Last updated January 3, 2022

Management of Adult Overweight and Obesity (OBE)

Recommendations

Management of Overweight or Obesity

Comprehensive Lifestyle Interventions (CLIs)

We recommend offering an in-person group or individual comprehensive lifestyle intervention that always includes behavioral, dietary, and physical activity components for patients with overweight or obesity.
Strong Recommendation
6731
There is insufficient evidence to recommend a specific number of sessions of a comprehensive lifestyle intervention for patients with overweight or obesity
6731
We suggest offering a comprehensive lifestyle intervention for weight maintenance to patients who have completed a comprehensive lifestyle intervention for weight loss.
Weak Recommendation
6731
We suggest offering an individual or group telephonedelivered comprehensive lifestyle intervention for weight loss, either as an alternative to or in conjunction with an in-person intervention.
Weak Recommendation
6731
There is insufficient evidence for or against offering a comprehensive lifestyle intervention for weight loss that uses technology as its primary mode of delivery.
6731
We suggest choosing one or more of the following as the physical activity component of a comprehensive lifestyle intervention: aerobic, resistance, and/or lifestyle physical activity.
Weak Recommendation
6731

Physical Activity Component of a CLI

We suggest choosing one or more of the following as the physical activity component of a comprehensive lifestyle intervention: aerobic, resistance, and/or lifestyle physical activity.
Weak Recommendation
6731

Dietary Component of a CLI

We recommend offering patients a dietary approach that contributes to a negative energy balance to achieve weight loss as the dietary component of a comprehensive lifestyle intervention.
Strong Recommendation
6731
We suggest meal replacement (for example portion-controlled shake, protein bar, or meal) as an option to achieve negative energy balance as a component of a comprehensive lifestyle intervention.
Weak Recommendation
6731

Long-term Pharmacotherapy

We suggest offering prescribed pharmacotherapy (specifically liraglutide, naltrexone/bupropion, orlistat, or phentermine/topiramate) for long-term weight loss in patients with a body mass index ≥30 kg/m2 and for those with a body mass index ≥27 kg/m2 who also have obesity-associated conditions, in conjunction with a comprehensive lifestyle intervention.
Weak Recommendation
6731
There is insufficient evidence to recommend for or against offering phentermine monotherapy, benzphetamine, diethylpropion, or phendimetrazine, for short-term, longterm, or intermittent weight loss in patients with overweight or obesity.
6731

Dietary Supplements and Nutraceuticals

We suggest against using dietary supplements or nutraceuticals for clinically meaningful short-term weight loss or long-term weight management.
Weak Recommendation against
6731

Metabolic/Bariatric Procedures and Devices

We suggest offering the option of metabolic/bariatric surgery, in conjunction with a comprehensive lifestyle intervention, to patients with a body mass index of ≥30 kg/m2 and type 2 diabetes mellitus.
Weak Recommendation
6731
We suggest offering the option of metabolic/bariatric surgery, in conjunction with a comprehensive lifestyle intervention, for long-term weight loss/maintenance and/or to improve obesity-associated condition(s) in adult patients with a body mass index ≥40 kg/m2 or those with body mass index ≥35 kg/m2 with obesity-associated condition(s).
Weak Recommendation
6731
There is insufficient evidence to recommend for or against metabolic/bariatric surgery to patients over age 65.
6731
There is insufficient evidence to recommend for or against percutaneous gastrostomy devices for weight loss in patients with obesity.
6731

Short-term Weight Loss (Up to Six Months)

We suggest offering intragastric balloons in conjunction with a comprehensive lifestyle intervention to patients with obesity (body mass index ≥30 kg/m2 ) who prioritize short-term (up to six months) weight loss.
Weak Recommendation
6731
There is insufficient evidence to recommend for or against intragastric balloons for long-term weight loss to support chronic weight management or maintenance.
6731
We suggest offering a low-carbohydrate diet over a low-fat diet as the dietary component of a comprehensive lifestyle intervention for patients who prioritize short-term (up to six months) weight loss.
Weak Recommendation
6731

Recommendation Grading

Overview

Title

Management of Adult Overweight and Obesity (OBE)

Authoring Organization

Publication Month/Year

July 1, 2020

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Inclusion Criteria

Female, Male, Adult, Older adult

Health Care Settings

Ambulatory

Intended Users

Dietician nutritionist

Scope

Counseling, Assessment and screening, Management

Diseases/Conditions (MeSH)

D009765 - Obesity, D014493 - United States Department of Veterans Affairs, D058014 - Veterans Health, D014728 - Veterans, D050177 - Overweight

Keywords

obesity, overweight