Obesity in adults

Presentation of obesity may range from asymptomatic to presentation complicated by multiple comorbidities, including cancer, coronary artery disease, diabetes, hypertension, gout, obstructive sleep apnea, and osteoarthritis. It is estimated that nearly 4 million people die each year as a consequence of weight-related comorbidities.

The definitive test for the diagnosis of obesity remains the body mass index (BMI; obesity is defined as a BMI ≥30 kg/m²).

Central or abdominal obesity has a stronger association with obesity-related comorbidity than peripheral (i.e., subcutaneous) obesity, so waist circumference may be a better indicator of the risk for obesity-related comorbidity than BMI.

The mainstay of nonsurgical treatment of obesity is diet and exercise, with psychological therapy as a recommended adjunct for all patients. The risk of complications is low, but the overall efficacy and durability of this combination is poor.

Drug therapy may be considered as an adjunct to diet and exercise (never as monotherapy) for patients with a BMI ≥30 kg/m². Pharmacotherapy has modest short-term efficacy but a high attrition rate and a lack of long-term efficacy.

Surgical treatment is an option for patients with BMI ≥40 kg/m², or ≥30 kg/m² with significant comorbidities. In general, weight-reductive surgery is performed through manipulation of the stomach or small bowel, or a hybrid of both. Potential complications are numerous, but have declined in recent decades. Studies now suggest that surgical treatment is more effective for severe obesity than nonsurgical treatment.

Obesity can be defined as a chronic adverse condition due to an excess amount of body fat. While there are many methods to determine the relative amount of body fat, the most widely used method to determine obesity is the body mass index (BMI), defined as weight divided by height squared ([weight in kg]/[height in m]²).[1]Jensen MD, Ryan DH, Apovian CM, et al; American College of Cardiology/American Heart Association Task Force on Practice Guidelines; Obesity Society. 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society. Circulation. 2014 Jun 24;129(25 suppl 2):S102-38. https://www.ahajournals.org/doi/full/10.1161/01.cir.0000437739.71477.ee http://www.ncbi.nlm.nih.gov/pubmed/24222017?tool=bestpractice.com [2]World Health Organization. WHO discussion paper: draft recommendations for the prevention and management of obesity over the life course, including potential targets. August 2021 [internet publication]. https://www.who.int/publications/m/item/who-discussion-paper-draft-recommendations-for-the-prevention-and-management-of-obesity-over-the-life-course-including-potential-targets [3]Kopelman PG. Obesity as a medical problem. Nature. 2000 Apr 6;404(6778):635-43. http://www.ncbi.nlm.nih.gov/pubmed/10766250?tool=bestpractice.com