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. Three drugs (orlistat, sibutramine and rimonabant) can double the benefits at 1–2 years. Gastric bypass surgery is effective and improves health risks for extreme obesity (BMI > 40) and when severe medical complications (e.g. diabetes, sleep apnoea) have arisen.