Guide to Managing Patients with Obesity

Patient presents with obesity: 

  • Obesity-related health complications
    • Type 2 diabetes
    • Cardiovascular disease
    • Hypertension
    • Obstructive sleep apnoea
    • Degenerative joint disease
    • Gastro-oesophogeal reflux disease
    • Gout
    • Gallstones
    • Venous stasis disease
    • Polycystic ovarian syndrome
    • Metabolic syndrome
    • Non-alcoholic steatohepatitis
    • Asthma
    • Mental health illness
  • History of obesity
    • Chronicity of obesity
    • Previous weight loss programs
    • Medications
    • Alcohol
    • Smoking history
    • Surgical history
    • Hypothyroidism

Clinical examination: 

  • Blood pressure
  • Signs of Cushing’s syndrome
  • Abdominal exam
  • BMI 

Investigations:

  • FBC
  • ELFTs
  • TFTs
  • HbA1c
  • Fasting glucose
  • Glucose tolerance
  • Fasting lipid profile (with HDL)

Management Plan

If BMI > 27 with health complications, or BMI > 30

  • Multidisciplinary lifestyle plan  with advice on diet, exercise, behavioural modification, alcohol and smoking [reliably produces and sustains between 5 and 10% excess weight loss]
  • Consider the addition of pharmacotherapy

Refer to the Surgical Weight Loss Centre

  • If BMI > 30 with Type 2 diabetes and increased cardiovascular risk
  • If BMI > 35 with obesity related co-morbidities
  • If BMI > 40 

[reliably produces and sustains between 60 and 80% excess weight loss]

 

For your convenience, you can download an A4 printable version of this guide here