Management of obesity and overweight

Modern weight management incorporates optimization of health and risk factors, irrespective of weight change short-term weight loss, and long-term prevention of weight gain/regain (SIGN 2010). Patients with excess body fat and metabolic risks in need of professional weight management can be identified by a large waist (>102 cm for men, >88 cm for women). For most overweight and obese patients, a modest weight loss of 5–10 kg, achievable by many methods, brings multiple benefits. A target loss of 15 kg is now recommended for severe and medically complicated obesity, for example, to obtain remission from type 2 diabetes mellitus. 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. Based on results from bariatric surgery, which improves multiple health risks and extends life expectancy for extreme obesity (BMI >40), a target of >15-kg loss, more in line with the wishes of patients, is now justified on medical grounds. Low energy, nutritionally complete formula diets (c.800 kcal/day) for 8–12 weeks of Total Diet Replacement will produce >15-kg weight loss for 30–40% of patients, which can be maintained using stepped food reintroduction, and/or anti-obesity drugs.