More than one third of adults in the United States today are classified as obese. Defined as a body mass index (BMI) of ≥30 kg/m2, obesity isassociated with extremely high medical costs, including absenteeism. In addition, comorbidities related to obesity are many of the leading causes of preventabledeath: heart disease, stroke, type 2 diabetes, and certain types of cancer.4

Significant and clinically relevant improvements in cardiovascular disease risk factors such as glycemia, blood pressure, triglycerides, and HDL cholesterolcan be produced with modest weight loss, 5% to 10% of body weight, with even greater improvements observed with reductions of 10% to 15% of bodyweight.4

As a heterogenous disease, obesity requires an individualized approach to treatment. The new evidence-based American Association of ClinicalEndocrinologists/American College of Endocrinology Comprehensive Clinical Practice Guidelines for Medical Care of Patients with Obesity provides acomprehensive treatment algorithm that includes whether the patient presents with “weight-related disease or complication that could be improved by weight losstherapy.”1 

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The guidelines differentiate between an “anthropometric component” of the medical diagnosis of obesity, defined as excess adiposity, and the “clinicalcomponent,” defined as weight-related complications. These 16 complications are prediabetes, metabolic syndrome, type 2 diabetes, dyslipidemia, hypertension,cardiovascular disease, nonalcoholic fatty liver disease, polycystic ovary syndrome, female infertility, male hypogonadism, obstructive sleep apnea,asthma/reactive airway disease, osteoarthritis, urinary stress incontinence, gastroesophageal reflux disease, and depression.

Based on clinical judgment, for patients who are obese with at least 1 severe complication, suggested treatment may include lifestyle therapy (meal plan,physical activity, and behavioral intervention), the addition of pharmacotherapy (BMI ≥27 kg/m2), or consideration for bariatric surgery (BMI ≥35kg/m2).1, 3