Despite its increasing prevalence, obesity is one of the most misunderstood conditions in medicine. In fact, the AMA didn’t recognize it as a disease until 2013! In the United States, there are an estimated 30 million adults with diabetes, and 100 million adults with obesity. Obesity increases health risks and is associated with more than 60 comorbidities.

Physicians are key to the diagnosis of obesity, nevertheless studies show that only 55% of patients with obesity who seek treatment are diagnosed with this condition. Two key criteria for diagnosis include BMI ≥ 30 and sex-specific waist circumference (>40 inches in men; >35 inches in women).

When assessing waist circumference, be sure to take the following steps:

1. Place the tape measure horizontally around the patient’s waist (i.e., between the lowest rib and the top of the hip bone); the umbilicus (i.e., belly button); or at the narrowest point of the midsection.
2. Maintain a snug fit around the patient’s waist without pressing the skin and have the patient take a deep breath and exhale.
3. Measure the waist circumference on exhalation.

Which of your patients do you evaluate for obesity? What measures do you use to diagnose obesity, and who takes these measures?

The prevalence of obesity is expected to reach 49% by 2023, and this chronic, relapsing disease is linked to comorbidities, including T2DM, dyslipidemia, hypertension, CAD, stroke, and certain cancers. The total financial costs of chronic conditions linked to obesity are estimated at $1.71 trillion. The effective weight management of patients with obesity is necessary to optimize quality of life, minimize medical and financial costs, and decrease morbidity and mortality.

Various weight-loss interventions have been developed, including diet/exercise lifestyle interventions; antiobesity medications (AOMs); surgical interventions, and endoscopic interventions. AOMs are effective and improve quality of life and decrease the risk of weight-related comorbidities. Nevertheless, AOMs demonstrate a wide variation in the percentage of weight loss, between 5% and 12%, per the results of clinical trials.

Five FDA-approved AOMs are semaglutide, liraglutide, orlistat, phentermine plus topiramate, and naltrexone plus bupropion. These drugs are indicated for long-term use in patients with a BMI ≥ 30 without weight-related comorbidities and a BMI ≥ 27 in those with weight-related comorbidities.

Are you discussing anti-obesity medications with your patients more proactively? Please share your current comfort in prescribing anti-obesity medications.