• PALANISAMY AMIRTHALINGAM Department of Pharmacy Practice, Faculty of Pharmacy, University of Tabuk, Tabuk, Saudi Arabia.


Objectives: Obesity causes morbidity and mortality and also impairs the quality of life in humans. Clinical practice guidelines are well established to treat the obese population with or without comorbidities in all the age groups. Obesity in adults is a risk factor for metabolic disorders including Type-2 diabetes mellitus, hypertension, dyslipidemia, etc. Hence, this review has compared the various international clinical practice guidelines for the management of obesity in adults.

Methods: Four articles were included in the qualitative synthesis after the systematic review of the literature obtained from PubMed/MEDLINE and Web of Sciences. Diagnosis and various interventions including lifestyle, pharmacotherapy and bariatric surgery are compared for the management of obesity in adults.

Results: The diagnosis is crucial since the criteria to determine overweight/obesity is still under debate due to inconclusive evidence. Various interventions including diet, exercise, behavior, drug therapy, and surgery are being recommended currently for the management of obesity. However, ethnicity and culture play a major role in diagnosis and also interventions. Moreover, personalizing the interventions according to the subject will make sense and offers success in the management of obesity.

Conclusion: Diagnosis and the intervention should be subject oriented based on ethnicity, culture and patient characteristics. In this connection, many longitudinal studies warranted to specify the diagnostic and management criteria for adults among the various ethnic populations across the world.

Keywords: Behavior, Clinical practice guidelines, Diet, Drug therapy, Exercise, Obesity


1. Haslam DW, James WP. Obesity. Lancet 2005;366:1197-209.
2. World Health Organization. WHO Report on Obesity and Overweight Published 16th February 2018. Available from: news-room/fact-sheets/detail/obesity-and-overweight.
3. Fryar CD, Carroll MD, Ogden CL. Prevalence of Overweight, Obesity, and Extreme Obesity among Adults aged 20 and over: The United States, 1960-1962 Through 2013-2014. In: National Center for Health Statistics. Available from: obesity_child_15_16/obesity_child_15_16.pdf.
4. Janssen I, Katzmarzyk PT, Ross R. Waist circumference and not body mass index explains obesity-related health risk. Am J Clin Nutr 2004;79:379-84.
5. Balkau B, Deanfield JE, Després JP, Bassand JP, Fox KA, Smith SC Jr., et al. International Day for the Evaluation of Abdominal Obesity (IDEA): A study of waist circumference, cardiovascular disease, and diabetes mellitus in 168,000 primary care patients in 63 countries. Circulation 2007;116:1942-51.
6. Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults the evidence report. National Institutes of Health. Obes Res 1998;6 Suppl 2:51S-209.
7. Grundy SM. Metabolic syndrome scientific statement by the American Heart Association and the National Heart, Lung, and Blood Institute. Arterioscler Thromb Vasc Biol 2005;25:2243-4.
8. Jacobson TA, Ito MK, Maki KC, Orringer CE, Bays HE, Jones PH, et al. National lipid association recommendations for patient-centered management of dyslipidemia: Part 1--full report. J Clin Lipidol 2015;9:129-69.
9. PRISMA. Transparent Reporting of Systematic Reviews and Meta-analyses. Available from:
10. CASP. Critical Appraisal Skills Programme. Available from: https://
11. Garvey WT, Mechanick JI, Brett EM, Garber AJ, Hurley DL, Jastreboff AM, et al. American association of clinical endocrinologists and American college of endocrinology comprehensive clinical practice guidelines for medical care of patients with obesity. Endocr Pract 2016;22 Suppl 3:1-203.
12. Durrer Schutz D, Busetto L, Dicker D, Farpour-Lambert N, Pryke R, Toplak H, et al. European practical and patient-centred guidelines for adult obesity management in primary care. Obes Facts 2019;12:40-66.
13. Obesity: Identification, Assessment, and Management. National Institute for Health and Care Excellence; 2014. Available from: https://
14. Clinical Practice Guidelines for the Management of Overweight and Obesity in Adults, Adolescents and Children in Australia. National Health and Medical Research Council; 2013. Available from: http:// www.c:/users/058316/downloads/n57-obesity-guidelines-%20(3).pdf.
15. Yumuk V, Tsigos C, Fried M, Schindler K, Busetto L, Micic D, et al. European guidelines for obesity management in adults. Obes Facts 2015;8:402-24.
16. Eat for Health; Australian Dietary Guidelines Summary. National Health and Medical Research Council; 2013. Available from: https:// australian_dietary_guidelines_summary_book.pdf.
17. Babu GR, Murthy GV, Ana Y, Patel P, Deepa R, Neelon SE, et al. Association of obesity with hypertension and Type 2 diabetes mellitus in India: A meta-analysis of observational studies. World J Diabetes 2018;9:40-52.
18. Keskin M, Kurtoglu S, Kendirci M, Atabek ME, Yazici C. Homeostasis model assessment is more reliable than the fasting glucose/insulin ratio and quantitative insulin sensitivity check index for assessing insulin resistance among obese children and adolescents. Pediatrics 2005;115:e500-3.
19. Huang Z, Willett WC, Manson JE, Rosner B, Stampfer MJ, Speizer FE, et al. Body weight, weight change, and risk for hypertension in women. Ann Intern Med 1998;128:81-8.
20. Singh AK, Singh SK, Singh N, Agrawal N, Gopal K. Obesity and dyslipidemia. Int J Biol Med Res 2011;2:824-8.
21. Csige I, Ujvárosy D, Szabó Z, L?rincz I, Paragh G, Harangi M, et al. The impact of obesity on the cardiovascular system. J Diabetes Res 2018;2018:3407306.
22. Wilson PW, D’Agostino RB, Sullivan L, Parise H, Kannel WB. Overweight and obesity as determinants of cardiovascular risk: The Framingham experience. Arch Intern Med 2002;162:1867-72.
23. Song YM, Sung J, Davey Smith G, Ebrahim S. Body mass index and ischemic and hemorrhagic stroke: A prospective study in Korean men. Stroke 2004;35:831-6.
24. Weiss ST, Shore S. Obesity and asthma: Directions for research. Am J Respir Crit Care Med 2004;169:963-8.
25. Guerra S, Wright AL, Morgan WJ, Sherrill DL, Holberg CJ, Martinez FD. Persistence of asthma symptoms during adolescence: Role of obesity and age at the onset of puberty. Am J Respir Crit Care Med 2004;170:78-85.
26. Hampel H, Abraham NS, El-Serag HB. Meta-analysis: Obesity and the risk for gastroesophageal reflux disease and its complications. Ann Intern Med 2005;143:199-211.
27. Aspden RM, Scheven BA, Hutchison JD. Osteoarthritis as a systemic disorder including stromal cell differentiation and lipid metabolism. Lancet 2001;357:1118-20.
28. Basen-Engquist K, Chang M. Obesity and cancer risk: Recent review and evidence. Curr Oncol Rep 2011;13:71-6.
29. Peeters A, Barendregt JJ, Willekens F, Mackenbach JP, Al Mamun A, Bonneux L, et al. Obesity in adulthood and its consequences for life expectancy: A life-table analysis. Ann Intern Med 2003;138:24-32.
30. Kuciene R, Dulskiene V. Associations between body mass index, waist circumference, waist-to-height ratio, and high blood pressure among adolescents: A cross-sectional study. Sci Rep 2019;9:9493.
31. Li N, Yang T, Yu WQ, Liu H. Is waist-to-height ratio superior to body mass index and waist circumference in predicting the incidence of hypertension? Ann Nutr Metab 2019;74:215-23.
32. Jeon J, Jung KJ, Jee SH. Waist circumference trajectories and risk of Type 2 diabetes mellitus in Korean population: The Korean genome and epidemiology study (KoGES). BMC Public Health 2019;19:741.
33. Hajian-Tilaki K, Heidari B. Is waist circumference a better predictor of diabetes than body mass index or waist-to-height ratio in Iranian adults? Int J Prev Med 2015;6:5.
34. Adegbija O, Hoy WE, Wang Z. Corresponding waist circumference and body mass index values based on 10-year absolute Type 2 diabetes risk in an Australian Aboriginal community. BMJ Open Diabetes Res Care 2015;3:e000127.
35. Brenner DR, Tepylo K, Eny KM, Cahill LE, El-Sohemy A. Comparison of body mass index and waist circumference as predictors of cardiometabolic health in a population of young Canadian adults. Diabetol Metab Syndr 2010;2:28.
36. Hou X, Lu J, Weng J, Ji L, Shan Z, Liu J, et al. Impact of waist circumference and body mass index on risk of cardiometabolic disorder and cardiovascular disease in Chinese adults: A national diabetes and metabolic disorders survey. PLoS One 2013;8:e57319.
37. Alberti KG, Zimmet P, Shaw J, IDF Epidemiology Task Force Consensus Group. The metabolic syndrome a new worldwide definition. Lancet 2005;366:1059-62.
38. Grundy SM, Cleeman JI, Daniels SR, Donato KA, Eckel RH, Franklin BA, et al. Diagnosis and management of the metabolic syndrome: An American Heart Association/national heart, lung, and blood institute scientific statement. Circulation 2005;112:2735-52.
39. Agnoli C, Sieri S, Ricceri F, Giraudo MT, Masala G, Assedi M, et al. Adherence to a Mediterranean diet and long-term changes in weight and waist circumference in the EPIC-Italy cohort. Nutr Diabetes 2018;8:22.
40. Bendall CL, Mayr HL, Opie RS, Bes-Rastrollo M, Itsiopoulos C, Thomas CJ. Central obesity and the Mediterranean diet: A systematic review of intervention trials. Crit Rev Food Sci Nutr 2018;58:3070-84.
41. Paula Bricarello L, Poltronieri F, Fernandes R, Retondario A, de Moraes Trindade BS, de Vasconcelos FA. Effects of the Dietary Approach to Stop Hypertension (DASH) diet on blood pressure, overweight and obesity in adolescents: A systematic review. Clin Nutr ESPEN 2018;28:1.
42. Makris A, Foster GD. Dietary approaches to the treatment of obesity.Psychiatr Clin North Am 2011;34:813-27.
43. Daly P, Pace T, Berg J, Menon U, Szalacha LA. A mindful eating intervention: A theory-guided randomized anti-obesity feasibility study with adolescent Latino females. Complement Ther Med 2016;28:22-8.
44. Ard JD, Miller G, Kahan S. Nutrition interventions for obesity. Med Clin North Am 2016;100:1341-56.
45. Smethers AD, Rolls BJ. Dietary management of obesity: Cornerstones of healthy eating patterns. Med Clin North Am 2018;102:107-24.
46. An J, Yoon SR, Lee JH, Kim H, Kim OY. Importance of adherence to personalized diet intervention in obesity related metabolic improvement in overweight and obese Korean adults. Clin Nutr Res 2019;8:171-83.
47. Jakicic JM, Rogers RJ, Davis KK, Collins KA. Role of physical activity and exercise in treating patients with overweight and obesity. Clin Chem 2018;64:99-107.
48. Philippou Ch, Andreou E, Menelaou N, Hajigeorgiou P, Papandreou D. Effects of diet and exercise in 337 overweight/obese adults. Hippokratia 2012;16:46-50.
49. Gordeladze JO. Hidetaka Hamasaki. In: Physical Activity and Obesity in Adults, Adiposity Epidemiology and Treatment Modalities. London: Intech Open; 2017. Available from: https:// [Last accessed on 2017 Mar 15].
50. Thenmozhi P. Priya T. Factors contributing for noncompliance of follow-up care among post cardiac patients. Int J Pharm Pharm Sci 2019;11:22-5.
51. Nkeiruka GO, Chinwe VU, Mattew JO. Prescription pattern of cardiovascular and/or antidiabetic drugs in Abuja district hospitals. Int J Pharm Pharm Sci 2019;11:21-7.
52. Management of Obesity. A National Clinical Guideline. Edinburgh (Scotland): Scottish Intercollegiate Guidelines Network (SIGN); 2010. Available from:
53. Jacobsen DJ, Bailey BW, LeCheminant JD, Hill JO, Mayo MS, Donnelly JE. A comparison of three methods of analyzing post-exercise oxygen consumption. Int J Sports Med 2005;26:34-8.
54. Jakicic JM, Winters C, Lang W, Wing RR. Effects of intermittent exercise and use of home exercise equipment on adherence, weight loss, and fitness in overweight women: A randomized trial. JAMA 1999;282:1554-60.
55. Church TS, LaMonte MJ, Barlow CE, Blair SN. Cardiorespiratory fitness and body mass index as predictors of cardiovascular disease mortality among men with diabetes. Arch Intern Med 2005;165:2114-20.
56. Farrell SW, Braun L, Barlow CE, Cheng YJ, Blair SN. The relation of body mass index, cardiorespiratory fitness, and all-cause mortality in women. Obes Res 2002;10:417-23.
57. Sui X, LaMonte MJ, Laditka JN, Hardin JW, Chase N, Hooker SP, et al. Cardiorespiratory fitness and adiposity as mortality predictors in older adults. JAMA 2007;298:2507-16.
58. Rankinen T, Church TS, Rice T, Bouchard C, Blair SN. Cardiorespiratory fitness, BMI, and risk of hypertension: The HYPGENE study. Med Sci Sports Exerc 2007;39:1687-92.
59. Wing RR, Jakicic J, Neiberg R, Lang W, Blair SN, Cooper L, et al. Fitness, fatness, and cardiovascular risk factors in Type 2 diabetes: Look ahead study. Med Sci Sports Exerc 2007;39:2107-16.
60. Jakicic JM, Egan CE, Fabricatore AN, Gaussoin SA, Glasser SP, Hesson L, et al. Change in cardiorespiratory fitness and influence on diabetes control and CVD risk factors in adults with Type 2 diabetes: 4-year results from the Look AHEAD Trial. Diabetes Care 2013;36:1297-303.
61. Cameron N, Godino J, Nichols JF, Wing D, Hill L, Patrick K. Associations between physical activity and BMI, body fatness, and visceral adiposity in overweight or obese Latino and non-Latino adults. Int J Obes (Lond) 2017;41:873-7.
62. Loprinzi PD, Cardinal BJ. Association between biologic outcomes and objectively measured physical activity accumulated in ? 10-minute bouts and <10-minute bouts. Am J Health Promot 2013;27:143-51.
63. Wolff-Hughes DL, Fitzhugh EC, Bassett DR, Churilla JR. Total activity counts and bouted minutes of moderate-to-vigorous physical activity: Relationships with cardiometabolic biomarkers using 2003-2006 NHANES. J Phys Act Health 2015;12:694-700.
64. Creasy SA, Rogers RJ, Davis KK, Gibbs BB, Kershaw EE, Jakicic JM. Effects of supervised and unsupervised physical activity programmes for weight loss. Obes Sci Pract 2017;3:143-52.
65. Polzien KM, Jakicic JM, Tate DF, Otto AD. The efficacy of a technology-based system in a short-term behavioral weight loss intervention. Obesity (Silver Spring) 2007;15:825-30.
66. Shuger SL, Barry VW, Sui X, McClain A, Hand GA, Wilcox S, et al. Electronic feedback in a diet- and physical activity-based lifestyle intervention for weight loss: A randomized controlled trial. Int J Behav Nutr Phys Act 2011;8:41.
67. Pellegrini CA, Verba SD, Otto AD, Helsel DL, Davis KK, Jakicic JM. The comparison of a technology-based system and an in-person behavioral weight loss intervention. Obesity (Silver Spring) 2012;20:356-63.
68. Rogers RJ, Lang W, Gibbs BB, Davis KK, Burke LE, Kovacs SI, et al. Comparison of a technology-based system and in-person behavioral weight loss intervention in adults with severe obesity. Obes Sci Pract 2016;2:3-12.
69. LeFevre ML, U.S. Preventive Services Task Force. Behavioral counseling to promote a healthful diet and physical activity for cardiovascular disease prevention in adults with cardiovascular risk factors: U.S. Preventive Services Task Force Recommendation Statement. Ann Intern Med 2014;161:587-93.
70. US Preventive Services Task Force, Grossman DC, Bibbins- Domingo K, Curry SJ, Barry MJ, Davidson KW, et al. Behavioral counseling to promote a healthful diet and physical activity for cardiovascular disease prevention in adults without cardiovascular risk factors: US preventive services task force recommendation statement. JAMA 2017;318:167-74.
71. Siu AL, U S Preventive Services Task Force. Screening for abnormal blood glucose and Type 2 diabetes mellitus: U.S. preventive services task force recommendation statement. Ann Intern Med 2015;163:861-8.
72. Sniehotta FF, Evans EH, Sainsbury K, Adamson A, Batterham A, Becker F, et al. Behavioural intervention for weight loss maintenance versus standard weight advice in adults with obesity: A randomised controlled trial in the UK (NULevel Trial). PLoS Med 2019;16:e1002793.
73. Resnicow K, Teixeira PJ, Williams GC. Efficient allocation of public health and behavior change resources: The “difficulty by motivation” matrix. Am J Public Health 2017;107:55-7.
74. Dombrowski SU, O’Carroll RE, Williams B. Form of delivery as a key “active ingredient” in behaviour change interventions. Br J Health Psychol 2016;21:733-40.
75. Griffiths F, Lindenmeyer A, Powell J, Lowe P, Thorogood M. Why are health care interventions delivered over the internet? A systematic review of the published literature. J Med Internet Res 2006;8:e10.
76. Michie S, West R. A Guide to Development and Evaluation of Digital Behaviour Change Interventions in Healthcare. UCL Centre for Behaviour Change Monograph. Bream, Silverback Publishing; 2016. Available from:
77. Webb TL, Joseph J, Yardley L, Michie S. Using the internet to promote health behavior change: A systematic review and meta-analysis of the impact of theoretical basis, use of behavior change techniques, and mode of delivery on efficacy. J Med Internet Res 2010;12:e4.
78. Hutchesson MJ, Rollo ME, Krukowski R, Ells L, Harvey J, Morgan PJ, et al. eHealth interventions for the prevention and treatment of overweight and obesity in adults: A systematic review with meta-analysis. Obes Rev 2015;16:376-92.
79. Sherrington A, Newham JJ, Bell R, Adamson A, McColl E, Araujo- Soares V. Systematic review and meta-analysis of internet-delivered interventions providing personalized feedback for weight loss in overweight and obese adults. Obes Rev 2016;17:541-51.
80. Colon-Gonzalez F, Kim GW, Lin JE, Valentino MA, Waldman SA. Obesity pharmacotherapy: What is next? Mol Aspects Med 2013;34:71-83.
81. Cheung BM, Cheung TT, Samaranayake NR. Safety of antiobesity drugs. Ther Adv Drug Saf 2013;4:171-81.
82. Hocking S, Dear A, Cowley MA. Current and emerging pharmacotherapies for obesity in Australia. Obes Res Clin Pract 2017;11:501-21.
83. Floriana EI, Simona N, Oana CS, Cornel C. Drug therapy in the treatment of obesity. Rom J Diabetes Nutr Metab Dis 2016;3:415-22.
84. Jackson VM, Breen DM, Fortin JP, Liou A, Kuzmiski JB, Loomis AK, et al. Latest approaches for the treatment of obesity. Expert Opin Drug Discov 2015;10:825-39.
85. Chatzigeorgiou A, Kandaraki E, Papavassiliou AG, Koutsilieris M. Peripheral targets in obesity treatment: A comprehensive update. Obes Rev 2014;15:487-503.
86. Ali KF, Shukla AP, Aronne LJ. Bupropion-SR plus naltrexone-SR for the treatment of mild-to-moderate obesity. Expert Rev Clin Pharmacol 2016;9:27-34.
87. Zhang ZY, Wang MW. Obesity, a health burden of a global nature. Acta Pharmacol Sin 2012;33:145-7.
88. American Diabetes Association. 7. obesity management for the treatment of Type 2 diabetes. Diabetes Care 2017;40:S57-S63.
89. Frühbeck G. Bariatric and metabolic surgery: A shift in eligibility and success criteria. Nat Rev Endocrinol 2015;11:465-77.
90. Wolfe BM, Kvach E, Eckel RH. Treatment of obesity: Weight loss and bariatric surgery. Circ Res 2016;118:1844-55.
91. Schroeder R, Harrison TD, McGraw SL. Treatment of adult obesity with bariatric surgery. Am Fam Physician 2016;93:31-7.
92. Buchwald H, Estok R, Fahrbach K, Banel D, Sledge I. Trends in mortality in bariatric surgery: A systematic review and meta-analysis. Surgery 2007;142:621-32.
93. Maggard MA, Shugarman LR, Suttorp M, Maglione M, Sugerman HJ,Livingston EH, et al. Meta-analysis: Surgical treatment of obesity. Ann Intern Med 2005;142:547-59.
94. Encinosa WE, Bernard DM, Du D, Steiner CA. Recent improvements in bariatric surgery outcomes. Med Care 2009;47:531-5.
95. Longitudinal Assessment of Bariatric Surgery (LABS) Consortium, Flum DR, Belle SH, King WC, Wahed AS, Berk P, et al. Perioperative safety in the longitudinal assessment of bariatric surgery. N Engl J Med 2009;361:445-54.
96. Birkmeyer NJ, Dimick JB, Share D, Hawasli A, English WJ, Genaw J, et al. Hospital complication rates with bariatric surgery in Michigan. JAMA 2010;304:435-42.
97. Finks JF, Kole KL, Yenumula PR, English WJ, Krause KR, Carlin AM, et al. Predicting risk for serious complications with bariatric surgery: Results from the Michigan Bariatric Surgery Collaborative. Ann Surg 2011;254:633-40.
98. Arterburn DE, Courcoulas AP. Bariatric surgery for obesity and metabolic conditions in adults. BMJ 2014;349:g3961.
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How to Cite
AMIRTHALINGAM, P. “NARRATIVE REVIEW ON THE CLINICAL PRACTICE GUIDELINES FOR THE MANAGEMENT OF OVERWEIGHT/OBESITY IN ADULTS”. Asian Journal of Pharmaceutical and Clinical Research, Vol. 13, no. 2, Dec. 2019, pp. 10-16, doi:10.22159/ajpcr.2020.v13i2.36404.
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