Treatment Plan & Prognosis

Treatment Plan

1. BMI 25-29.9:

• Lifestyle intervention’s primary approach
• Consider orlistat if BMI >27 with risk factors

2. BMI ≥30:

• Secondary care referral consideration
• Tier 2 services: BMI >30 (>27.5 for South Asians)
• Tier 3: For those failing primary/secondary care

3. Bariatric Surgery Criteria:

• BMI >40 or
• BMI 35-40 with comorbidities
• lower threshold for South Asians (from obesity stage 1)

4. Medication:

Orlistat:

• Indications: BMI >30 or >27 with risk factors
• Review at 3 months
• Continue if ≥5% weight loss (or ≥3% with diabetes)
• Contraindications: breastfeeding, cholestasis, chronic malabsorption
• Drug interactions: warfarin (monitor INR), levothyroxine (2-hour spacing)

Other medications:

• GLP-1 agonists: liraglutide, semaglutide

Prognosis

Benefits of 10kg weight loss:

• Mortality: 20-25% reduction
• BP: 10mmHg systolic/10-20mmHg diastolic reduction – Diabetes markers:
• Fasting glucose: 30-50% reduction
• Hba1c: 15% reduction
• Lipids:
• Total cholesterol: 10% reduction
• Non-HDL cholesterol: 15% reduction
• Triglycerides: 30% reduction
• Other improvements:
• Joint function
• Lung function
• Back pain
• Insulin sensitivity
• Ovarian function