Adults with Obesity: Clinical Practice Guideline for Office Visits

Summary of the Endocrine Society's Guideline on the Pharmacological Management of Obesity

This article is the second in a 4-part series on the Endocrine Society’s clinical practice guideline on the pharmacological management of obesity. This section presents steps to take during an office visit for adults with obesity.  

The task force that developed the guidelines recommended that, for adults with obesity, the following be done during office visits:

Screen for the chronic co-morbid conditions:

  • type 2 diabetes
  • cardiovascular disease
  • hypertension
  • hyperlipidemia
  • obstructive sleep apnea
  • nonalcoholic fatty liver disease
  • osteoarthritis
  • major depression

Follow national cancer screening guidelines as adults with obesity are at increased risk for many types of cancer (including breast, esophagus, stomach, gallbladder and colon).

Look for potential contributing factors for obesity, including family history, sleep disorders, eating disorders, genetics, and environmental or socioeconomic causes.

Screen for the following secondary causes of obesity if history and/or physical examination suggest that these factors may play a role in the patient’s condition:

  • Neurological
    • Brain injury or tumor
    • History of brain radiation therapy
    • Hypothalamic obesity
  • Endocrine
    • Cushing syndrome
    • Growth hormone deficiency
    • Hypothyroidism
    • Pseudohypoparathyroidism
  • Psychological
    • Depression associated with overeating or binging
    • Other eating disorders
  • Drug related
    • Antipsychotics
    • Anticonvulsants
    • β-blockers
    • Glitazones
    • Glucocorticoids
    • Oral contraceptives
    • Sulfonylureas
    • Tricyclic antidepressants

Follow the 2013 guidelines on management of overweight and obesity in adults issued by the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society:

  • Pharmacotherapy can be considered as an adjunct to a comprehensive lifestyle intervention for chronic weight management in adults with a body mass index (BMI) ≥30 kg/m2 or ≥27 kg/m2 with ≥1 obesity-related comorbidity who are motivated to lose weight. See Part 3 of this series for more information on pharmacotherapy for obesity.
  • Referral to a bariatric surgeon may be offered to adults with a BMI ≥40 kg/m2 or BMI ≥35 kg/m2 with obesity-related comorbidities who have not sufficiently responded to lifestyle intervention with or without pharmacotherapy.
  • Identify medications patients are taking for other conditions (eg, diabetes) that may contribute to weight gain and prescribe agents that are weight neutral or promote weight loss (eg, bupropion, exenatide, liraglutide, metformin, methylphenidate, thyroid hormones, topiramate, and zonisamide). See Part 4 this series for more information.
  • Prescribe a treatment plan based on healthy eating and good nutrition, increased physical activity, and behavioral changes.

June 6, 2015

Read other sections of the clinical practice guideline summary:

Continue Reading:
Pharmacological Management of Obesity: Agents and Mechanisms of Action
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