How should I assess the need for pharmacological treatment in a patient with obesity?

Assessing the need for pharmacological treatment in a patient with obesity involves several key steps.

• First, confirm the patient's body mass index (BMI) and assess central adiposity using waist-to-height ratio, especially if BMI is below 35 kg/m², to estimate health risks related to obesity. This helps identify increased cardiometabolic risk and guides treatment decisions.
• Identify any weight-related comorbidities such as type 2 diabetes, hypertension, cardiovascular disease, or severe mobility problems, as these influence the urgency and type of treatment.
• Consider pharmacological treatment as an adjunct to a reduced-calorie diet and increased physical activity, ensuring the patient is motivated and informed about the potential benefits and side effects of medicines.
• Pharmacological treatment is generally considered for adults with a BMI of 30 kg/m² or more who have weight-related comorbidities, or a BMI of 35 kg/m² or more regardless of comorbidities.
• For people with recent-onset type 2 diabetes, expedited assessment for pharmacological treatment is recommended at lower BMI thresholds (e.g., BMI ≥ 30 kg/m² or lower for certain ethnic groups) due to higher cardiometabolic risk.
• Discuss with the patient the goals of treatment, emphasizing realistic, sustainable weight loss and the importance of ongoing lifestyle changes alongside medication.
• Arrange regular monitoring of treatment effectiveness and adherence, adjusting the plan as needed.
• Consider referral to specialist weight management services for comprehensive assessment and possible bariatric surgery if BMI thresholds and comorbidity criteria are met.

These steps ensure pharmacological treatment is appropriately targeted, patient-centred, and integrated with broader obesity management strategies.

References: NICE CKS,NICE NG246,NICE