Obesity Management

Obesity is a common and important topic in family medicine, yet we often struggle to find the most effective ways to help our patients, many of whom may be reluctant to discuss it. Because weight is often tangled with identity and emotion, these conversations can be challenging. At the same time, it is essential to consider the effect of obesity on health because it is linked to diabetes, hypertension, obstructive sleep apnea, and many other chronic diseases.

This edition of FP Essentials provides practical, evidence-based tools to help family physicians tailor obesity management to each individual, whether the focus is on lifestyle changes, pharmacotherapy, or surgical intervention. Although new drugs offer promising options for weight management, long-term success still depends on the trusted relationship between the family physician and the patient.

Section One reviews the prevalence of obesity and its broad impact on both individual and societal health, while offering strategies to decrease disease stigma and initiate productive conversations with patients. Section Two focuses on comprehensive lifestyle interventions, highlighting a range of diets. It also discusses the role of technology in supporting behavioral change and improving health outcomes. Section Three examines pharmacotherapy, detailing the differences among available drugs and their relative effectiveness. What stands out is the expansion of anti-obesity drugs in recent years. Section Four addresses surgical interventions, including indications, preoperative evaluation, and long-term management after bariatric surgery.

What I appreciate the most in this monograph is the focus on actionable advice and practical tools that can be used daily. I hope you find this edition useful and inspiring in your ongoing efforts to support patients in their journey toward better health. As always, we welcome your feedback and suggestions for future topics.

Michelle Nelson, MD, FAAFP, DipABLM, Associate Medical Editor
Clinical Assistant Professor,
Department of Family Medicine
Michigan State University College of Human Medicine

Morgan A. Rhodes, PharmD, BCACP, BC-ADM, is a clinical associate professor in the Department of Family and Preventive Medicine and director of faculty development in the Office of Continuous Professional Development and Strategic Affairs at the University of South Carolina School of Medicine. She is also core faculty at Prisma Health Family Medicine Residency Program (FMRP) in Columbia. She practices in a family medicine residency teaching clinic working with medical and pharmacy residents and students, and educating patients about diabetes, obesity, and other metabolic diseases.

Mark Shaffer, MD, is vice chief of quality and medical staff affairs for the Primary Care Division of Prisma Health, a clinical associate professor in the Department of Family and Preventive Medicine at the University of South Carolina School of Medicine, and faculty at Prisma Health FMRP in Columbia. He helps develop and implement standard guidelines around condition management across multiple primary care offices, including standards for the management of obesity. Dr. Shaffer has been a repeat speaker on childhood obesity for the American Academy of Family Physicians. He helped develop a community garden at his rural office to address nutritional needs of his patients.

Matthew Nodelman, MD, is a clinical assistant professor in the Department of Family and Preventive Medicine and director of the FMRP at the University of South Carolina School of Medicine and a physician with Prisma Health Midlands in Columbia. He teaches and supervises family medicine residents, medical students, and physician assistant students; he provides patient care in the residency teaching clinic that sees a high prevalence of diabetes, metabolic syndrome, and obesity in an under-resourced community.

A. Miles Scott, DO, is a clinical assistant professor in the Department of Family and Preventive Medicine at the University of South Carolina School of Medicine, medical director of the Family Medicine Center for the Prisma Health FMRP, and assistant program director for the FMRP in Columbia. His clinical interests include diabetes, hypertension, and obesity management.

Disclosure: It is the policy of the AAFP that all individuals in a position to control CME content disclose any relationships with ineligible companies upon nomination/invitation of participation. Disclosure documents are reviewed for potential relevant financial relationships. If relevant financial relationships are identified, mitigation strategies are agreed to prior to confirmation of participation. Only those participants who had no relevant financial relationships or who agreed to an identified mitigation process prior to their participation were involved in this CME activity. Associate medical editor Michelle Nelson, MD, disclosed stock ownership in Eli Lilly. This relevant financial relationship was mitigated when she sold her shares in May 2024, before her work as FPE associate medical editor began. All other individuals in a position to control content for this activity have indicated they have no relevant financial relationships to disclose.

• Define the categories of obesity in adults and children and describe the methods used to identify obesity.
• Screen patients annually for obesity and associated comorbidities.
• Apply strategies to reduce weight stigma and implement office policies to reduce bias for patients with overweight or obesity.
• Counsel patients about options for evidence-based dietary interventions.
• Compare commercial weight loss programs and guide patients on choosing a program that aligns with their goals.
• Summarize pharmacologic treatment options for obesity and counsel patients regarding the effectiveness, risks, and adverse effects of each.
• Describe the surgical options for obesity management.
• Develop a pre- and postoperative plan with patients undergoing surgical intervention for weight management, including drug adjustments and long-term follow-up.