Selection of treatment for overweight subjects is based upon an initial risk assessment. All should be evaluated for their readiness to change, an essential feature of those who are successful in losing weight. Patients who are in a pre-contemplative phase, in the early stages of thinking about it, are probably not candidates for an active program.

Those who are ready to lose weight should all receive basic information about behavior modification, diet, and exercise.

Diet and lifestyle

• All patients who are overweight (BMI ≥ 27 kg/m2) or obese (BMI ≥30 kg/m2), should receive counseling on diet, lifestyle, and goals for weight loss.

   

  Patients with a BMI of 25 to 29.9 kg/m2 who have an increased waist circumference (>40 inches/102 cm in men or >35 inches/88 cm in women) or those with a BMI 27 to 30 kg/m2 with comorbidities deserve the same consideration for obesity intervention as those with BMI≥30 kg/m2.

Pharmacotherapy

• For patients who have failed to achieve weight loss goals through diet and exercise alone, we suggest pharmacologic therapy

   

  Detailed recommendations for pharmacotherapy are discussed separately.
• Bariatric surgery

• For patients with BMI ≥40 kg/m2 who have failed diet and exercise (with or without drug therapy) or for patients with BMI >35 kg/m2 and obesity-related co-morbidities (hypertension, impaired glucose tolerance, diabetes mellitus, dyslipidemia, sleep apnea), we suggest bariatric surgery