[Treatment of overweight and obesity in adults: proposal for a guideline]

Abstract

Overweight and obesity are rapidly increasing health problems, leading to considerable co-morbidity and increased mortality. In this article a Dutch guideline is proposed for the management of overweight and obesity, which in part is based on North American and European treatment proposals. After having assessed the degree of overweight and associated health risks, based on medical history, physical examination and laboratory investigations, a decision to start treatment can be made. First, consensus with regard to treatment goals has to be reached between doctor and patient, who has to be motivated to change his or her lifestyle. A modest (5-15% of pre-treatment weight) weight loss, which has to be sustained in the long term, is a desirable, realistic and achievable treatment goal for the majority of patients. Dietary management, an increased level of physical activity and behavioural advice are the most important basic treatment options in obesity. This advice is best provided as a multidisciplinary approach. In selected patients pharmacotherapy and in severe obesity bariatric surgery can be a useful addition to basic obesity management.