BMI ≥30 kg/m² (Asians ≥27.5); excess adiposity linked to cardiometabolic risk.
Etiology
- • Energy imbalance
- • Genetic / endocrine (Cushing, hypothyroidism)
- • Drugs (steroids, antipsychotics, insulin)
Risk factors
- • Sedentary lifestyle
- • High-calorie diet
- • Family history
- • Sleep deprivation
History taking
- • Weight trajectory, dieting attempts
- • Diet recall, physical activity
- • Snoring, daytime sleepiness
- • Mood, binge eating
Examination
- • BMI, waist circumference, BP
- • Acanthosis nigricans, striae, hirsutism
- • Signs of OSA, hepatomegaly
Red flags
- • Rapid unintentional weight gain with hypertension (Cushing)
- • Severe OSA with hypoxia
- • Suicidal ideation
Differential diagnosis
- • Hypothyroidism
- • Cushing syndrome
- • PCOS
- • Drug-induced weight gain
Recommended investigations
- • Fasting glucose / HbA1c
- • Lipid profile
- • TSH
- • LFT, uric acid
- • Consider sleep study if OSA suspected
Diagnosis
- • Clinical diagnosis supported by targeted investigations
Initial treatment / management
- • Aim 5–10% weight loss in 6 months
- • 500–750 kcal/day deficit
- • ≥150 min/week aerobic + resistance
- • Behavioural therapy
Drug therapy
- • Orlistat 120 mg TDS with meals
- • Liraglutide 3 mg SC OD (titrate)
- • Semaglutide 2.4 mg SC weekly
- • Consider bariatric surgery if BMI ≥35 with comorbidity
Lifestyle advice
- • Mediterranean / DASH diet
- • Reduce ultra-processed foods
- • Sleep 7–9 h
- • Limit alcohol
Follow-up advice
- • Monthly weight, BP, waist
- • Reassess pharmacotherapy at 3 months — stop if <5% loss
Patient counselling
- • Set realistic, sustainable goals
- • Address weight stigma
- • Family meal planning
Referral criteria
- • Endocrinology if secondary cause
- • Bariatric surgery clinic if BMI ≥35 with comorbidity
Clinical pearls
- • Every 1 kg lost reduces fasting glucose ~0.2 mmol/L
- • Waist > 90 cm (M) / 80 cm (F) Asians = central obesity
References
- • NICE CG189 Obesity
- • WHO 2024 Clinical management of obesity
Educational outpatient guide — verify against local guidelines before clinical use.
