 2 diabetes: standards of medical care in diabetes-2020. Diabetes Care. 2020;43(Suppl 1):S89–S97. https://doi.org/10.2337/dc20-S008. Accessed 26 Aug 2020
  45. Yumuk V, Tsigos C, Fried M, et al; Obesity Management Task Force of the European Association for the Study of Obesity. European guidelines for obesity management in adults. Obes Facts. 2015;8(6):402-424. doi: 10.1159/000442721. Accessed 06 Jan 2021. PMID: 26641646
  46. American Diabetes Association (ADA). Standards of medical care in diabetes - 2021. Diabetes Care. 2021 Jan;44(Suppl 1):S1-S232. https://care.diabetesjournals.org. Accessed 08 Jan 2021
  47. Asokkumar R. Endoscopic sleeve gastroplasty: a non-surgical approach to obesity. SingHealth. https://www.singhealth.com.sg. 04 Nov 2020.
  48. Bray GA, Kim KK, Wilding JPH, World Obesity Federation. Obesity: a chronic relapsing progressive disease process. A position statement of the World Obesity Federation. Obes Rev. 2017 Jul;18(7):715-723. doi: 10.1111/obr.12551. PMID: 28489290
  49. Coulter AA, Rebello CJ, Greenway FL. Centrally acting drugs for obesity: past, present, and future. Drugs. 2018 Jul;78(11):1113–1132. doi: 10.1007/s40265-018-0946-y. PMID: 30014268
  50. Ohta M, Seki Y, Wong SK, et al. Bariatric/metabolic surgery in the Asia-Pacific region: APMBSS 2018 survey. Obes Surg. 2019 Feb;29(2):534-541. doi: 10.1007/s11695-018-3539-7. PMID: 30306499
  51. Purcell K, Sumithran P, Prendergast LA, et al. The effect of rate of weight loss on long-term weight management: a randomised controlled trial. Lancet Diabetes Endocrinol. 2014 Dec;2(12):954-962. doi: 10.1016/S2213-8587(14)70200-1. Accessed 24 Feb 2021. PMID: 25459211
  52. Rubino F, Nathan DM, Eckel RH, et al. Metabolic surgery in the treatment algorithm for type 2 diabetes: a joint statement by international diabetes organizations. Diabetes Care. 2016 Jun;39(6):861-877. doi: 10.2337/dc16-0236. Accessed 24 Feb 2021. PMID: 27222544
  53. Veugen C, Teunissen EM, den Otter LAS, et al. Prediction of obstructive sleep apnea: comparative performance of three screening instruments on the apnea-hypopnea index and the oxygen desaturation index. Sleep Breath. 2020 Oct 24. doi: 10.1007/s11325-020-02219-6. PMID: 33098537
  54. Centers for Disease Control and Prevention (CDC). Obesity, race/ethnicity, and COVID-19. CDC. https://www.cdc.gov. 22 Mar 2021.
  55. World Obesity. Obesity and COVID-19 policy statement. World Obesity. https://www.worldobesity.org. Aug 2020.
  56. Ryan DH. Semaglutide for obesity: four STEPs forward, but more to come. Lancet Diabetes Endocrinol. 2021 May;9(5):252-254. doi: 10.1016/S2213-8587(21)00081-4. PMID: 33864806
  57. U.S. Food & Drug Administration (US FDA). Wegovy highlights of prescribing information. US FDA. https://www.accessdata.fda.gov. Jun 2021.
  58. Shah P, Rathi P, Mandot A, et al. Study and comparison of metabolic profile of lean and obese subjects with non alcoholic fatty liver disease. J Assoc Physicians India. 2020 Aug;68(8):51-54. PMID: 32738842
  59. Tak YJ, Lee SY. Long-term efficacy and safety of anti-obesity treatment: where do we stand?. Curr Obes Rep. 2021 Mar;10(1):14-30. doi: 10.1007/s13679-020-00422-w. PMID: 33410104
  60. U.S. Food & Drug Administration (US FDA). Contrave highlights of prescribing information. US FDA. https://www.accessdata.fda.gov. Sep 2014.
  61. Wharton S, Serodio KJ. Next generation of weight management medications: implications for diabetes and CVD risk. Curr Cardiol Rep. 2015 May;17(5):35. doi: 10.1007/s11886-015-0590-z. PMID: 25894803
  62. Whyte MB, Velusamy S, Aylwin SJB. Disease severity and staging of obesity: a rational approach to patient selection. Curr Atheroscler Rep. 2014 Nov;16(11):456. doi: 10.1007/s11883-014-0456-7. PMID: 25278281
  63. Yanovski SZ, Yanovski JA. Long-term drug treatment for obesity: a systematic and clinical review. JAMA. 2014 Jan 1;311(1):74-86. doi: 10.1001/jama.2013.281361. PMID: 24231879
  64. Modi N, Priefer R. Effectiveness of mainstream diets. Obesity Medicine. 2020 Jun;18:100239. https://doi.org/10.1016/j.obmed.2020.100239.
  65. Vargas G, Azarbal J, Tota-Maharaj R. A comparative review of established diets for prevention of cardiovascular disease and newer dietary strategies. Curr Probl Cardiol. 2021 Mar;46(3):100582. doi: 10.1016/j.cpcardiol.2020.100582. PMID: 32389436
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