Obesity Due to Excess Calories When Weight-Loss Pharmacotherapy Plus Lifestyle Changes Has Not Achieved Target Weight Loss

Clinical Scenario

This protocol covers patients with obesity due to excess calories who have completed a course of pharmacotherapy combined with lifestyle modification but have not met the expected weight-loss response by the designated assessment point.

Previous Line: Failure Condition

The preceding treatment consisted of obesity pharmacotherapy — agents such as semaglutide, tirzepatide, liraglutide, phentermine/topiramate, naltrexone/bupropion, orlistat, or phentermine — used together with lifestyle changes. Progression to this protocol is indicated when the patient fails to achieve more than 5% weight loss after 3 months of pharmacotherapy, with weight assessed at least monthly for the first 3 months and at least quarterly thereafter.

Next-Line Approach

For patients who meet appropriate BMI criteria and are otherwise good surgical candidates, this protocol involves a metabolic surgical intervention performed at a high-volume centre. The full eligibility criteria, procedure selection, and perioperative pathway are detailed in the complete protocol.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.2337/dc26-S008

Consider metabolic surgery as a weight and glycemic management approach in people with type 2 diabetes with BMI ≥30.0 kg/m² (or ≥27.5 kg/m² in Asian American individuals) who are otherwise good surgical candidates.

The overwhelming majority of procedures performed in the U.S. are vertical sleeve gastrectomy (VSG) and Roux-en-Y gastric bypass (RYGB).

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