GP · metabolic-and-endocrine-health
Obesity and weight management
Also known as Obesity management · Weight management · Bariatric medicine
GP-fellowship guide to obesity and weight management: obesity as a chronic relapsing disease, BMI and waist limitations, Edmonton staging, the DPP lifestyle intervention (58% diabetes reduction), Look AHEAD cardiovascular outcomes, STEP 1 semaglutide and SURMOUNT-1 tirzepatide efficacy figures, orlistat and naltrexone-bupropion roles, phentermine in the Australian context, bariatric surgery criteria (BMI ≥35, or ≥30 with comorbidity), STAMPEDE diabetes remission results, weight regain biology from the Biggest Loser study, and weight stigma.
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Red flags
- Never frame weight loss failure as willpower failure — the Biggest Loser follow-up showed resting metabolic rate still 704 kcal/day below baseline six years after competition; biology defends regained weight
- GLP-1 receptor agonists are contraindicated with personal/family history of medullary thyroid carcinoma or MEN2 — check before prescribing
- Naltrexone-bupropion is contraindicated in uncontrolled hypertension and seizure disorders — screen before prescribing
- Rapid unintentional weight gain or suspected Cushing syndrome (central adiposity + striae + proximal myopathy) requires endocrine workup, not a diet sheet
Overview
Obesity is the chronic disease that general practice manages at population scale. Its complications — type 2 diabetes, cardiovascular disease, obstructive sleep apnoea, metabolic dysfunction-associated steatotic liver disease (MASLD) and osteoarthritis — generate more consulting-room morbidity than almost any other condition. The Canadian Adult Obesity Guideline reframed care: obesity is a chronic medical disease with biological, psychological and environmental root causes, not a failure of willpower; management targets health outcomes (complication remission, quality of life) rather than weight alone.[8]
References10ShowHide
- [1]Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med, 2002.PMID 11832527
- [2]Greenway FL, Fujioka K, Plodkowski RA, Mudaliar S, Guttadauria M, et al. Effect of naltrexone plus bupropion on weight loss in overweight and obese adults (COR-I): a multicentre, randomised, double-blind, placebo-controlled, phase 3 trial. Lancet, 2010.PMID 20673995
- [3]Padwal RS, Pajewski NM, Allison DB, Sharma AM Using the Edmonton obesity staging system to predict mortality in a population-representative cohort of people with overweight and obesity. CMAJ, 2011.PMID 21844111
- [4]Flegal KM, Kit BK, Orpana H, Graubard BI Association of all-cause mortality with overweight and obesity using standard body mass index categories: a systematic review and meta-analysis. JAMA, 2013.PMID 23280227
- [5]Wing RR, Bolin P, Brancati FL, et al. Cardiovascular effects of intensive lifestyle intervention in type 2 diabetes. N Engl J Med, 2013.PMID 23796131
- [6]Schauer PR, Bhatt DL, Kirwan JP, Wolski K, Brethauer SA, et al. Bariatric surgery versus intensive medical therapy for diabetes--3-year outcomes. N Engl J Med, 2014.PMID 24679060
- [7]Fothergill E, Guo J, Howard L, Kerns JC, Knuth ND, et al. Persistent metabolic adaptation 6 years after 'The Biggest Loser' competition. Obesity (Silver Spring), 2016.PMID 27136388
- [8]Schauer PR, Bhatt DL, Kirwan JP, Wolski K, Aminian A, et al. Bariatric Surgery versus Intensive Medical Therapy for Diabetes - 5-Year Outcomes. N Engl J Med, 2017.PMID 28199805
- [9]Wilding JPH, Batterham RL, Calanna S, Davies M, Van Gaal LF, et al. Once-Weekly Semaglutide in Adults with Overweight or Obesity. N Engl J Med, 2021.PMID 33567185
- [10]Jastreboff AM, Aronne LJ, Ahmad NN, Wharton S, Connery L, et al. Tirzepatide Once Weekly for the Treatment of Obesity. N Engl J Med, 2022.PMID 35658024