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Patient Care Process for the Management of Obesity

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  • Patient characteristics (e.g., age, race, sex)

  • Patient history (past medical, family, social—dietary habits, tobacco use)

  • Obesity-related conditions (see Figure 144-1)

  • Current medications including prescription, nonprescription, and herbal product use

  • Weight loss history and prior attempts to lose weight

  • Objective data

    • Height, weight, BMI, waist circumference, and blood pressure

    • Labs (e.g., glucose, hemoglobin A1c, lipid panel)


  • Presence of secondary obesity (e.g., hypothyroidism, Cushing syndrome)

  • Current medications that may contribute to weight gain (see Etiology)

  • Presence of obesity-related comorbidities (e.g., hypertension, dyslipidemia, coronary artery disease, type 2 diabetes mellitus, sleep apnea, increased waist circumference; see Figure 144-3)

  • Class of overweight and obesity determined by BMI, waist circumference, and obesity-related comorbidities (see Table 144-3)

  • Readiness to engage in weight loss efforts and potential barriers to success

  • Candidacy for treatment with implantable medical devices, bariatric surgery, or pharmacotherapy


  • Nonpharmacologic lifestyle intervention including low-calorie diet, physical activity, and behavioral modifications

  • Pharmacotherapy (if appropriate) including specific medication, dose, route, frequency, and duration; specify the continuation and discontinuation of existing therapies (see Table 144-4)

  • Initial weight loss goal of 5% to 10% over a 6-month time period

  • Monitoring parameters including efficacy (weight loss) and tolerability (medication-specific adverse effects)

  • Patient education (e.g., purpose of dietary and lifestyle modification, drug therapy)

  • Self-monitoring of weight—when and how to record results

  • Referrals to other providers when appropriate (e.g., physician, dietician, psychologist)


  • Educate patient regarding health risks associated with overweight and obesity

  • Provide patient education regarding all elements of treatment plan

  • Use motivational interviewing and coaching strategies to maximize adherence

  • Schedule follow-up (e.g., monthly for first 3 months and every 3 months thereafter)

Follow-up: Monitor and Evaluate

  • Determine weight loss goal attainment

  • Presence of adverse effects

  • Patient adherence to treatment plan using multiple sources of information

*Collaborate with patient, caregivers, and other health professionals


For the chapter in the Wells Handbook, please go to Chapter 58. Obesity.



  • Image not available. Two clinical measures of excess body fat, regardless of sex, are the body mass index (BMI) and the waist circumference (WC). BMI and WC provide a better assessment of total body fat than weight alone and are independent predictors of obesity-related disease risk.

  • Image not available. Excessive central adiposity increases risk for development of type 2 diabetes, hypertension, and dyslipidemia.

  • Image not available. Weight loss of as little as 5% of total body weight can significantly improve blood pressure, lipid levels, and glucose tolerance in overweight and obese patients. Sustained, large weight losses (eg, after bariatric surgery) are associated with a lower risk of cardiovascular events and death and with long-term improvements in many of the complications associated with obesity.

  • Image not available. Clinicians should consider the weight-altering effects of medications used to treat comorbid conditions (eg, antidepressants, antipsychotics, antiepileptics, and antidiabetics) and select medications that promote weight loss or ...

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