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Practice Guidelines

Management of obesity: summary of SIGN guideline

BMJ 2010; 340 doi: (Published 24 February 2010) Cite this as: BMJ 2010;340:c154

This article has a correction. Please see:

  1. Jennifer Logue, clinical lecturer in metabolic medicine 1,
  2. Lorna Thompson, programme manager 2,
  3. Finn Romanes, consultant in public heath3,
  4. David C Wilson, reader in paediatric gastroenterology and nutrition4,
  5. Joyce Thompson, dietetic consultant in public health nutrition3,
  6. Naveed Sattar, professor of metabolic medicine1
  7. on behalf of the Guideline Development Group
  1. 1Division of Cardiovascular and Medical Sciences, Faculty of Medicine, University of Glasgow, Glasgow G12 8TA
  2. 2Scottish Intercollegiate Guidelines Network (SIGN), Edinburgh EH7 5EA
  3. 3Directorate of Public Health, NHS Tayside, Dundee DD3 8EA
  4. 4Child Life and Health, University of Edinburgh, Edinburgh EH9 1UW
  1. Correspondence to: J Logue j.logue{at}

    Why read this summary?

    In Scotland 68.5% of men, 61.8% of women, 36.1% of boys, and 26.9% of girls are classified as overweight or obese.1 The cost of obesity and obesity related illnesses to the NHS in Scotland was estimated to be £171m (€190m; $273m) in 2001,2 and forecasts in England suggest that NHS expenditure attributable to these conditions could double between 2007 and 2050.3 Being obese at age 40 reduces life expectancy by 7.1 years for women and 5.8 years for men.4 Given the massive detrimental effect of obesity on health and wellbeing, all health professionals should know how obesity should be managed. This article summarises the most recent recommendations from the Scottish Intercollegiate Guidelines Network (SIGN) on the management of obesity.5


    SIGN recommendations are based on systematic reviews of best available evidence, and the strength of the evidence is indicated as A, B, C, or D (figure). Recommended best practice (“good practice points”), based on the clinical experience of the guideline development group, is also indicated (as GPP).

    Explanation of SIGN grades of recommendations

    Obesity and overweight in adults


    Use body mass index (BMI) to classify overweight or obesity in adults (B):

    • Less than 18.5—underweight.

    • 18.5-24.9—normal range.

    • 25-29.9—overweight.

    • 30-34.9—obesity I.

    • 35-39.9—obesity II.

    • 40 or more—obesity III.6

    Waist circumference may be used in addition to BMI to help assess the risk of obesity related comorbidities (C). Waist circumference cut-off values for an increased risk of obesity related health problems are:

    • Women: 80 cm or more.

    • Men: 94 cm (Asian men 90 cm) or more.6 7

    Prevention and identification of high risk groups

    • Help prevent obesity by emphasising healthy eating ( (GPP), encouraging physical activity, and reducing sedentary behaviour (B).

    • Encourage patients to weigh themselves (B).

    • Be aware that patients at higher risk of obesity include those planning to stop smoking and those prescribed drugs that are associated …

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