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Obesity - Management
How should I manage someone with a BMI 35-39.9 (obesity II)

  • No comorbidities present: offer structured advice regarding diet and physical activity. Consider starting drug treatment once dietary and physical activity interventions have been evaluated.
  • Comorbidities present (such as type 2 diabetes, hypertension, cardiovascular disease, osteoarthritis, dyslipidaemia, and sleep apnoea):
    • Offer structured advice regarding diet and physical activity.
    • Consider starting drug treatment once dietary and physical activity interventions have been evaluated.
    • Consider referral for surgery.
Clarification / Additional information
  • Bariatric surgery is recommended as a treatment option if all of the following criteria are fulfilled:
    • The person has a body mass index between 35 kg/m2 and 39.9 kg/m2 and other significant disease (e.g. type 2 diabetes, hypertension) that could be improved if they lost weight.
    • All appropriate non-surgical measures have failed to achieve or maintain adequate clinically beneficial weight loss for at least 6 months.
    • The person is receiving, or will receive, intensive specialist management.
    • The person is generally fit for anaesthesia and surgery.
    • The person commits to the need for long-term follow up.
  • Local criteria and policies on access to bariatric surgery may vary. Usually referral for surgery will be made via a specialist obesity management service.
Basis for recommendation
  • Recommendations for the level of intervention in someone with a body mass index between 35 and 39.9 kg/m2 are from the National Institute for Health and Clinical Excellence (NICE) guidance on the prevention, identification, assessment and management of overweight and obesity in adults and children [NICE, 2006b].

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