Outpatient Obesity Screening and Management
Definition: ...
340
Description

Outpatient Obesity Screening and Management

Definition: Overweight BMI 25.0-29.9 kg/m2; Obesity BMI ≥ 30 kg/m2; Severe Obesity BMI ≥ 40 kg/m2

Management: 

Set goals: Target initial weight loss of 5-7% body weight

Diet: Diet compliance (↓ # calories) more important than macronutrient composition. No data to guide specific diet choice. JAMA 2014;312:923

 • Mediterranean: High in monounsaturated fats, fruits, vegetables, legumes, grains; moderate dairy & EtOH; low meat (↓ overall mortality, CV mortality; may ↓ DM incidence independent of weight loss) PREDIMED NEJM. 2018 21;378

 • DASH: High in fruits/vegetables, moderate dairy, <25% caloric intake from fat (↓ SBP/DBP) Br J Nutr. 2015 14;113

Exercise:

 • >30 min, 5-7 days/wk; combine aerobic + resistance training for optimal health gains Arch Intern Med 2009;169:122

 • Not sufficient for wt loss; improves glycemic control, BP, and physical functioning; ↓CVD risk, predicts long-term weight mgmt

Medications:

 • Consider pharmacotherapy if BMI>30 or BMI>27 with >1 comorbidity

 • Options: Orlistat, phentermine/topiramate, naltrexone/bupropion, lorcaserin, liraglutide, metformin (if pre-diabetic)

 • All have significant short-term weight loss (~5-15 lbs), but weight is typically gained back when medication d/c’d Bariatric surgery: Recommended for: BMI ≥40 OR BMI ≥35 with comorbid conditions; BMI <35 with insufficient evidence



#Obesity #Screening #Management #diagnosis #WeightLoss #primarycare
Contributed by

MGH White Book Manual
@MGHWhiteBook
Account created for the MGH Internal Medicine Housestaff Manual "White Book" - https://stk10.github.io/MGH-Docs/WhiteBook-2019-2020.pdf
0 Comments

Related content