Obesity management in primary care should begin with lifestyle interventions for patients ready to engage in behavior change. Using the 5As counseling model (assess, advise, agree, assist, arrange) in a patient-centered, nonjudgmental manner enhances motivation and adherence. Comprehensive lifestyle interventions (combining reduced caloric intake, increased physical activity, and behavioral changes) are most effective, typically achieving 5% to 10% weight loss over 6 months. Physicians should refer patients to multidisciplinary programs when possible or recommend digital or commercial alternatives with personalized feedback. Key components include setting specific, measurable, achievable, relevant, and time-based (SMART) goals; calculating caloric deficits; and promoting self-monitoring. Various dietary approaches can be effective and should be tailored to patient preferences. Physical activity lasting at least 150 minutes per week at moderate intensity or at least 75 minutes per week of vigorous activity is recommended. Digital tools (eg, apps, wearable trackers) can enhance engagement and outcomes. Physicians should also address barriers such as food insecurity, time constraints, and lack of support. Although adjunctive strategies such as sleep optimization and workplace modifications may be benefician, they should not replace core lifestyle changes.

Case 2. ST is a 41-year-old patient who comes to your office for an annual examination. He has no consequential medical history, but his current weight is 100 kg and body mass index (BMI) is 34.6 kg/m², indicating class I obesity. He has a family history of diabetes and cardiovascular disease and wants to implement strategies to help prevent development of these conditions. He has been reading about intermittent fasting and wants to know if you would recommend it for him.