Clinical Review

Management of overweight and obese adults

BMJ 2002; 325 doi: https://doi.org/10.1136/bmj.325.7367.757 (Published 05 October 2002) Cite this as: BMJ 2002;325:757
  1. Polly Hitchcock Noël, associate director (pollyh@verdict.uthscsa.edu),
  2. Jacqueline A Pugh, director
  1. VERDICT Health Services Research Center of Excellence, South Texas Veterans Health Care System, San Antonio, TX 78229-5700, USA
  1. Correspondence to: P Hitchcock Noël
  • Accepted 25 July 2002

New treatment strategies have failed to control the global increase in obesity. Here two scientists discuss common barriers that need to be overcome by both healthcare professionals and patients if weight reduction is to be achieved and maintained

The 1980s and ‘90s witnessed alarming increases in obesity across the globe.1 This epidemic has not been slowed by new treatment strategies, leading some health professionals to doubt if they can help their patients. A recent audit documented wide variation in the management of overweight and obese patients in general practices in England and uncertainty about which treatments were most effective.2 Healthcare providers may fail to address obesity for many reasons, including cynicism about the efficacy of treatments, lack of time, perceived non-compliance of patients, and lack of training in counselling and motivating patients to change their behaviour. 3 4 Although the control of obesity ultimately requires population based strategies, doctors can and should provide effective individual care. We review evidence based recommendations for managing overweight and obese adults.

Summary points

  • Obesity is an increasingly serious health problem worldwide

  • Body mass index, waist circumference, and comorbidities related to obesity should be monitored in patients who have a body mass index >= 25

  • Healthy behaviours should be encouraged in all patients

  • Most people can be helped to manage their weight, and healthcare providers must avoid stigmatising and blaming patients for their obesity

  • For motivated patients, weight loss should aim for a gradual and modest weight loss of 5-10% of initial body weight by caloric restriction, increased physical activity, and behaviour therapy

  • The trade-off between potential benefits and harms of pharmacotherapies must be considered

  • Surgical interventions are effective but should be restricted to patients who are morbidly obese

Methods

We searched Medline (1966-March 2002) using the terms “obesity or overweight” and “practice guideline, systematic review, …

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