September 1, 2016 ◆ Volume 94, Number 5 www.aafp.org/afp American Family Physician 361
Obesity is a common condition that is associated with numerous medical problems such as cardiovascular disease, pulmonary disease, and diabetes mellitus. Primary care physicians have an
important role in helping patients develop a successful weight loss plan to improve their overall
health. Dietary strategies emphasizing reduced caloric intake, regardless of the nutrient composition, are important for weight loss. Behavioral interventions such as motivational interviewing
and encouraging physical activity lead to additional weight loss when combined with dietary
changes. Medication regimens for concomitant medical problems should take into account the
effect of specific agents on the patient’s weight. Persons with a body mass index of 30 kg per m2
or greater or 27 kg per m2 or greater with comorbidities who do not succeed in losing weight
with diet and activity modifications may consider medication to assist with weight loss. Medications approved for long-term treatment of obesity include orlistat, lorcaserin, liraglutide, phentermine/topiramate, and naltrexone/bupropion. Physicians should consider referring patients
for bariatric surgery if they have a body mass index of 40 kg per m2 or greater. For those with
obesity-related comorbid conditions, patients should be considered for adjustable gastric banding or other bariatric surgical approaches if they have a body mass index of 30 to 39.9 kg per m2.
The most commonly performed procedures for weight loss are Roux-en-Y gastric bypass, sleeve
gastrectomy, and adjustable gastric banding. Bariatric surgery is the most effective intervention
for weight loss in obese patients, and it leads to improvement in multiple obesity-related conditions, including remission of diabetes. (Am Fam Physician. 2016;94(5):361-368. Copyright ©
2016 American Academy of Family Physicians.)
Update on Office-Based Strategies
for the Management of Obesity
MICHAEL ERLANDSON, MD; LAURIE C. IVEY, PsyD; and KATIE SEIKEL, DO, RD
Swedish Family Medicine Residency, University of Colorado School of Medicine, Littleton, Colorado
Obesity is a pervasive problem confronting patients and their physicians. From 2011 to 2012, 69% of U.S. adults were overweight or obese.1 Many common medical
problems, such as diabetes mellitus, pulmonary disease, and cardiovascular disease,
are related to obesity and can improve with
weight loss.2 The management of obesity
continues to evolve with the approval of new
treatments. This review will provide answers
to some of the common clinical questions
that physicians encounter when managing
obesity in the outpatient setting.
What Is the Family Physician’s Role in
Screening for and Managing Obesity?
Physicians should screen all patients for obesity
with measurement of body mass index (BMI)
or waist circumference. Diet and behavioral
interventions should be initiated in patients
who are obese.
The U.S. Preventive Services Task Force
(USPSTF) recommends that all persons
18 years and older be screened for obesity
(Table 11,3), and that those with a BMI of
30 kg per m2 or greater be offered intensive,
multicomponent behavioral interventions.2
The American Academy of Family Physicians recommends screening for obesity
followed by intensive counseling and behavioral interventions, with at least one session
per month for at least three months.4 Waist
circumference may be an acceptable alternative in some persons because BMI may not
account for the cardiovascular risk of central adiposity. Family physicians can assist
patients in setting weight loss goals, improving nutrition, increasing physical activity,
addressing barriers to change, and developing strategies to maintain long-term lifestyle changes. Behavior modifications can
lead to clinically important weight loss of
CME This clinical content
conforms to AAFP criteria
for continuing medical education (CME). See CME Quiz
Questions on page 346.
Author disclosure: No relevant financial affiliations.
▲ Patient information:
A handout on this topic is
available at http://www.