Mount Carmel Health Partners Clinical Guidelines Adult Obesity

Adult Obesity Clinical Guideline
Quick Guide to Obesity
Definition: Obesity refers to abnormal or excessive fat accumulation that may impair health.
• 36.5% adults in the U.S. are obese.
• Weight loss in overweight/obese adults is
associated with decreased mortality.
• All patients who would benefit from
weight loss should receive counseling on
lifestyle changes and goals for weight
loss.
• A comprehensive lifestyle intervention
(combined diet, exercise, and behavioral
treatment) is the most important
strategy for weight loss.
• Pharmacologic and bariatric treatments
are recommended for consideration only
after diet and exercise weight loss
attempts have failed.
Evaluate for underweight
Causes: Obesity is the result of an imbalance between calories consumed and calories
burned. This is often caused by an increased intake of calorie-dense foods along with limited
physical activity.
Evaluation
Measure weight, height;
calculate BMI
No
BMI <18.5
Treatment
Is BMI 25 to 29.9 (overweight)
or 30 to 34.9 (class I obese)
or 35 to 39.9 (class II obese)
or ≥40 (class III obese)?
Yes
BMI ≥25
Assess and treat CVD risk
factors and obesity-related
comorbidities (See Table 1)
Assess weight and
lifestyle histories
No
BMI 18.5 – 24.9
Measure weight and
calculate BMI annually
or more frequently
Yes
Advise to avoid weight
gain; address and treat
other risk factors
Follow-up and
weight loss
maintenance
Is there a weight loss
of ≥ 5 % and sufficient
improvement in health
targets?
No
Does the patient need to
lose weight: BMI ≥30 or
BMI 25 to 29.9 with ≥1
risk factor(s) for CVD?
Yes
Intensive behavioral
treatment; reassess and
address medical or other
contributory factors;
consider adding or
reevaluating obesity
pharmacotherapy, and/or
refer to a Mount Carmel
bariatric surgeon
No
Yes
Is there a weight loss
of ≥ 5 % and sufficient
improvement in health
targets?
Determine weight
loss health goals
and intervention
strategies
No
Continue intensive
medical management
of CVD risk factors and
obesity-related
conditions; weight
management options
BMI ≥40 or BMI ≥35 with
comorbidity: offer referral
to an experienced bariatric
clinic for consultation and
evaluation as an adjunct to
comprehensive lifestyle
intervention
BMI ≥30 or BMI ≥27
with comorbidity: option
for adding
pharmacotherapy as an
adjunct to
comprehensive lifestyle
intervention
July 2017