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Obesity management in adults
Obesity is a chronic disease treated in steps: lifestyle change for every patient, a drug when BMI is 30 or more (or 27 with a comorbidity), and bariatric surgery when BMI is 40 or more (or 35 with a comorbidity).
Why it matters in the exam
The exam asks when to add a drug and when to refer for surgery, how much weight loss improves the comorbidities, and which drugs cause weight gain. Other questions describe weight gain and ask about a secondary cause (hypothyroidism, Cushing's, medicines).
The most tested point is that losing 5–10% of body weight already improves blood pressure, glucose and lipids, and that the aim is health, not a "normal weight".
Obesity accompanies almost every chronic disease in primary care — diabetes, hypertension, fatty liver, knee osteoarthritis and sleep apnoea — so a respectful, non-blaming conversation about weight is part of treating each of them. Success is measured by improvement in the comorbidities, not only in kilograms.
In questions about children and adolescents BMI is judged by percentiles rather than fixed values, and treatment focuses on the whole family — eating habits, activity, sleep and screens — not on the child alone. Explaining expectations matters too: slow, steady loss is better than rapid loss that returns.
Key points
- Obesity is a chronic disease; a 5–10% loss improves comorbidities.
- Lifestyle: a deficit of 500–750 kcal a day and 150 minutes of activity a week.
- Drug: BMI 30, or 27 with a comorbidity; GLP-1 analogues are the most effective.
- Surgery: BMI 40, or 35 with a comorbidity.
- Always look for a medicine that causes weight gain.
Summary table
| Step | For whom | What is given | Expected result |
|---|---|---|---|
| Lifestyle | Every BMI of 25 or more | Deficit of 500–750 kcal a day, 150 minutes of activity a week, behavioural support | 5–10% loss on average |
| Drug | BMI 30 or more, or 27 or more with a comorbidity | Semaglutide 2.4 mg weekly, tirzepatide, liraglutide 3 mg daily, orlistat | 10–20% with GLP-1 analogues; less with orlistat |
| Bariatric surgery | BMI ≥40, or BMI ≥35 together with an obesity-related disease | Sleeve gastrectomy, gastric bypass | Large, lasting loss and improvement in diabetes |
| Search for a secondary cause | Rapid weight gain or suggestive signs | TSH, Cushing's work-up, medication review | The common cause: medicines |
| Children and adolescents | BMI at the 95th percentile or above | Family-based lifestyle treatment, and a drug from age 12 in selected cases | Family involvement is the key |
A free exam question
בת 26 , ברקע– :השמנה BMI 41 , נוטלת גלולות מגיל צעיר בשל מחזור לא סדיר, מתייעצת לגבי הריון עתידי. מהי ההמלצה המתאימה? (the question as examined, in Hebrew)
- א. יש לחסנה לשעלת(Pertusis) כ הכנה לקראת ה.היריון
- ב. יש לדחות ניתוח בריאטרי לאחר השלמת תוכניות הילודה שלה
- ג. בדיקה לרמת החומצה הפולית
- ד. ההשמנה מעלה את הסיכון למום פתוח בתעלה העצבית בעובר
In the full version for subscribers
- A simple algorithm
- Memory aid
- Exam traps
- 5 review cards
- Enough for IMLE
The full version is open to subscribers of: Family medicine, Medical licensing exam (IMLE), Internal medicine.
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Sources
- Israel Ministry of Health and Israeli medical societies, current edition — Clinical guidance on the treatment of obesity in adults
- American Diabetes Association, Standards of Care in Diabetes, 2025 — Obesity and weight management for the prevention and treatment of diabetes
- ASMBS/IFSO, 2022 — Indications for metabolic and bariatric surgery
Sources are given for further reading; the text is written afresh and not copied from them.
Reviewed by the Examqo AI Professor · 2026-11-06. The text may contain errors; when in doubt, check the source.