Diagnosis
Table 2. Comorbid Conditions in Obesity and Evidence
for Amelioration with Weight Reduction
Comorbidity
Improvement After
Weight Loss
Type 2 diabetes mellitus (T2DM) Yes
Hypertension (HTN) Yes
Dyslipidemia and metabolic syndrome Yes
Cardiovascular disease (CVD) Yes
Nonalcoholic fatty liver disease (NAFLD) Variable outcomes
Osteoarthritis Yes
Cancer Yes
Major depression Insufficient evidence
Obstructive sleep apnea Yes
Treatment
Î Endocrine Society (ES) recommends that diet, exercise, and
behavioral modification be included in all obesity management approaches
for BMI ≥25 kg/m
2
and that other tools such as pharmacotherapy (BMI
≥27 kg/m
2
with comorbidity or >30) and bariatric surgery (BMI ≥35 kg/m
2
with comorbidity or >40) be used as adjuncts to behavioral modification
to reduce food intake and increase physical activity when this is possible.
Drugs may amplify adherence to behavior change and may improve physical
functioning such that increased physical activity is easier in those who
cannot exercise initially. Patients who have a history of being unable to
successfully lose and maintain weight and who meet label indications are
candidates for weight loss medications. (1|⊕⊕⊕⊕)
Î In order to promote long-term weight maintenance, ES suggests the use
of approved
a
weight loss medication (over no pharmacological therapy)
to ameliorate comorbidities and amplify adherence to behavior changes,
which may improve physical functioning and allow for greater physical
activity in individuals with a BMI ≥30 kg/m
2
or in individuals with a BMI of
≥27 kg/m
2
and at least one associated comorbid medical condition such as
hypertension, dyslipidemia, T2DM, and obstructive sleep apnea. (2|⊕⊕
)
a
Approval in the United States is based on FDA determination. Approval in Europe
is based on EMA determination.