Management of obesity and overweight

Modern weight management incorporates optimization of health and risk factors, short-term weight loss, and long-term weight maintenance and prevention of regain. Patients in need of professional weight management can be identified by a large waist (>102 cm for men, >88 cm for women). A structured programme addressing diet and physical activity, and behavioural management, as used in the UK Counterweight Programme, is cost-effective in generating 5–10% weight loss for 30–40% of patients. The available anti-obesity drugs (orlistat, sibutramine (in some countries) and liraglutide (for obese patients with diabetes)) can double the weight loss and clinical benefits for at least 2–4 years. Bariatric surgery is effective and improves multiple health risks for extreme obesity (BMI >40) and when severe medical complications (e.g. diabetes, sleep apnoea) have arisen. Very low-energy diets (400–800 kcal) produce 10–20 kg weight loss that can be maintained using stepped food reintroduction and anti-obesity drugs. For most overweight and obese patient, a modest weight loss of 5–10 kg, achievable by many methods, brings multiple benefits. A target loss of 15 kg is necessary to reverse the diagnosis of type 2 diabetes, and restore a non-diabetic life expectancy.