The 2026 Obesity Algorithm from the Obesity Medicine Association (OMA) was recently released and today, we’re taking a look at key highlights from the four main sections of the guidance document: Assessment and Pathophysiology, Nutrition/Physical Activity/Behavior, Medications and Bariatric Procedures, and Professionalism.

The 2026 OMA Obesity Algorithm provides clinicians guidance on the key components of caring for patients with dysfunction and/or increased body fat. The algorithm is updated once a year to better improve the management and care of patients living with overweight and obesity. For the most thorough explanation of the following key points, view the full-text version of the algorithm. 

Key Highlights of the OMA 2026 Obesity Algorithm Update:

Assessment and Pathophysiology

  • 1.1.1 – Determine the onset and pattern of weight gain. Ask when weight gain began, whether it was gradual or sudden, and identify any triggers (e.g., life events, pregnancies, medications).
  • 1.1.3 – Review past weight-loss attempts. Ask about prior methods (diet, physical activity, medications, commercial programs, surgery), degree and duration of success, and factors contributing to weight regain.
  • 1.2.3 – Identifying a history of developmental delays can reveal underlying genetic, neurologic, or behavioral conditions that affect weight, eating behaviors, and physical activity. This insight supports tailoring interventions to the individual’s abilities and needs.
  • 1.2.4 – Referral to psychiatry or other mental health specialists is often needed for the diagnosis and management of neuropsychiatric conditions.
  • 1.3.7 – Family and peer relationships are crucial in shaping eating habits and activity levels, thereby positively or negatively impacting obesity risk.
  • 1.4.6 – A thorough history should include current and past symptoms, weight trajectory, mental health conditions, and functional limitations.
  • 1.5.1 – Systematic evaluation for weight-related complications should address metabolic, cardiovascular, pulmonary, musculoskeletal, and other organ systems, using evidence-based screening protocols and age-appropriate diagnostic criteria.
  • 1.5.4 – Obesity significantly increases cardiovascular disease risk through multiple mechanisms, necessitating comprehensive risk assessment and appropriate referral for specialized evaluation when indicated.
  • 1.5.6 – Children and adolescents with obesity require age-specific screening approaches and recognition of unique complications, including orthopedic conditions and puberty disorders.
  • 1.7.1 – The most common genetic contribution to obesity is polygenic, estimated to affect 40% to 75% of individuals with obesity.
  • 1.8.6 – The most significant component of total energy expenditure (TEE) is resting metabolic rate, while physical activity and diet thermogenesis contribute less.
  • 1.8.7 – TEE can be measured using direct calorimetry, indirect calorimetry, or the doubly labeled water method.

Nutrition, Physical Activity, and Behavior

  • 2.1.2 – Gather detailed behavioral and contextual information. Assess why, when, and how patients eat, not just what they eat. Include behaviors such as emotional eating, convenience  eating, rapid eating pace, night eating, snacking, and eating environment (e.g., television meals vs. family table).
  • 2.1.3 – Assess meal patterns and intake quantitatively. Use validated tools such as a 24-hour recall (preferably 72 hours, including a weekend day), food diaries (over three to seven days), or smartphone app-based trackers to estimate calorie, macronutrient, and food quality intake.
  • 2.1.7 – Translate findings into actionable, patient-centered goals. Document findings clearly using a structured format (eg, total daily calories, protein intake, servings of fruits and vegetables, snacking patterns). Provide feedback that empowers change without stigma or guilt.
  • 2.2.4 – Be culturally responsive. Respect dietary customs, differentiate cultural practices from disordered patterns, and integrate culturally familiar foods into care plans to improve adherence.
  • 2.2.7 – Acknowledge mental health associations. Disordered eating often co-occurs with depression, anxiety, posttraumatic stress disorder, or attention-deficient/ hyperactivity disorder. Addressing these underlying conditions can improve eating behavior and outcomes.
  • 2.3.4 – Readiness for exercise can be assessed using tools such as The Physical Activity Readiness Questionnaire for Everyone (PAR-Q+).
  • 2.4.3 – Screening for sleep and circadian rhythm disorders involves both subjective measures (history-taking and questionnaires) and objective measures (laboratory studies).
  • 2.5.1 – The Transtheoretical Model outlines distinct stages demonstrating that behavior change is not a single event but a process that individuals move through, starting from precontemplation and ideally reaching termination.
  • 2.6.3 – Very low-calorie diets should be undertaken under the supervision of a healthcare professional, such as a clinician or registered dietitian.
  • 2.7.2 – Engaging in moderate-intensity activity for 150 minutes per week can contribute to weight loss and help prevent weight gain. Increasing the weekly duration to 250 minutes or more can result in clinically significant weight loss and effective weight maintenance.
  • 2.7.5 – A daily step count of fewer than 5000 steps is classified as sedentary and is linked to an elevated risk of all-cause mortality, whereas a daily step count exceeding 10,000 steps is deemed active.

Medications and Bariatric Procedures

  • 3.1.3 – Patients frequently use supplements, herbal formulations, or over-the-counter (OTC) products that are not subject to US Food and Drug Administration (FDA) regulation or review. These agents may interact with prescription obesity treatment.
  • 3.2.4 – The following obesity medications have received approval for long-term treatment: orlistat, naltrexone-bupropion extended-release, phentermine HCl-topiramate extended-release, liraglutide, semaglutide, tirzepatide, setmelanotide, metrelpetin, and diazoxide choline extended-release.
  • 3.2.5 – All obesity medications have potential adverse effects and contraindications that must be assessed before initiation. The use of all obesity medications is either contraindicated or used with caution in breastfeeding.
  • 3.2.6 – Setmelanotide acts in place of deficient α-melanocyte-stimulating hormone (α-MSH) and is approved for monogenic obesity due to proopiomelanocortin (POMC), proprotein convertase subtilisin/kexin type 1 (PCSK1), or leptin receptor (LEPR) deficiency, as well as for Bardet-Biedl syndrome.
  • 3.2.7 – All obesity medications, except for orlistat, must be slowly titrated to minimize adverse effects.
  • 3.4.1 – Metabolic and bariatric surgery (MBS) is a durable and effective treatment for obesity and related conditions.
  • 3.4.3 – Eligibility now includes patients with a BMI of 30 kg/m² or higher and metabolic disease, although insurers often use older criteria (BMI of 40 kg/m² or higher or ≥ 35 kg/m² with comorbidities).
  • 3.4.8 – Complications such as dumping syndrome, vitamin and mineral deficiencies, gastroesophageal reflux, and weight regain require early recognition. Persistent abdominal or neurological symptoms postoperatively should prompt further evaluation.
  • 3.5.1 – There is wide individual variability in the effects of weight-promoting medications. Clinical decisions should balance the weight-promoting effects with the optimal therapy for the patient.
  • 3.5.6 – Obesity treatment may improve fertility. Obesity medications are contraindicated or otherwise not recommended during pregnancy and require careful management in individuals of reproductive potential. Obesity treatment strategies should be tailored to address the specific needs of women in perimenopause and postmenopause.
  • 3.6.8 – Evaluate for and manage obesity-related neuroendocrine disorders such as polycystic ovarian syndrome (PCOS) and idiopathic intracranial hypertension in collaboration with specialists.

Professionalism

  • 4.1.3 – Collaborate across disciplines. Collaborate with dietitians, mental health professionals, physical therapists, and other healthcare professionals to deliver comprehensive care for obesity.
  • 4.2.4 – Collaborate with fellow clinicians and community programs to improve care coordination and support growth.
  • 4.3.1 – People-first language is key.
  • 4.3.2 – Obesity is a disease, not a character flaw.
  • 4.3.3 – Ask permission to discuss weight.
  • 4.3.4 – Empathy empowers patients.
  • 4.5.3 – While public health interventions are beneficial, individualized medical care is crucial for long-term success.
  • 4.5.5 – Clinicians can improve outcomes using early screening, stigma-free language, and the four treatment pillars.

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