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Obesity management — MCCQE Part 1 MCQ

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HardPreventive MedicineObesity managementMCCQE Part 1

A 43-year-old man has BMI 34 kg/m², obstructive sleep apnea, and prediabetes. A respectful assessment confirms that he wants medical treatment after repeated unsustained lifestyle-only attempts. There is no contraindication to available obesity medication. Which counselling is most appropriate?

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Correct answer: E — Offer evidence-based pharmacotherapy with behavioural support as long-term, individualized chronic-disease treatment

He meets guideline criteria to discuss evidence-based obesity pharmacotherapy because BMI is at least 30 kg/m² and he has important adiposity-related complications. Treatment should be selected through shared decision-making, combined with behavioural and health supports that fit his goals, and continued long term when it is effective and tolerated. Stopping an effective medication after an arbitrary short course commonly leads to weight recurrence because obesity is a chronic disease. Unregulated supplements lack the efficacy, quality control, and safety evidence required for first-line treatment. Stigma or a willpower-only framework undermines care. Sleep apnea and prediabetes should be managed concurrently rather than withheld as leverage for weight loss. Metabolic or bariatric surgery can also be discussed when appropriate.

Reference: Canadian adult obesity pharmacotherapy guideline update, CMAJ 2025: https://www.cmaj.ca/content/197/27/E797