Obesity & Weight Management — GCC Nursing Guide

BMI Classification — WHO & Asian Cut-offs

Category	WHO BMI (kg/m²)	Asian BMI (kg/m²)	Risk
Underweight	<18.5	<18.5	Low
Normal weight	18.5–24.9	18.5–22.9	Normal
Overweight / Pre-obese	25.0–29.9	23.0–27.4	Increased
Obese Class I	30.0–34.9	27.5–32.4	High
Obese Class II	35.0–39.9	32.5–37.4	Very High
Obese Class III (Severe)	≥40.0	≥37.5	Extremely High

Asian populations develop metabolic complications at lower BMI thresholds. South-East Asian and East Asian patients should be assessed using Asian cut-offs. Many GCC Arab populations show intermediate metabolic risk profiles.

Waist Circumference Risk

Population	Increased Risk	High Risk
European men	≥94 cm	≥102 cm
European women	≥80 cm	≥88 cm
South Asian / Arab men	≥90 cm	≥102 cm
South Asian / Arab women	≥80 cm	≥88 cm

Waist-to-Hip Ratio (WHR)

Men: risk >0.90 Women: risk >0.85 Central obesity = visceral fat ↑

IDF Metabolic Syndrome Criteria

Central obesity (mandatory) PLUS any 2 of the following:

Triglycerides ≥1.7 mmol/L (or on treatment)
HDL-C <1.03 (men) / <1.29 mmol/L (women)
BP ≥130/85 mmHg (or on treatment)
Fasting glucose ≥5.6 mmol/L (or T2DM diagnosis)

MetS doubles CVD risk and increases T2DM risk 5-fold. Prevalence in GCC adults estimated 30–40%.

Edmonton Obesity Staging System (EOSS)

Stage	Description	Management
0	No risk factors, no symptoms, no functional impairment	Prevention; lifestyle counselling
1	Sub-clinical risk factors (pre-HTN, IFG, mild MSK symptoms)	Lifestyle intervention; monitoring
2	Established comorbidities (T2DM, HTN, OSA, OA)	Intensive lifestyle ± pharmacotherapy
3	Significant organ damage, major functional limitations	Pharmacotherapy + bariatric surgery consideration
4	Severe disability, end-stage organ disease	Palliative; symptom management

EOSS is superior to BMI alone for predicting mortality and guiding treatment intensity. Stage ≥2 justifies pharmacological or surgical intervention.

Obesity-Related Comorbidities

Metabolic

Type 2 Diabetes Mellitus
Dyslipidaemia
Non-alcoholic fatty liver disease (NAFLD/MASH)
Metabolic syndrome

Cardiovascular

Hypertension
Coronary artery disease
Heart failure
Atrial fibrillation

Respiratory

Obstructive sleep apnoea (OSA)
Obesity hypoventilation syndrome
Asthma exacerbation

Musculoskeletal

Osteoarthritis (knee/hip)
Gout
Lower back pain
Plantar fasciitis

Reproductive

PCOS (women)
Infertility
Gestational diabetes
Erectile dysfunction (men)

Psychological

Depression & anxiety
Binge eating disorder
Low self-esteem
Social stigma

5As Framework for Obesity Counselling

ASK

Seek permission to discuss weight. Use non-stigmatising language.

ASSESS

BMI, WC, EOSS stage, comorbidities, readiness to change.

ADVISE

Provide evidence-based information on risks and options.

AGREE

Collaboratively set SMART goals aligned with patient values.

ASSIST

Connect with resources; arrange follow-up; monitor progress.

5As Consultation Framework — Detailed Script▼

ASK — Permission & Language

Use person-first language: "person with obesity" not "obese person." Ask: "Would it be alright to talk about your weight today?" Respect refusal without judgment.

ASSESS — Comprehensive Evaluation

Anthropometrics: BMI, waist circumference, WHR
History: duration of weight gain, previous attempts, eating patterns, physical activity, sleep, stress
Medications contributing to weight gain: insulin, antipsychotics, steroids, anticonvulsants
Eating disorders screening (BED, night eating syndrome)
Readiness to change: Prochaska stages of change model

ADVISE — Evidence-Based Information

Even 5–10% weight loss improves metabolic parameters significantly
Explain treatment options at appropriate literacy level
Avoid blame; frame as a chronic disease requiring long-term management

AGREE — Goal Setting

SMART goals: Specific, Measurable, Achievable, Relevant, Time-bound
Initial target: 5–10% loss over 6 months (0.5–1 kg/week)
Focus on health gains, not just numbers on the scale

ASSIST — Ongoing Support

Referral to dietitian, physiotherapist, psychologist as needed
Weight management programme referral (NHS Tier 2/3 equivalent)
Follow-up appointments scheduled before patient leaves

Dietary Interventions

Caloric Deficit Targets

Deficit of 500–600 kcal/day = 0.5 kg/week loss
Low calorie diet (LCD): 1200–1500 kcal/day (women), 1500–1800 (men)
Very low calorie diet (VLCD): 450–800 kcal/day

Evidence-Based Dietary Patterns

Mediterranean diet: CV benefit + sustainable
Low-carbohydrate diet: rapid initial weight loss, T2DM benefit
Low-fat diet: long-term comparable to low-carb
Intermittent fasting (5:2 / TRE): equivalent to continuous restriction

VLCD requires medical supervision. Contraindicated in pregnancy, eating disorders, certain cardiac conditions. Provide adequate protein (≥50g/day) to preserve muscle mass.

Physical Activity Guidelines

WHO / NICE Recommendations

≥150 min/week moderate aerobic activity (walking, swimming, cycling)
75 min/week vigorous aerobic activity
Resistance training ≥2 days/week
Reduce sedentary time; break sitting every 30 minutes

For Weight Loss

200–300 min/week moderate activity recommended
Exercise alone produces modest weight loss (~2–3 kg)
Critical for weight maintenance and metabolic benefit
Tailor to musculoskeletal limitations (aqua aerobics, chair exercises)

Exercise preserves lean muscle mass during weight loss, improves insulin sensitivity, mood, and cardiovascular fitness independently of weight lost.

NHS Tier Structure for Weight Management

Tier	Setting	Intervention	Who qualifies
Tier 1	Universal / community	Public health advice, NHS health checks, GP brief interventions	All adults; overweight/obese
Tier 2	Community weight management	12-week structured programme (e.g., Weight Watchers NHS referral, group/individual sessions)	BMI ≥30 (or ≥28 with comorbidity)
Tier 3	Specialist outpatient MDT	Intensive lifestyle, psychology, pharmacotherapy, VLCD	BMI ≥40 or failed Tier 2; complex needs
Tier 4	Bariatric surgery	Sleeve gastrectomy, RYGB, gastric band	NICE BMI criteria; completed Tier 3

Behavioural Therapy Techniques

Motivational Interviewing (MI)

Express empathy; roll with resistance
Develop discrepancy between current behaviour and goals
Support self-efficacy
Avoid unsolicited advice; ask open questions
OARS: Open questions, Affirmation, Reflection, Summary

Behaviour Change Techniques

Self-monitoring: food diary, step counter, weight log
Stimulus control: remove unhealthy foods from home
Problem solving: anticipate high-risk situations
Goal setting: process + outcome goals
Relapse prevention: normalise lapses, not failures
Cognitive restructuring: address all-or-nothing thinking

Psychological co-morbidity must be screened and addressed. Untreated depression, anxiety and binge eating disorder significantly reduce treatment success.

NICE Weight Management Guidance (NG246, 2023)

Offer weight management interventions to all adults with BMI ≥30 (or ≥27.5 for South Asian/Black/Chinese/other ethnic groups)
Multicomponent programmes (diet + activity + behavioural support) are most effective
At least 12 sessions over at least 3 months
Consider pharmacotherapy when lifestyle intervention alone is insufficient
Bariatric surgery considered after all appropriate non-surgical interventions
Weight maintenance support should be offered after successful loss

Realistic expectations: 5–10% weight loss significantly improves BP, HbA1c, lipids, OSA severity, joint pain and quality of life — even without reaching a "normal" BMI.

Prescribing Criteria (NICE / GCC)

Standard: BMI ≥30 kg/m² with adequate lifestyle intervention

With comorbidity: BMI ≥27 kg/m² + T2DM, HTN, dyslipidaemia, OSA or CVD risk

Pharmacotherapy is adjunct to — not replacement for — lifestyle modification. Stop if <5% weight loss after 3 months (orlistat) or <5% at 16 weeks (GLP-1 agonists).

Orlistat (Xenical / Alli)

Mechanism of Action

Pancreatic and gastric lipase inhibitor. Prevents absorption of ~30% of dietary fat. Acts locally in the GI tract.

Dosing

120 mg TDS with each main meal containing fat (or up to 1 hour after meal). 60 mg OTC version available.

Side Effects (Fat-related)

Oily spotting, faecal urgency, oily/fatty stools
Flatus with discharge, faecal incontinence
Reduced absorption of fat-soluble vitamins (A, D, E, K)

Nursing Counselling Points

Limit dietary fat to <30% of calories (<15g/meal)
Take multivitamin (fat-soluble) 2 hours before or after orlistat
Side effects improve with dietary fat restriction
Contraindicated in cholestasis, malabsorption syndromes

Expected weight loss: ~3–4 kg more than placebo at 1 year. Less effective than GLP-1 agonists but available OTC in some GCC countries.

GLP-1 Receptor Agonists

Semaglutide (Wegovy) — Weight Management

Dose: 0.25 mg SC weekly → escalate to 2.4 mg over 16–20 weeks
Expected loss: 12–17% body weight (STEP trials)
Also approved for T2DM as Ozempic (1 mg) — different licence

Liraglutide (Saxenda)

Dose: 0.6 mg SC daily → escalate to 3.0 mg over 5 weeks
Expected loss: 5–10% body weight

Tirzepatide (Mounjaro / Zepbound)

Dual GIP + GLP-1 agonist
Expected loss: 15–22% body weight (SURMOUNT trials)
2.5 mg SC weekly → escalate to 15 mg

Common Side Effects

NauseaVomitingDiarrhoea Pancreatitis (rare)Thyroid C-cell tumour risk (animal data)

Contraindicated in: personal/family history of medullary thyroid carcinoma, MEN2 syndrome, prior pancreatitis, pregnancy.

GLP-1 Agonist Mechanism & Monitoring

Mechanism of Action

Mimics endogenous GLP-1 hormone
Increases insulin secretion (glucose-dependent)
Suppresses glucagon release
Slows gastric emptying → prolonged satiety
Central appetite suppression via hypothalamic receptors

Monitoring Requirements

Baseline: weight, BMI, HbA1c, lipids, LFTs, renal function
BP at each visit
Weight at 4-weekly intervals initially
Dose escalation diary reviewed
Screen for GI side effects; manage with antiemetics if needed
Review concurrent diabetes medications (hypoglycaemia risk)

GLP-1 agonists are experiencing a prescribing surge in GCC countries (UAE, Saudi Arabia, Qatar). Nurses must counsel on realistic expectations, injection technique, sharps disposal, and the need for concurrent lifestyle change.

When to Stop Pharmacotherapy

Drug	Stop if	Reassess if
Orlistat	<5% weight loss at 12 weeks	Sustained >5% loss; review at 3, 6, 12 months
Semaglutide / Liraglutide	<5% weight loss at 16 weeks on maintenance dose	Weight regain after cessation; restart consideration
Tirzepatide	<5% at 16 weeks	Continue indefinitely if effective + tolerated

Obesity is a chronic relapsing condition. Weight regain after stopping pharmacotherapy is expected (~two-thirds of lost weight returns within 1 year). Long-term or indefinite treatment may be appropriate.

NICE Criteria for Bariatric Surgery

Standard criteria: BMI ≥40 kg/m² OR BMI 35–39.9 with significant obesity-related comorbidity (T2DM, HTN, OSA, joint disease)

Accelerated pathway: BMI ≥35 with recent-onset T2DM (<10 years) — consider surgery as first-line after assessment

All appropriate non-surgical treatments tried and failed
Fit for anaesthesia and surgery
Committed to long-term follow-up
No untreated major psychiatric contraindication

Lower BMI thresholds apply for South Asian, Chinese, Black and other ethnic minority groups — consider at BMI ≥35 (or ≥32.5 in Asian groups) with comorbidities.

Surgical Options

Sleeve Gastrectomy (SG)

Removes ~80% of stomach (greater curvature)
Restricts volume; reduces ghrelin (hunger hormone)
Expected loss: 25–30% total body weight
No malabsorption; simpler technically
Irreversible; can progress to RYGB

Roux-en-Y Gastric Bypass (RYGB)

Small gastric pouch + intestinal bypass
Restriction + malabsorption mechanism
Expected loss: 30–35% total body weight
Superior T2DM remission rates
Higher nutritional deficiency risk

Adjustable Gastric Band (AGB)

Silicone band around upper stomach
Restriction only; no malabsorption
Expected loss: 15–20% total body weight
Reversible; adjustable
Higher long-term complication/revision rates; declining use

Biliopancreatic Diversion with DS (BPD/DS)

Sleeve + extensive intestinal bypass
Highest weight loss: 35–45% total body weight
Highest T2DM remission (>90%)
Highest nutritional deficiency risk
Reserved for BMI >50 or severe metabolic disease

Pre-operative Assessment

Bariatric Pre-op Checklist (expand)▼

Medical Assessment

Full metabolic panel: FBC, U&E, LFTs, TFTs, HbA1c, lipids
Nutritional bloods: B12, folate, iron studies, vitamin D, PTH, zinc, copper
Cardiac: ECG, echo if BMI >50 or cardiac symptoms
Respiratory: sleep study (polysomnography) if OSA suspected; pulmonary function tests
Endoscopy: H. pylori testing and eradication; Barrett's screening
Abdominal USS: gallstones assessment
Medication review: anticoagulants, antidiabetics, contraceptives

Psychological & Social Assessment

Psychiatric evaluation: screen BED, depression, psychosis, personality disorders
Substance use assessment (alcohol, recreational drugs)
Understanding of surgery, risks and lifelong dietary changes
Support system assessment (family/social support)
Ability to commit to follow-up

Optimisation Before Surgery

Optifast / VLCD for 2–4 weeks pre-op: reduces liver size → easier surgery
Ensure OSA treated with CPAP
Glycaemic optimisation: HbA1c <9% ideally
Smoking cessation ≥8 weeks pre-op
DVT prophylaxis planning

Post-operative Nutritional Deficiencies

Post-bariatric Nutritional Monitoring Protocol (expand)▼

Nutrient	Deficiency Risk	Mechanism	Supplementation	Monitoring
Vitamin B12	RYGB/SG high	Loss of intrinsic factor (IF) secretion from bypassed stomach	1000 mcg oral daily or 1000 mcg IM monthly	Annually; check MMA if borderline
Iron	RYGB very high (esp. women)	Bypass of duodenum (main absorption site); reduced gastric acid	Ferrous sulfate 200 mg TDS; IV iron if refractory	6-monthly; ferritin + TIBC
Folate	Moderate all procedures	Reduced dietary intake; bypass of jejunum	400–1000 mcg daily (5 mg if planning pregnancy)	Annually
Vitamin D & Calcium	All procedures	Bypass of absorption sites; reduced intake	Vitamin D 3000 IU + calcium citrate 1200–1500 mg/day	6-monthly; PTH, ALP, DEXA at 2 years
Thiamine (B1)	Persistent vomiting	Reduced intake + absorption	100 mg daily; IV if Wernicke's risk	If vomiting or neurological symptoms
Zinc	BPD/DS high	Malabsorption + reduced intake	8–22 mg elemental zinc/day	Annually; hair loss = early sign
Protein	All, esp. BPD/DS	Reduced intake, malabsorption	≥60–120 g/day protein target	Regular albumin, pre-albumin

Lifelong supplementation is mandatory after RYGB and BPD/DS. Failure to supplement leads to serious neurological, haematological and skeletal complications.

Dumping Syndrome

Dumping Syndrome Management Protocol (expand)▼

Early Dumping (30–60 min post-meal)

Osmotic shift of fluids into bowel
Symptoms: nausea, abdominal cramps, bloating, diarrhoea, palpitations, flushing, dizziness
Mechanism: rapid gastric emptying of high-osmolarity foods

Late Dumping (1–3 hours post-meal)

Reactive hypoglycaemia
Symptoms: sweating, weakness, tremor, confusion, hunger
Mechanism: excessive insulin release in response to glucose surge

Dietary Management

Eat small, frequent meals (6–8/day)
Avoid simple sugars and refined carbohydrates
Do not drink fluids within 30 minutes of meals
Eat slowly and chew thoroughly
Lie down for 30 minutes after eating if symptomatic
High protein, low glycaemic index foods preferred

Medical Management

Acarbose: for late dumping reactive hypoglycaemia
Octreotide SC: severe refractory cases
Dietitian review essential
Continuous glucose monitoring (CGM) for diagnosis

Nursing Role in Bariatric MDT

Pre-operative

Patient education sessions
VLCD compliance support
CPAP adherence monitoring
DVT prophylaxis education
Informed consent support

Peri-operative

Bariatric-specific equipment (wide beds, large cuffs)
Airway management awareness
Enhanced recovery protocols
Early ambulation facilitation
Pain management

Post-operative

Dietary progression monitoring
Supplement adherence education
Dumping syndrome teaching
Wound and anastomosis monitoring
Long-term annual follow-up coordination

T2DM Remission Post-Bariatric Surgery

Definition (ADA 2021)

HbA1c <6.5% for ≥3 months without glucose-lowering medication.

Remission Rates

RYGB: 60–80% T2DM remission at 1 year
Sleeve gastrectomy: 50–70% remission
BPD/DS: >90% remission
Gastric band: 40–50% remission

Mechanisms

Caloric restriction (immediate — before weight loss)
Improved incretin effect (GLP-1 surge post-RYGB)
Gut microbiome changes
Weight loss and improved insulin sensitivity

Remission predictors: shorter duration of T2DM (<5 years), no insulin use, higher C-peptide, greater preop hyperglycaemia.

Hypertension Management

Impact of Weight Loss

Each 1 kg weight loss reduces SBP by ~1 mmHg
5–10% weight loss can resolve hypertension in 30–50%
Bariatric surgery achieves HTN remission in 60–75%

Nursing Monitoring

Regular BP monitoring: target <130/80 mmHg
Review antihypertensives after weight loss (risk of hypotension)
DASH diet education: low sodium (<2.3g/day), high potassium
Alcohol reduction counselling

Post-bariatric Caution

Antihypertensive dose reduction may be needed after surgery. Closely monitor BP in first weeks — hypotension risk is real, especially with ACE inhibitors + diuretics.

Obstructive Sleep Apnoea (OSA)

Assessment

STOP-BANG screening questionnaire
Polysomnography (gold standard) or home sleep apnoea test
AHI: mild 5–14, moderate 15–29, severe ≥30 events/hour

CPAP Therapy

First-line for moderate-severe OSA
Titrated CPAP or AutoCPAP
Compliance ≥4h/night on ≥70% of nights = adequate
Benefits: daytime sleepiness, cognitive function, CV risk, BP

Impact of Weight Loss

10% weight loss reduces AHI by ~26%
Bariatric surgery: OSA resolution in 80–85%
Review need for CPAP after significant weight loss

NAFLD / MASH Monitoring

Staging

Simple steatosis → NASH → fibrosis → cirrhosis → HCC
MASH (metabolic dysfunction-associated steatohepatitis): new nomenclature 2023

Non-invasive Fibrosis Assessment

FIB-4 score = (Age × AST) / (Platelets × √ALT)
FIB-4 <1.30: low fibrosis risk
FIB-4 1.30–2.67: indeterminate → FibroScan
FIB-4 >2.67: high fibrosis risk → hepatology referral

Management

Weight loss 7–10% improves steatohepatitis, 10%+ improves fibrosis
No alcohol
Vitamin E 800 IU/day (non-diabetic NASH)
Bariatric surgery improves histological NAFLD markedly

New MASH-targeted drugs entering clinical practice 2024–2025: resmetirom (THR-β agonist) — first FDA-approved for MASH with fibrosis.

PCOS & Fertility

Obesity-PCOS Link

Obesity worsens insulin resistance → hyperinsulinaemia → excess androgen production
5–10% weight loss restores ovulation in 55–90% of anovulatory PCOS women

Management

Lifestyle intervention is first-line
Metformin: insulin sensitiser, weight-neutral
Inositol (myo-inositol): improves insulin sensitivity, menstrual regularity
GLP-1 agonists: emerging evidence in PCOS
Clomiphene / letrozole for ovulation induction after weight management

Fertility counselling: advise achieving healthy weight before conception. Obesity increases risk of GDM, pre-eclampsia, macrosomia, and C-section.

Musculoskeletal & Psychological

Musculoskeletal

Each BMI unit increase raises knee OA risk ~10%
Weight loss of 5 kg reduces knee force by ~20 kg per step
Aquatic exercise, physiotherapy for exercise intolerance
Consider orthopaedic referral for severe OA — weight loss pre-surgery improves outcomes

Psychological Support

Screen for depression (PHQ-9), anxiety (GAD-7) at each visit
Binge eating disorder (BED) prevalence: 20–30% in bariatric candidates
BED treatment: CBT is first-line; lisdexamfetamine if indicated
Address weight stigma and internalised shame
Refer to psychologist as part of MDT

Untreated BED predicts poorer bariatric outcomes. Pre-operative psychological clearance is mandatory in most bariatric centres.

GCC Obesity Epidemiology

Country	Obesity Prevalence (%)	Key Notes
Kuwait	~37–42%	Among highest globally; high sedentary lifestyle prevalence
Qatar	~35–40%	Rapid urbanisation; expat population variation
UAE	~33–38%	Dubai/Abu Dhabi clinical guidelines align with NICE + local adaptations
Saudi Arabia	~30–35%	SCFHS licensing examinations; MOH national obesity programme
Bahrain	~29–35%	High metabolic syndrome burden
Oman	~25–30%	Lower but rapidly rising

GCC countries have some of the world's highest obesity rates. Female obesity prevalence often exceeds male in Gulf populations.

GCC-Specific Contributing Factors

Dietary Patterns

High carbohydrate traditional Gulf diet (rice-heavy meals)
Increased ultra-processed food consumption
Large portion sizes; food as hospitality/culture
High sugar beverage consumption (karak chai, juices)
Eating late at night; irregular meal timing

Ramadan Weight Cycling

Prolonged fasting → large iftar + suhoor meals
Nocturnal eating pattern disrupts circadian rhythm
Some individuals gain weight during Ramadan
Opportunity for dietary counselling and habit change
Medication timing adjustments required (orlistat, GLP-1)

Lifestyle Factors

Extreme heat limits outdoor physical activity 6+ months/year
Car-dependent infrastructure; low active transport
Reliance on domestic workers reduces physical activity
Indoor sedentary leisure (gaming, social media)
Air-conditioned malls as primary social venue

Cultural & Social Factors

Body weight sometimes viewed positively (prosperity, fertility)
Stigma around mental health may limit psychological referrals
Gender-segregated exercise facilities may limit women's access
Domestic worker health often neglected (overweight + sedentary)
Family-centred decision making affects treatment adherence

GCC Regulatory Bodies & Exam Preparation

DHA (Dubai Health Authority)
Licensing for Dubai healthcare professionals. MCQ-based examination. Obesity pharmacology and bariatric nursing are high-yield topics.

DOH (Department of Health — Abu Dhabi) / HAAD
Abu Dhabi licensing. Similar format to DHA. Focus on NICE guidelines adapted for regional practice.

SCFHS (Saudi Commission for Health Specialties)
Saudi nursing licensing. Broader clinical scope. Includes obesity guidelines, T2DM management, surgical nursing.

High-Yield Exam Topics

BMI Classification MCQs

WHO Class I obesity = BMI 30.0–34.9
WHO Class II = BMI 35.0–39.9
WHO Class III = BMI ≥40
Asian cut-off for overweight = 23.0 kg/m²
Bariatric surgery threshold = BMI ≥40 OR ≥35 + comorbidity
Pharmacotherapy threshold = BMI ≥30 OR ≥27 + comorbidity

Orlistat Counselling MCQs

Mechanism: inhibits pancreatic lipase
Blocks ~30% dietary fat absorption
Dose: 120 mg three times daily with meals
Side effect trigger: high dietary fat intake
Fat-soluble vitamin supplementation required
Stop if <5% weight loss at 12 weeks

Bariatric Surgery MCQs

Best T2DM remission: BPD/DS >90%
Most common deficiency post-RYGB: iron (women), B12
Dumping syndrome: avoid simple sugars, no fluids with meals
Pre-op VLCD: reduces liver size for laparoscopic access
Thiamine deficiency risk: persistent post-op vomiting → Wernicke's

GLP-1 Agonist MCQs

Semaglutide (Wegovy): 2.4 mg SC weekly
Expected weight loss: 12–17% body weight
Contraindication: personal/family history MTC or MEN2
Most common side effect: nausea (usually transient)
Stop if <5% loss at 16 weeks on maintenance dose

Remember: Obesity is classified as a chronic disease (WHO 1997). Use non-stigmatising language in practice and in exam scenario questions. Person-centred care and MDT approach are always preferred answers.

BMI & Metabolic Risk Calculator

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