Office-Based Strategies in Obesity Management

Obesity is on the rise, with the latest data from the United States showing a prevalence of 41.9%. Although obesity is typically defined as a body mass index (BMI) of 30 kg/m² or higher, a waist circumference of 35 inches or more for women and 40 inches or more for men may be a more accurate indicator, particularly in older adults. 

In evaluating patients who are overweight or obese, it is essential to assess whether they are under medications that can lead to weight gain and to identify any comorbid conditions linked to or resulting from obesity. Clinicians should also inquire about past weight-management efforts and their effectiveness. 

the initial lab tests must include a complete blood count, metabolic profile, lipid panel, thyroid-stimulating hormone, and A1C levels, with additional tests as needed. 

The Obesity Medicine Association suggests a comprehensive approach to weight management consisting of five pillars – behavioral counseling, nutrition, physical activity, pharmacotherapy, and, when appropriate, bariatric procedures. Medications like glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and sympathomimetics should be considered for patients with a BMI of 30 kg/m² or higher and in those with a BMI of 27 kg/m² or higher with metabolic comorbidities. Bariatric surgery is an additional option for patients who meet this criteria. 

Effective obesity management requires personalized support and regular follow-ups throughout all treatment phases.  

Source: Keating MK, Woodruff RK, Saner EM. Am Fam Physician. 2024;110(2):145-156.