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ALL / Endocrinology
Obesity: classification and therapeutic options
Obesity: classification and therapeutic options
Classification
BMI = weight (kg) / height (m)²
| Description | BMI range (kg/m²) |
|---|---|
| Underweight | < 18.5 |
| Normal | 18.5 - 24.9 |
| Overweight | 25 - 29.9 |
| Obese class 1 | 30 - 34.9 |
| Obese class 2 | 35 - 39.9 |
| Obese class 3 | ≥ 40 |
Management
The management of obesity consists of a step-wise approach:
- conservative: diet, exercise, behavioural interventions
- medical
- orlistat
- GLP-1 receptor agonists (e.g. liraglutide, semaglutide)
- surgical
Orlistat is a pancreatic lipase inhibitor used in the management of obesity. Adverse effects include faecal urgency/incontinence and flatulence. A lower dose version is now available without prescription ('Alli'). NICE have defined criteria for the use of orlistat. It should only be prescribed as part of an overall plan for managing obesity in adults who have:
- BMI of 28 kg/m^2 or more with associated risk factors, or
- BMI of 30 kg/m^2 or more
- continued weight loss e.g. 5% at 3 months
- orlistat is normally used for ≤ 12 months
GLP-1 receptor agonists
- mimic endogenous GLP-1 → increase satiety, reduce appetite, delay gastric emptying
- examples: liraglutide (once daily SC), semaglutide (once weekly SC)
- NICE recommends use in specialist weight management services
- current NICE criteria for use (summary):
- BMI ≥ 35 kg/m² with at least one weight-related comorbidity (e.g. T2DM, hypertension)
- consider lower BMI thresholds (e.g. ≥ 32.5 kg/m²) in people from minority ethnic groups
- used alongside diet, physical activity and behavioural support
- continue only if adequate response (e.g. ≥ 5% weight loss at 6 months for semaglutide; 3 months for liraglutide)
+PassMedicine Notes
Classification
BMI = weight (kg) / height (m)²
Description_BMI range (kg/m²)| Underweight_< 18.5 | Normal_18.5 - 24.9 | Overweight_25 - 29.9 | Obese class 1_30 - 34.9 | Obese class 2_35 - 39.9 | Obese class 3 _≥ 40 |Management
The management of obesity consists of a step-wise approach:- conservative: diet, exercise, behavioural interventions
- medical
- orlistat
- GLP-1 receptor agonists (e.g. liraglutide, semaglutide)
- surgical
- BMI of 28 kg/m^2 or more with associated risk factors, or
- BMI of 30 kg/m^2 or more
- continued weight loss e.g. 5% at 3 months
- orlistat is normally used for ≤ 12 months
- mimic endogenous GLP-1 → increase satiety, reduce appetite, delay gastric emptying
- examples: liraglutide (once daily SC), semaglutide (once weekly SC)
- NICE recommends use in specialist weight management services
- current NICE criteria for use (summary):
- BMI ≥ 35 kg/m² with at least one weight-related comorbidity (e.g. T2DM, hypertension)
- consider lower BMI thresholds (e.g. ≥ 32.5 kg/m²) in people from minority ethnic groups
- used alongside diet, physical activity and behavioural support
- continue only if adequate response (e.g. ≥ 5% weight loss at 6 months for semaglutide; 3 months for liraglutide)
