Addressing
Obesity
in the Clinic
Treatment Modalities
Lifestyle changes, psychological interventions, pharmacological management, and bariatric surgery are the key treatment modalities for obesity.1-3
Lifestyle Modification2,4
Medical nutrition therapy:
- Long-term adherence to a healthy eating pattern that is personalized to meet individual values and preferences
Increased exercise:
- At least 150 minutes of physical activity per week
Pharmacotherapy5-8
Some treatment options could be not available in your country, please refer to locally approved SmPc
| Name | Class | FDA Approval Year |
|---|---|---|
| Phentermine monotherapy | Sypathomimetic | 1959 |
| Orlistat | Pancreatic lipase inhibitor | 1999 |
| Phentermine/topiramate ER | Sympathomimetic anticonvulsant | 2012 |
| Naltrexone/bupropion SR | Opioid receptor antagonist, dopamine and norepinephrine reuptake inhibitor | 2014 |
| Liraglutide 3 mg | GLP-1 receptor agonist | 2014 |
| Semaglutide 2.4 mg | GLP-1 receptor agonist | 2021 |
| Tirzepatide | GIP/GLP-1 receptor agonist | 2023 |
ER= extended release; SR= sustained release.
Bariatric Surgery2
- BMI of ≥40 kg/m2
- BMI of ≥35 kg/m2 with a complication related to obesity, such as T2D, or obstructive sleep apnea
- BMI of ≥30 kg/m2 with T2D that is difficult to control with medical treatments and lifestyle changes alone
Effective partnership is essential for long-term success2
The “5 As” model can help you discuss weight management with your patients9
The graphic shows a conversation flow based on the "5A" model. The "5A" model is an easily implemented evidence-based and behavior-oriented intervention strategy. It can help to increase the success of weight management in primary care. 6
- Ask: Ask for permission. Ask patients for permission to talk about body weight together. Don't judge and explore readiness for change.
- Assess: Assess the current situation. Measure BMI, waist circumference and degree of obesity. Record possible causes and complications caused by excess weight.
- Advise: Educate and advise patients about the health risks of obesity and the benefits of moderate weight loss and advise them on long-term strategies and treatment options.
- Agree: Agree on specific goals. Talk to patients about realistic expectations. Agree on realistic goals for weight loss, behavior change, and other details of the treatment plan.
- Assist: Support. Identify and address potential obstacles. Provide information, support in finding suitable co-treatment partners and arrange regular follow-up appointments.
Find important information about obesity therapy
- Garvey WT, Mechanick JI, Brett EM, et al. American Association of Clinical Endocrinologists and American College of Endocrinology comprehensive clinical practice guidelines for medical care of patients with obesity. Endocr Pract. 2016;22(suppl 3):1-203. doi:10.4158/EP161365.GL
- Wharton S, Lau DCW, Vallis M, et al. Obesity in adults: a clinical practice guideline. I.2020;192(31):E875-E891. doi:10.1503/cmaj.191707
- Ruban A, Stoenchev K, Ashrafian H, Teare J. Current treatments for obesity. Clin Med (Lond). 2019;19(3):205-212. doi:10.7861/clinmedicine.19-3-205
- Jastreboff AM, Aronne LJ, Ahmad NN, et al. Tirzepatide once weekly for the treatment of obesity. N Engl J Med. 2022;387(3):205-216. doi:10.1056/NEJMoa2206038
- Garvey WT. New horizons. A new paradigm for treating to target with second-generation obesity medications. J Clin Endocrinol Metab. 2022;107(4):e1339-e1347. doi:10.1210/clinem/dgab848
- Bersoux S, Byun TH, Chaliki SS, Poole KG. Pharmacotherapy for obesity: what you need to know. Cleve Clin J Med. 2017;84(12):951-958. doi:10.3949/ccjm.84a.16094
- Mounjaro (tirzepatide once weekly) [Summary of Product Characteristics]. Houten, The Netherlands: Eli Lilly and Company.
- FDA approves new medication for chronic weight management. Press release. FDA. November 8, 2023. Accessed December 13, 2023. https://www.fda.gov/newsevents/press-announcements/fda-approves-new-medication-chronic-weightmanagement
- Vallis M, Piccinini-Vallis H, Sharma AM, Freedhoff Y. Clinical review: modified 5 As: minimal intervention for obesity counseling in primary care. Can Fam Physician. 2013;59(1):27-31.