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<sup>1</sup> Risk assessment for CVD, diabetes includes: hx, exam/BP, lab (including FBG, fasting lipid panel). Waist circ cutpoints indicate ↑ cardiometabolic risk [E]: women: >88 cm (>35 in); men: >102 cm (>40 in). If BMI >35, not necessary to measure waist circ. If CV risks (↑ BP, hyperlipidemia, hyperglycemia): counsel that lifestyle changes producing even modest, sustained wt ↓ of 3-5% produce clinically meaningful health benefits [S/A].<br><br>
<sup>2</sup> Adjust calorie restriction to current weight. Very low-cal diet (<800 kcal/day) used only in limited circumstances by trained practitioners in medical setting w/ medical monitoring/supervision and high-intensity lifestyle intervention [S/A].
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<sup>3</sup> Commercial programs can be prescribed, if peer-reviewed evidence of safety/efficacy [M/A].
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<sup>4</sup> Electronically delivered w/ personalized feedback from trained interventionist may result in smaller wt loss than face-to-face [M/A].
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<sup>5</sup> [Recommendations on specific drugs were not included in guideline.] If pt has not lost ≥5% initial weight after 12 wks on max-dose obesity drug, reassess risk/benefit, consider d/c.
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<sup>6</sup> Bariatric surgery: Procedure choice affected by pt factors (age, obesity severity/BMI, obesity-related comorbidities, other operative risk factors, short-/long-term complication risks, behavior/psychosocial factors, pt risk tolerance, provider factors (surgeon, facility), etc) [E/C]. Benefits of bariatric surgery: Greater weight loss/maintenance of lost weight, favorable impact on obesity-related comorbid conditions (↓ fasting glucose/insulin, ↓ T2DM incidence, ↑ T2DM remission, ↓ BP/use of BP meds, ↓ TGs, ↑ HDL-C, ↓ total:HDL-C ratio), improved health-related QOL, ↓ total mortality. Complications of bariatric surgery vary by procedure and pt-derived risk factors and may include: DVT/PE, need for reoperation, wound infxn, hemorrhage, anemia, iron/zinc/protein/vit D deficiency, neuropathy, ↑ PTH. <br><br>
<sup>7</sup> Progress: If ≥5% wt ↓ w/ sufficient health improvements: maintenance program x ≥1 yr [S/A]. If <5% wt ↓ and/or insufficient health improvements: intensive behavioral tx, reassess medical/contributing factors, add/re-eval obesity-drug tx, consider referral to experienced bariatric surgeon; consider options. Calculate BMI ≥1x/yr [E/C], measure waist circ ≥1x/yr [E/B].
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<sup>8</sup> Options: More intensive behavioral tx, alternate diet including options for meal replacement, referral to a nutrition professional, adjunctive obesity drug, refer for bariatric surgery eval if otherwise appropriate. If BMI <35, insufficient evidence to recommend for/against bariatric surgery [N].
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<sup>9</sup> Maintenance: Face-to-face/phone w/ regular contact (≥ monthly) w/ trained interventionist on physical activity (200-300 min/wk), wt monitoring (≥ weekly) and diet [S/A].
<sup>2</sup> Adjust calorie restriction to current weight. Very low-cal diet (<800 kcal/day) used only in limited circumstances by trained practitioners in medical setting w/ medical monitoring/supervision and high-intensity lifestyle intervention [S/A].
<br><br>
<sup>3</sup> Commercial programs can be prescribed, if peer-reviewed evidence of safety/efficacy [M/A].
<br><br>
<sup>4</sup> Electronically delivered w/ personalized feedback from trained interventionist may result in smaller wt loss than face-to-face [M/A].
<br><br>
<sup>5</sup> [Recommendations on specific drugs were not included in guideline.] If pt has not lost ≥5% initial weight after 12 wks on max-dose obesity drug, reassess risk/benefit, consider d/c.
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<sup>6</sup> Bariatric surgery: Procedure choice affected by pt factors (age, obesity severity/BMI, obesity-related comorbidities, other operative risk factors, short-/long-term complication risks, behavior/psychosocial factors, pt risk tolerance, provider factors (surgeon, facility), etc) [E/C]. Benefits of bariatric surgery: Greater weight loss/maintenance of lost weight, favorable impact on obesity-related comorbid conditions (↓ fasting glucose/insulin, ↓ T2DM incidence, ↑ T2DM remission, ↓ BP/use of BP meds, ↓ TGs, ↑ HDL-C, ↓ total:HDL-C ratio), improved health-related QOL, ↓ total mortality. Complications of bariatric surgery vary by procedure and pt-derived risk factors and may include: DVT/PE, need for reoperation, wound infxn, hemorrhage, anemia, iron/zinc/protein/vit D deficiency, neuropathy, ↑ PTH. <br><br>
<sup>7</sup> Progress: If ≥5% wt ↓ w/ sufficient health improvements: maintenance program x ≥1 yr [S/A]. If <5% wt ↓ and/or insufficient health improvements: intensive behavioral tx, reassess medical/contributing factors, add/re-eval obesity-drug tx, consider referral to experienced bariatric surgeon; consider options. Calculate BMI ≥1x/yr [E/C], measure waist circ ≥1x/yr [E/B].
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<sup>8</sup> Options: More intensive behavioral tx, alternate diet including options for meal replacement, referral to a nutrition professional, adjunctive obesity drug, refer for bariatric surgery eval if otherwise appropriate. If BMI <35, insufficient evidence to recommend for/against bariatric surgery [N].
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<sup>9</sup> Maintenance: Face-to-face/phone w/ regular contact (≥ monthly) w/ trained interventionist on physical activity (200-300 min/wk), wt monitoring (≥ weekly) and diet [S/A].
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Patient Type Detail Header (Long)
Assess progress:<sup>7</sup> ≥5% wt ↓, health goals; if goals not met, consider options.<sup>8</sup> Follow w/ maintenance program.<sup>9</sup>