Introduction and current guidance
Obesity is directly linked to a number of different illnesses including type 2 diabetes, fatty liver disease, hypertension, gallstones and gastro-oesophageal reflux disease, as well as psychological and psychiatric morbidities. The NICE guideline on identifying, assessing and managing obesity classifies adults with a BMI over 30 kg/m2 as obese and those with a BMI of 25 to 29.9 kg/m2 as overweight. Obesity is a complex problem. Treatment involves multicomponent interventions such as weight management programmes including behaviour change strategies to: increase people's physical activity levels or decrease inactivity, improve eating behaviour and the quality of the person's diet, and to reduce energy intake.
The NICE guideline on identifying, assessing and managing obesity recommends considering pharmacological treatment only after dietary, exercise and behavioural approaches have been started and evaluated. The guideline recommends to consider medicines for people who have not reached their target weight loss or have reached a plateau on dietary, activity and behavioural changes. The guideline recommends orlistat as a pharmacological treatment option only as part of a weight management plan in adults who are obese or have a BMI of 28 kg/m2 or more with associated risk factors, such as type 2 diabetes. Orlistat therapy should be continued beyond 3 months only if the person has lost at least 5% of their initial body weight since starting drug treatment. Rates of weight loss may be slower in people with type 2 diabetes, so less strict goals than those for people without diabetes may be appropriate.
A NICE interactive flowchart on obesity brings together all related NICE guidance and associated products on this topic in a set of interactive topic-based diagrams.