Management of Adult Overweight and Obesity (OBE)
Publication Date: June 30, 2020
Last Updated: March 14, 2022
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.
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There is insufficient evidence to recommend a specific number of sessions of a comprehensive lifestyle intervention for patients with overweight or obesity
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We suggest offering a comprehensive lifestyle intervention for weight maintenance to patients who have completed a comprehensive lifestyle intervention for weight loss.
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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.
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There is insufficient evidence for or against offering a comprehensive lifestyle intervention for weight loss that uses technology as its primary mode of delivery.
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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.
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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.
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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.
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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.
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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.
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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.
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Dietary Supplements and Nutraceuticals
We suggest against using dietary supplements or nutraceuticals for clinically meaningful short-term weight loss or long-term weight management.
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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.
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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).
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There is insufficient evidence to recommend for or against metabolic/bariatric surgery to patients over age 65.
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There is insufficient evidence to recommend for or against percutaneous gastrostomy devices for weight loss in patients with obesity.
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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.
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There is insufficient evidence to recommend for or against intragastric balloons for long-term weight loss to support chronic weight management or maintenance.
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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.
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Title
Management of Adult Overweight and Obesity (OBE)
Authoring Organization
Veterans Health Administration / Department of Defense
Publication Month/Year
June 30, 2020
Last Updated Month/Year
April 1, 2024
External Publication Status
Published
Country of Publication
US
Inclusion Criteria
Female, Male, Adult, Older adult
Health Care Settings
Ambulatory
Intended Users
Dietician nutritionist, nurse, nurse practitioner, physician, physician assistant
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
Source Citation
Mayer SB, Graybill S, Raffa SD, Tracy C, Gaar E, Wisbach G, Goldstein MG, Sall J. Synopsis of the 2020 U.S. VA/DoD Clinical Practice Guideline for the Management of Adult Overweight and Obesity. Mil Med. 2021 Aug 28;186(9-10):884-896. doi: 10.1093/milmed/usab114. PMID: 33904926.