Clinical Guidelines

Are There Guidelines for Clinical Evaluation and Treatment of Obesity?
Yes. The Endocrine Society and other medical organizations generally follow the clinical guidelines established by the National Heart, Lung, and Blood Institute and published in NHLBI’s Obesity Education Task Force’s Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults⁹².

How Do Endocrinologists Assess Obesity?
Physicians assess obesity risk status, including:

• Disease conditions such as established coronary heart disease (CHD), other atherosclerotic diseases, Type 2 diabetes, and sleep apnea. Patients with these conditions are classified as being at very high-risk for obesity disease complications;
• Other obesity-associated disease, such as gynecological abnormalities, PCOS, osteoarthritis, gallstones and their complications, and stress urinary incontinence;
• Cardiovascular risk factors such as cigarette smoking, hypertension, high LDL cholesterol, low HDL cholesterol, family history of premature CHD, and age;
• Other risk factors including physical inactivity and high serum triglycerides; and
• Patient motivation to for weight loss.

How Do Endocrinologists Provide Support for Obesity?
An endocrinologist will:

Assess the patient’s condition
In most cases, an endocrinologist will measure body mass index (BMI) to assess and classify overweight and obesity, and to estimate relative risk for disease compared to ideal weight. Waist circumference measurements may be taken to gauge abdominal fat, allowing for the identification of obesity and disease risks. Patients at high absolute risk for chronic conditions such as coronary heart disease, myocardial infarction, atherosclerotic diseases, hormonal disorders (hypothyroidism) and metabolic syndrome, will be advised to explore weight loss treatment options.

Counsel patients about the advantages of weight loss
Obesity can lead to serious health implications. An endocrinologist will assess the patient’s health and typically recommend initiating a weight-loss regimen to lower the following: blood pressure in overweight and obese people with high blood pressure; total cholesterol, low-density lipoprotein cholesterol and triglycerides in overweight and obese persons with dyslipidemia; and blood glucose levels in overweight and obese persons with Type 2 diabetes.

Help set realistic and individualized goals for weight loss
In order to develop customized weight loss goals for each patient, an endocrinologist will take into account family and personal health history, as well as the patient’s risk factors for related conditions and weight loss motivation. The initial goal of weight loss therapy is likely to be a reduction in body weight by approximately 10 percent from baseline, but any weight loss achieved may be beneficial. Healthy weight loss is typically about one to two pounds per week for a period of six months, with the subsequent strategy based on the amount of weight lost in the initial period.

Initiate and monitor weight loss
Implementing a multi-faceted weight loss regimen can help combat overweight and obesity. Measures may include:

• Dietary therapy: Modifying diet; portion and caloric intake;
• Physical activity: Initiating a consistent and realistic exercise regimen;
• Behavior therapy: Assessing the patient’s motivation and readiness to implement the weight loss therapy, providing continual encouragement;
• Combined therapy: Incorporating a regimen that combines low-calorie diets, increased physical activity and behavior therapy;
• Pharmacotherapy: Assessing the efficacy of implementing a pharmacotherapy (drug therapy) approach to weight loss (See Section I for additional information on treatment options); and
• Weight loss surgery: Exploring surgery as an option (See Section I for additional information on surgical options).

  Careful monitoring of weight loss during this stage of treatment is crucial. Since much depends on successful weight loss, an endocrinologist will carefully and closely monitor a patient’s progress and risk factors, and modify therapy, as necessary.

  Reinforce the importance of maintaining a healthy weight
  Once initial weight loss is achieved, patients are counseled to continue their diet and exercise regimens to maintain their new healthy weight. Their endocrinologist may help them set up long-term weight loss goals and continue to serve as coach.

  Provide advice and support for special considerations

• All patients are advised to quit smoking
• In some cases, a clinical decision to forego obesity treatment in older adults may result from an evaluation of the potential benefits of weight loss for day-to-day functioning and reduction of the risk of future cardiovascular events, as well as the patient’s
  motivation for weight reduction. Care is taken to ensure that any weight loss program minimizes the likelihood of adverse effects on bone health or other aspects of nutritional status
• When setting expectations for weight loss treatment outcomes, the possibility that a standard approach to weight loss will work differently in diverse populations is considered
• Special consideration is given to childhood (pediatric) obesity