Multidisciplinary endocrine treatment process for individuals with a body mass index of 30 or higher, covering nutrition, exercise, drug therapy, and surgical referral when needed.
Indication
- Obesity with a body mass index (BMI) of 30 kg/m² or higher
- BMI 27-29.9 kg/m² with comorbidities such as type 2 diabetes, hypertension, or dyslipidemia
- Insulin resistance and metabolic syndrome components
- Excess weight associated with polycystic ovary syndrome (PCOS)
- Weight problems unresponsive to lifestyle changes alone
- Need for endocrinological follow-up before and after bariatric (obesity) surgery
Preparation
- Measurement of height, weight, waist circumference, and body composition analysis
- Fasting blood glucose, HbA1c, lipid profile, and liver and kidney function tests
- Thyroid function tests (TSH, fT3, fT4) to rule out secondary causes of obesity
- Recording of nutritional diary and physical activity habits
- Inquiry about comorbidities (diabetes, sleep apnea, depression)
How it's performed
- Detailed medical history, family history, and a thorough physical examination are performed
- An individual calorie target is set and a nutrition plan is developed with a dietitian
- A weekly aerobic and resistance exercise program is planned according to the patient's condition
- When indicated, drug therapy is initiated such as GLP-1 receptor agonists (semaglutide, liraglutide), SGLT-2 inhibitors, or orlistat
- Suitable candidates with BMI ≥40, or BMI >35 with serious comorbidities, are referred to the bariatric surgery board
- Psychological support and motivational interviewing are recommended for behavioral change
Post-procedure
- Monthly check-ups for the first 3 months, then every 3-6 months
- Target weight loss is set at 5-10% of initial weight in the first 6 months
- Efficacy, side effects, and dose titration are evaluated in patients on medication
- Parameters of comorbidities (diabetes, hypertension, dyslipidemia) are re-measured
- Long-term lifestyle support is maintained for weight maintenance
Risks
- Gastrointestinal side effects with GLP-1 agonists, including nausea, vomiting, and constipation
- Urinary tract infections and rarely ketoacidosis with SGLT-2 inhibitors
- Oily stools and decreased absorption of fat-soluble vitamins with orlistat use
- Gallstone formation due to rapid weight loss
- General anesthesia and operative risks if surgical treatment is chosen
FAQ
Are obesity medications lifelong treatments?
Treatment duration is patient-specific. Some individuals continue therapy because weight may be regained when medication is stopped; in others, doses can be reduced under medical supervision once lifestyle changes are established.
Is bariatric surgery suitable for every patient with obesity?
No. It is generally considered, after multidisciplinary evaluation, for patients with BMI ≥40, or BMI >35 with serious comorbidities, who have not responded adequately to lifestyle and drug therapy.
Can sufficient weight loss be achieved with diet and exercise alone?
Most patients can achieve a 5-10% loss of initial weight through lifestyle changes. If greater loss is needed or comorbidities are present, drug therapy may be considered.
Which condition takes priority when obesity and type 2 diabetes coexist?
Both are treated together. Weight-reducing medications (e.g., GLP-1 agonists, SGLT-2 inhibitors) lower blood sugar and also support weight control.
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