Treatment of Obesity

First-Line Treatment Principles

• ✓Individualise glycaemic targets based on patient age, comorbidities, and hypoglycaemia risk
• ✓Metformin remains first-line for type 2 diabetes (unless contraindicated)
• ✓SGLT2 inhibitors and GLP-1 RAs for patients with established CV disease, HF, or CKD
• ✓Insulin when oral agents insufficient (T2DM) or as primary therapy (T1DM)
• ✓Thyroid hormone replacement (levothyroxine) is the standard of care for hypothyroidism

What to Do Now

1. Learn your personal risk factors for Obesity (family history, age, lifestyle)
2. Attend regular health check-ups and screening tests appropriate for your age and risk
3. Track new or changing symptoms, especially those associated with Obesity
4. Use our AI symptom checker to assess whether your symptoms fit an early Obesity pattern
5. Discuss preventive strategies and early monitoring with your GP
6. Build a personalised management plan with your GP or specialist
7. Adhere consistently to prescribed medications — do not stop without medical advice
8. Adopt a Obesity-appropriate diet (anti-inflammatory, low-glycaemic, or disease-specific)

Medications Used in Obesity

Non-Pharmacological Management

• •Medical nutrition therapy: calorie-controlled, low-glycaemic-index diet; carbohydrate counting for insulin users
• •Structured physical activity: 150 min/week aerobic + resistance training 2×/week
• •Weight loss: 5–10% body weight reduces HbA1c by 0.5–2% and improves insulin sensitivity
• •Smoking cessation: accelerates diabetes complications (retinopathy, nephropathy)
• •Alcohol restriction: masking of hypoglycaemia; contributes to metabolic dysfunction
• •Sleep optimisation: poor sleep worsens insulin resistance and metabolic control
• •Self-monitoring of blood glucose (SMBG) or continuous glucose monitoring (CGM)

Treatment Goals

Monitoring Parameters

• ◆HbA1c: every 3 months until stable, then every 6 months (target <7% in most T2DM)
• ◆Fasting glucose and CGM metrics (time in range >70% for most)
• ◆Blood pressure: target <130/80 mmHg in diabetes
• ◆Lipid panel: annually; intensify if LDL >2.5 mmol/L or established ASCVD
• ◆Renal function (eGFR, urine albumin-creatinine ratio): annually
• ◆Eye examination (retinal screening): annually
• ◆Foot examination: at every visit; annual podiatry review
• ◆TSH monitoring: 6-weekly after levothyroxine initiation, then annually when stable

Red Flags — When to Escalate

• ⚠Any of the characteristic symptoms of Obesity — even mild — in a high-risk individual
• ⚠Progressive worsening of early warning signs over weeks
• ⚠Laboratory abnormalities (e.g., blood sugar, inflammatory markers) without full symptoms
• ⚠Unexplained weight loss, night sweats, or fatigue persisting >2 weeks
• ⚠Strong family history of Obesity combined with new relevant symptoms
• ⚠Sudden worsening of Obesity symptoms despite established treatment

Escalation Criteria

• →HbA1c persistently >10% despite maximal oral therapy → insulin initiation
• →Diabetic ketoacidosis (DKA) or hyperosmolar hyperglycaemic state (HHS): emergency hospitalisation
• →Severe hypoglycaemia (glucose <3 mmol/L with confusion/loss of consciousness): glucagon, IV dextrose
• →New or worsening nephropathy (eGFR <30): nephrology review; restriction of nephrotoxic agents
• →Thyroid storm or myxoedema coma: intensive care emergency

Special Populations

Clinical Insights