Goals
Initially, attempt to reduce body weight by approximately 10 percent from baseline. With success, attempt further weight loss, if indicated, through further assessment.
Reduce weight at a rate of about 1 to 2 lb per week for six months.
Base subsequent strategies on the amount of weight lost.
Dietary therapy
Encourage low-calorie diets for overweight and obese adults.
As part of a low-calorie diet, fat reduction is a practical way to reduce calories.
Reducing dietary fat alone without reducing total calories is not sufficient for weight loss.
Reducing dietary fat along with dietary carbohydrates facilitates caloric reduction.
An individually planned diet creating a deficit of 500 to 1,000 kcal per day should be an integral part of any program aimed at achieving a weight loss of 1 to 2 lb per week. (See Table 1 for recommended daily energy allowances for adults.)
Physical activity
Exercise contributes modestly to weight loss in overweight and obese adults.
Physical activity may decrease abdominal fat.
Physical activity increases cardiorespiratory fitness.
Physical activity may help maintain weight loss.
Physical activity should be an integral part of weight loss therapy and weight maintenance.
Initially, encourage moderate levels of activity for 30 to 40 minutes per day, three to five days per week.
Set a long-term goal to accumulate at least 30 minutes or more of moderate-intensity physical activity on most, preferably all, days of the week.
Behavior therapy
Behavior therapy is a useful adjunct to diet and physical activity.
Assess patient motivation and readiness to implement the weight management plan and take steps to motivate patient for treatment.
Behavior strategies to promote diet and exercise should be used routinely, as they are helpful in achieving weight loss and maintenance.
Combined therapy
Weight loss and weight maintenance therapy should involve a combination of low-calorie diets, increased physical activity and behavior therapy. The combination of a reduced-calorie diet and increased physical activity has been shown to:
	Produce weight loss
	Decrease abdominal fat
	Increase cardiorespiratory fitness
Pharmacotherapy
Lifestyle therapy should be considered before drug therapy.
Weight loss drugs approved by the FDA may be used as part of a comprehensive weight loss program for patients with a BMI ≥30 kg per m2 with no accompanying obesity-related risk factors or diseases, and for patients with a BMI ≥27 kg per m2 accompanying obesity-related risk factors or diseases.
Avoid use of drugs without accompanying lifestyle modification.
Assess drug efficacy and safety continually.
Discontinue use if the drug is ineffective in weight loss or weight maintenance, or if there are serious adverse effects.
Pharmacotherapy cannot be expected to continue to be effective in weight loss or weight management after cessation of drug therapy.
Surgery
Weight loss surgery is an option in carefully selected patients with clinically severe obesity (i.e., persons with a BMI ≥40 kg per m2 or with a BMI ≥35 kg per m2 with comorbid conditions) when less invasive methods have failed and the patient is at high risk for obesity-related morbidity and mortality.