FL APRN Autonomous Practice Applicant (Pharmacology): Adult Obesity: Comprehensive Assessment and Management

Over 890 million adults worldwide are living with obesity (World Health Organization [WHO], 2025). Obesity was deemed a chronic disease in 2013. Despite advances in treatment options, the obesity epidemic in the United States continues to escalate. According to the Centers for Disease Control and Prevention (CDC) (Emmerich et al., 2024), the prevalence of obesity in the adult population is now at a staggering 40.3%, with the rates of severe obesity rising to 9.4%. The obesity rates did not differ between men and women, but for those with severe obesity, the prevalence was higher in women (Emmerich et al., 2024). The prevalence of obesity was also higher in those aged 40-59, in those with a lower education level, and in the non-Hispanic Black and Hispanic populations (Centers for Disease Control and Prevention [CDC], 2024a).

In the United States, there is ample access to high-calorie, ultra-processed foods, and in many areas, very little access to healthy foods such as fresh fruits or vegetables. Couple the easy access to these obesity promoting foods with a sedentary lifestyle and a lack of safe spaces for exercise, and the result is an obesogenic environment. These obesogenic environments fuel the obesity epidemic, while many adults in the US lack access to treatment and often are faced with weight stigma. As obesity rates rise, healthcare providers must have the knowledge and skills needed to care for adults living with obesity effectively.

Previously, obesity was thought to be a condition based on calorie intake versus calorie expenditure, which does not acknowledge the full picture of obesity. The pathophysiology of obesity is multifactorial, with complex interactions among genetic, hormonal, behavioral, and environmental factors that affect energy intake and expenditure.

Adults living with obesity have an increased risk of obesity-related complications and obesity-related diseases, leading to higher mortality levels than in the non-obese population. It has been estimated that obesity-related premature deaths per year in the United States outnumber the premature deaths caused by smoking (Ward et. al., 2022). Morbidity related to adult obesity has significant negative financial and quality-of-life implications.

Just as the pathophysiology of obesity is multifactorial, obesity-related adverse health outcomes affect multiple organ systems. Often, obesity treatment can improve some of these adverse health outcomes. Table 2 identifies several obesity-related medical conditions.

Type 2 diabetes is a growing obesity-related condition. Type 2 diabetes results from insulin resistance and pancreatic β-cell dysfunction. Insulin is a hormone excreted from the pancreatic β-cells to lower blood glucose. Excess adipose tissue increases proinflammatory cytokines and free fatty acids (FFA), which impair insulin's ability to enter cells (insulin resistance), thereby raising blood glucose levels. The elevated blood glucose levels trigger the pancreas to release more insulin. Excess lipids in the bloodstream that cannot be stored in adipose tissue also increase insulin resistance. Given these mechanisms, pancreatic β-cell hypertrophy results in β-cell dysfunction and reduced insulin production (Klein et al., 2022).

Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) is a common finding in those with obesity, metabolic syndrome, and type 2 diabetes. If not addressed, MASLD can lead to Metabolic Dysfunction–Associated Steatohepatitis (MASH), liver fibrosis, liver cirrhosis, and hepatocellular carcinoma. MASLD is caused by excessive accumulation of lipids in the liver, coupled with insulin resistance. These processes then lead to hepatocyte dysfunction, causing liver inflammation, oxidative stress, and mitochondrial changes, thereby worsening MASLD to MASH, fibrosis, cirrhosis, and carcinoma (Dua et al., 2025).

Obesity results in chronic exposure of the heart and blood vessels to proinflammatory substances. This ongoing inflammation, coupled with increased circulating fluid volume and dyslipidemia, leads to cardiovascular conditions such as hypertension, coronary artery disease, CVA, heart failure, atrial fibrillation, and thrombotic events (Norton et al., 2024; Jin et al., 2023). FFA enters the cardiac muscle cells, and the accumulation of excess adipose tissue surrounding the heart contributes to cardiac dysfunction, including left ventricular hypertrophy in adults with obesity (Jin et al., 2023).

Pulmonary conditions directly related to obesity in adults include obstructive sleep apnea (OSA), asthma, and hypoventilation syndrome. In adults with obesity, excess adipose tissue narrows the airways and induces a proinflammatory response, leading to airway inflammation and impaired gas exchange. Additionally, the smaller airway diameter relative to lung tissue volume results in limited lung volumes. Together, these factors result in a higher incidence of asthma and worsening of existing asthma in those with obesity (Fröhlich, 2025). Excess adipose tissue in the chest, neck, and abdominal cavity obstructs the airway during sleep in OSA. Similarly, hypoventilation syndrome is observed in obesity due to excess adipose tissue, also causing shallow breathing and hypoventilation, though it is continuous during both wakefulness and sleep (Fröhlich, 2025).

Adults with obesity have a higher incidence of multiple cancers, including, but not limited to, breast, colorectal, pancreatic, liver, esophageal, endometrial, and ovarian cancer. Numerous biological factors in obesity are thought to fuel the growth of cancer cells. Obesity can promote cancer cell proliferation through oxidative stress, leading to DNA damage and exposing cancer cells to elevated levels of lipids, insulin, leptin, and other proinflammatory cytokines (Jin et al., 2023).

Obesity is a complex chronic disease that requires a comprehensive clinical assessment provided by obesity informed healthcare providers. The assessment of adults living with obesity starts with the complete health history. Investigating family history, medications, and comorbid medical conditions will help assess potential contributors to obesity. It is also important to evaluate for any psychological disorders. Untreated depression, anxiety, or eating disorders can complicate the treatment of obesity. Next, evaluate the patient’s dietary habits, such as types of foods consumed, eating patterns, and access to healthy foods. Assessing sleep timing, duration, and quality provides a better understanding of disordered sleep patterns. Also, ask about the frequency, type, and duration of physical activity. A comprehensive health history also includes information about housing, socioeconomic barriers (such as low income or food insecurity), limited mobility, and cognitive concerns.

The physical exam is a critical part of clinical assessment, though it can be anxiety-provoking for many patients. Healthcare providers should use supportive language and a gentle, respectful approach. The physical assessment includes measurements of height, weight, BMI, neck circumference, and waist circumference. Vital sign measurements include blood pressure, heart rate, and pulse oximetry readings.

A comprehensive physical exam, found in Table 3, includes:

Skin: Common skin findings in obesity include acanthosis nigricans and skin tags, both of which are linked to insulin resistance. Hirsutism, or excessive hair growth on the face, chest, abdomen, and thighs in women, can be associated with conditions like PCOS. Facial plethora and violaceous striae (wide, purple stretch marks) on the abdomen, axilla, thighs, and breasts can be associated with conditions such as hypercortisolism. Skin breakdown, such as pressure ulcers, can occur with immobility. Lower-extremity skin abnormalities, such as skin discoloration in chronic venous insufficiency and cellulitis, can occur in obesity. Skin folds can retain moisture, leading to a rash or even candida infection (Taira et al., 2024).

Cardiopulmonary: Cardiac assessment includes identifying abnormal heart sounds, such as murmurs or carotid bruit. Evaluation for heart failure includes the assessment of lung sounds for crackles, lower extremity edema, jugular venous distention (JVD), and displaced apical impulse, as well as S3 and S4 heart sounds. Assessing the cardiac rhythm is essential for identifying arrhythmias, such as atrial fibrillation. Reduced lung sounds on physical examination may indicate reduced lung capacity due to obesity.

Abdomen: The abdominal assessment can be difficult in adults living with obesity, but it is vital to identifying obesity related conditions. Liver palpation can identify hepatomegaly. Palpation of the abdomen can reveal a pulsatile mass due to an abdominal aortic aneurysm (AAA). Non-pulsatile masses palpated in the abdomen could identify a cancerous process or an abdominal hernia. Ascites can result from heart failure and liver disease in adults living with obesity.

Musculoskeletal: The musculoskeletal examination is performed to identify obesity-related conditions, including osteoarthritis with joint pain, joint deformity, and limited joint range of motion. Evaluation of extremity muscle wasting can raise the suspicion of Cushing’s syndrome.

Psychological: A psychological exam evaluates the patient’s mood and affect as well as their interaction with the healthcare provider. Anxiety and depression are common mental health disorders in adults living with obesity, but they also play a role in the etiology of obesity. During the clinical evaluation, be aware of symptoms of mood disorders such as lack of eye contact, fidgeting, lack of engagement in the conversation, flat affect, becoming tearful, expressing excessive worry, or even expressing self-harm. Evaluation of other existing mental health disorders can also aid in addressing potential barriers to successful obesity treatment.

Laboratory evaluation of obesity includes assessment of fasting blood glucose, hemoglobin A1c, liver function tests, electrolytes, thyroid-stimulating hormone, and a lipid panel. Additional targeted laboratory tests may be performed, as indicated, to assess the status of pre-existing obesity-related complications and diseases. Other diagnostic tests that may be considered based on abnormal clinical examination findings include joint imaging, electrocardiogram, sleep study, and noninvasive liver evaluation.

Weight bias is considered the negative attitude of others toward those with obesity regarding their weight. This negative attitude is rooted in the belief that obesity is entirely within one’s control. Weight bias can be attitudes or thoughts that someone is aware of (explicit), or it may be unconscious attitudes or thoughts that someone is unaware of (implicit) (Bannuru & Professional Practice Committee, 2025). Unfortunately, many healthcare providers have explicit and implicit weight bias leading to weight stigma. Weight stigma is the mistreatment of those living with obesity and undervaluing people based on their size. Examples of weight bias include unfair assumptions about obese patients, attributing all symptoms to the patient's weight, disrespectful communication and blame, and using obesity stigmatizing language (Bannuru & Professional Practice Committee, 2025). Weight bias and stigma lead to lower healthcare utilization and worsening clinical and psychological outcomes related to obesity due to the distrust and overall negative healthcare experiences with those living with obesity. As healthcare providers, it is critical to be aware of any explicit or implicit biases within one's own practice.

Obesity is a common chronic health condition amongst adults in the US. Obesity is a complex, chronic disease and is vastly more complicated than the previous calories-in vs calories-out theory. Just as the disease itself is multifactorial, the layers of treatment are varied. However, all options require long-term commitment from the patient and a long-term relationship with the healthcare provider. Using clinical expertise, healthcare providers can assist patients in shared decision-making to identify the most appropriate course of action for weight loss and reduction in obesity-related complications.

Mr. Perez is a 52-year-old Hispanic male who presents to the primary care clinic for his annual physical examination. He is 6 ft tall and 285 lb. His BMI is 38.6 kg/m², classifying him as having class II obesity. He has a medical history of dyslipidemia, hypertension, OSA, MASLD, osteoarthritis of the knees, and prediabetes. He is currently taking lisinopril 20 mg daily, hydrochlorothiazide 12.5 mg daily, atorvastatin 40 mg daily, and metformin 500 mg twice a day. He uses his CPAP nightly. He has a sedentary job and admits he does not exercise. He does not eat breakfast and relies on fast food for lunch. Dinner is often a dish made of rice and beans. He does not like many vegetables. He drinks 1-2 cans of soda per day.

The physical exam reveals a male patient who appears to be his stated age. He has acanthosis nigricans on the posterior neck with skin tags. His lungs are clear throughout. Cardiac rate and rhythm are normal, without murmur. No S3 or S4 heart sounds heard. The abdomen is obese but non-tender, with no abnormal masses or abdominal bruits. He has a limited range of motion in both knees, with crepitus noted. There is also medial joint line tenderness in both knees.

His lab work and vital signs are as follows:

• BP: 146/72 mmHg
• Heart Rate: 64 bpm
• Fasting Glucose: 105 mg/dL
• GFR: 83 mL/min/1.73 m² 
• Hemoglobin A1c: 5.9%
• LDL: 82 mg/dL
• Triglycerides: 170 mg/dL
• Electrolytes and liver function tests are within normal limits
• CBC within normal limits

After obtaining Mr. Perez's permission to discuss his weight, you present him with the obesity classification chart. He says he has tried to lose weight in the past, but “nothing has ever worked”. He reports that both of his parents were overweight, as are all five of his siblings. He reports his brother just had an MI, and he is afraid that if he does not do something about his weight, he may be next.

You discuss with Mr. Perez his class II obesity and his current obesity-related complications. You also discuss the possibility of worsening complications if weight gain continues. You discuss with him the etiology of obesity, including his genetic predisposition, given his family history of obesity, as well as his high-risk ethnicity. He reports that he is highly motivated to begin making changes but is unsure where to start. With his permission, you offer to refer him to a local dietitian and physical therapy. Before he leaves the office, he makes a goal to reduce soda intake from 1-2 per day to 1-2 per week.

Mr. Perez follows up 3 months later, weighing 278 lb. He has completely discontinued soda and now drinks water or unsweetened tea. He walks twice per week. Despite dietary changes and exercise, he reports that his weight has plateaued. You discuss with him the options for pharmacologic therapy or surgical intervention. He would like to avoid surgery at this time but is very interested in pharmacologic therapy. You discuss the available medications, both short-term and long-term, with Mr. Perez. Using shared decision making, the plan is to start tirzepatide at 2.5 mg subcutaneous once a week and titrate every 4 weeks as tolerated.

He was able to titrate the tirzepatide up to 15 mg once a week. After 6 months on tirzepatide 15 mg once a week, Mr. Perez follows up in the clinic, weighing 225 lb. His vital signs and lab work now demonstrate:

• BP: 115/62 mmHg
• HR: 63 bpm
• Fasting glucose: 82 mg/dL
• GFR: 89 mL/min/1.73 m² 
• Hemoglobin A1c: 5.3%
• LDL: 68 mg/dL
• Triglycerides: 100 mg/dL
• Electrolytes and liver function tests are within normal limits
• CBC within normal limits

He has continued working with the dietician and has found several vegetables that he likes. The dietitian has helped him strike a balance between a healthy diet and his Hispanic heritage in his cooking. Unfortunately, due to osteoarthritis of his knees, he still cannot walk more than two days per week. He plans to undergo bilateral knee replacements soon. He aims to walk a 5k by next summer. He wishes to continue treatment with tirzepatide long-term.

Wanda is a 45-year-old female who was referred to physical therapy for strengthening, functional training, and weight-loss exercises, primarily because increased body weight had begun to interfere with her daily life. Her primary care physician has medically cleared her for participation in moderately intense exercise.

• Initial weight: 232 lbs
• Height: 5’6”
• Initial BMI: 37.4 (Class 2 Obesity)

During the initial evaluation, Wanda gave the physical therapist permission to discuss her weight and related problems. She reported persistent knee pain when walking, frequent fatigue during moderate activities, and repeated difficulty maintaining exercise routines. She identified three main goals: to lose weight safely, reduce knee discomfort, and build the endurance needed for activities of daily living. Wanda does not currently have access to a gym, but expressed interest in joining one of the nearby low-cost gyms, which also has a heated pool.

The physical therapist conducted a comprehensive assessment that included a functional movement screen, lower-extremity strength testing, resting cardiovascular measurements, and a six-minute walk test in which she covered 380 meters. The evaluation revealed significant deconditioning, weakness in the quadriceps and hip musculature, and low aerobic capacity; factors that contributed to excess joint stress and early fatigue during movement.

A 24-week rehabilitation and conditioning program was designed to address these findings. For the first 12 weeks, the patient attended two supervised sessions per week, transitioning later to one supervised session combined with a structured home program. The strengthening component began immediately and continued throughout the full 24 weeks, focusing on building lower-extremity and core strength to improve joint stability, metabolism, and functional mobility. Early exercises included sit-to-stand progressions, resistance-band hip strengthening, and core stabilization. As Wanda’s tolerance improved, leg-press exercises and progressively higher step-ups were added. Resistance and difficulty increased every 2 to 3 weeks, provided the technique and symptom response remained appropriate.

Aerobic conditioning was introduced concurrently but progressed gradually. During the first month, the patient performed 15–20 minutes of treadmill walking or recumbent cycling at low-to-moderate intensity in the clinic. By weeks 5-12, she was able to sustain 25–35 minutes at moderate intensity. Wanda decided to join her local gym and was able to incorporate the recumbent cycling or treadmill regularly, 3-5 times a week, especially as the frequency of her therapy visits decreased. This helped build consistency and long-term compliance with her new exercise habits. In the final phase of the program, sessions expanded to 35–45 minutes and incorporated interval-based walking or cycling. Intensity was maintained within approximately 50–70% of heart-rate reserve and monitored using perceived-exertion scales to ensure safe progression.

Wanda was also instructed in water exercises for strengthening and aerobic fitness that she could include when her knees were more painful. This allowed her to still incorporate exercise, when she would have previously declined to exercise because of pain.

Behavioral support played a key role in the program’s success. The therapist and patient set weekly activity goals, tracked daily movement using her smartwatch step tracker, and discussed pacing strategies, recovery, and methods for gradually increasing lifestyle activity outside formal exercise sessions. The patient also participated in nutrition counseling through an external referral, helping align dietary changes with the physical activity program.

After 24 weeks, Wanda demonstrated substantial improvements across multiple measures. Her weight decreased to 222 pounds (101 kg), representing a total loss of approximately 37 pounds (17 kg), or 14.4% of her starting body weight. Her BMI declined to 31.5. Functional capacity improved markedly, with her six-minute walk distance increasing from 380 meters to 525 meters. Knee pain, initially rated 6 out of 10, dropped to 2 out of 10, and her weekly physical activity rose from roughly 40 minutes to about 210 minutes.

At the 6-month follow-up, Wanda reported greater confidence exercising independently and maintained most of her weight loss while sustaining an active lifestyle. Several elements contributed to the successful outcome. Early emphasis on strengthening improved joint support and reduced pain, allowing more comfortable participation in aerobic exercise. Gradual cardiovascular progression prevented overexertion and improved adherence, while supervised sessions ensured correct technique and built confidence. Consistent goal tracking and therapist follow-up reinforced accountability and long-term behavior change.

• American Society for Metabolic and Bariatric Surgery [ASMBS]. (2025). ASMBS endorsed procedures and FDA-approved devices. American Society for Metabolic and Bariatric Surgery. Visit Source.
• Anekwe, C. V., Ahn, Y. J., Bajaj, S. S., & Stanford, F. C. (2024). Pharmacotherapy causing weight gain and metabolic alteration in those with obesity and obesity-related conditions: A review. Annals of the New York Academy of Sciences, 1533(1), 145-155. Visit Source.
• Bajaj, S. S., Zhong, A., Zhang, A. L., & Stanford, F. C. (2024). Body mass index thresholds for Asians: A race correction in need of correction?. Annals of Internal Medicine, 177(8), 1127–1129. Visit Source.
• Banerjee, E. S., Schroeder, R., & Harrison, T. D. (2022). Metabolic surgery for adult obesity: Common questions and answers. American Family Physician, 105(6), 593-601. Visit Source.
• Bannuru, R. R., & Professional Practice Committee (2025). Weight stigma and bias: Standards of care in overweight and obesity-2025. BMJ Open Diabetes Research & Care, 13(Suppl 1), e004962. Visit Source.
• Bedosky M. A. (2024) The 5As model: Obesity prevention and management in primary care. Journal of Obesity and Weight-Loss Medication, 10, 049. Visit Source.
• Cano, R., Rodríguez, D., Duran, P., Cano, C., Rojas-Gómez, D., Rivera-Porras, D., Barboza-González, P., Fuentes-Barría, H., Angarita, L., Boscan, A., & Bermúdez, V. (2025). Dumping syndrome after bariatric surgery: Advanced nutritional perspectives and integrated pharmacological management. Nutrients, 17(19), 3123. Visit Source.
• Carroll, A. (2025). Occupational Therapy for Sleep Difficulties. OT Potential. Visit Source.
• Centers for Disease Control and Prevention [CDC]. (2026). Spotting hidden sugars in everyday foods. Centers for Disease Control and Prevention. Visit Source.
• Centers for Disease Control and Prevention [CDC]. (2024a). Adult obesity facts. Centers for Disease Control and Prevention. Visit Source.
• Centers for Disease Control and Prevention [CDC]. (2024b). Adult BMI categories. Centers for Disease Control and Prevention. Visit Source.
• Cleveland Clinic. (2025). Endoscopic sleeve gastroplasty. Cleveland Clinic. Visit Source.
• Direksunthorn, T. (2025). Sleep and cardiometabolic health: A narrative review of epidemiological evidence, mechanisms, and interventions. International Journal of General Medicine, 18, 5831-5843. Visit Source.
• De Sena Anchieta Rodrigues, M., De Melo Atanasio, L., Santos, I. K. D., Da Silva, J. C. G., De Araujo Tinoco Cabral, B. G., & Dantas, P. M. S. (2026b). Efficacy of interventions to promote exercise adherence in people with overweight or obesity: a systematic review. Journal of Obesity, 2026(1), 4164477. Visit Source.
• Dowker-Key, P. D., Jadi, P. K., Gill, N. B., Hubbard, K. N., Elshaarrawi, A., Alfatlawy, N. D., & Bettaieb, A. (2024). A closer look into white adipose tissue biology and the molecular regulation of stem cell commitment and differentiation. Genes, 15(8), 1017. Visit Source.
• Dua, A., Kumari, R., Singh, M., Kumar, R., Pradeep, S., Ojesina, A. I., & Kumar, R. (2025). Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD): The interplay of gut microbiome, insulin resistance, and diabetes. Frontiers in Medicine, 12, 1618275. Visit Source.
• Eisenberg, D., Shikora, S., Aminian, A., Angrisani, L., Cohen, R.V., De Luca, M., Faria, S. L.,  Goodpaster, K. P. S., Haddad, A., Himpens, J. M., Kow, L., Kurian, M., Loi, K., Mahawar, K., Nimeri, A., O’Kane, M., Papasavas, P. K., Ponce, J., Pratt, J. S. A., … Kothari, S. N. (2022). 2022 American Society for Metabolic and Bariatric Surgery (ASMBS) and International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO): Indications for metabolic and bariatric surgery. Surgery for Obesity and Related Diseases, 18(12), 1345 – 1356. Visit Source.
• Elmaleh-Sachs, A., Schwartz, J. L., Bramante, C. T., Nicklas, J. M., Gudzune, K. A., & Jay, M. (2023). Obesity management in adults a review. JAMA, 330(20), 2000. Visit Source.
• Emmerich, S. D., Fryar, C. D., Stierman, B., & Ogden, C. L. (2024). Obesity and severe obesity prevalence in adults: United States, August 2021-August 2023. NCHS Data Brief, (508), 10.15620/cdc/159281. Visit Source.
• Fitch, A. K., Malhotra, S., & Conroy, R. (2024). Differentiating monogenic and syndromic obesities from polygenic obesity: Assessment, diagnosis, and management. Obesity Pillars, 11, 100110. Visit Source.
• Fröhlich E. (2025). The effects of obesity on lung physiology, the prevalence and severity of chronic pulmonary diseases, and inhalation treatment. Drug Design Development and Theory. 19,11885-11900. Visit Source.
• Gatto, A., Liu, K., Milan, N., & Wong, S. (2025). The Effects of GLP-1 Agonists on Musculoskeletal Health and Orthopedic Care. Current Reviews in Musculoskeletal Medicine, 18(10), 469–480. Visit Source.
• Hamamah, S., Hajnal, A., & Covasa, M. (2024). Influence of bariatric surgery on gut microbiota composition and its implication on brain and peripheral targets. Nutrients, 16(7), 1071. Visit Source.
• Hammer, O., Kuroski, J. A., Bray, E. P., Harris, C., Blundell, A., Schneider, E., & Watkins, C. (2024). Psychological interventions for weight reduction and sustained weight reduction in adults with overweight and obesity: A scoping review. BMJ Open, 14(12), e082973. Visit Source.
• International Federation for the Surgery and Other Therapies for Obesity (IFSO). (n.d.). One anastomosis gastric bypass. International Federation for the Surgery and Other Therapies for Obesity. Visit Source.
• Jakicic, J.M., Apovian, C. M., Barr-Anderson, D. J., Courcoulas, A. P., Donnelly, J. E., Ekkekakis, P., Hopkins, M., Lambert, E. V., Napolitano, M. A., & Volpe, S. L. (2024). Physical activity and excess body weight and adiposity for adults. American college of sports medicine consensus statement. Medicine & Science in Sports & Exercise, 56(10), 2076-2091. Visit Source.
• Jayedi, A., Soltani, S., Emadi, A., Zargar, M., & Najafi, A. (2024). Aerobic Exercise and Weight Loss in Adults. JAMA Network Open, 7(12), e2452185. Visit Source.
• Jensen, S. B. K., Sørensen, V., Sandsdal, R. M., Lehmann, E. W., Lundgren, J. R., Juhl, C. R., Janus, C., Ternhamar, T., Stallknecht, B. M., Holst, J. J., Jørgensen, N. R., Jensen, J. B., Madsbad, S., & Torekov, S. S. (2024). Bone Health After Exercise Alone, GLP-1 Receptor Agonist Treatment, or Combination Treatment. JAMA Network Open, 7(6), e2416775. Visit Source.
• Jin, X., Qiu, T., Li, L., Yu, R., Chen, X., Li, C., Proud, C. G., & Jiang, T. (2023). Pathophysiology of obesity and its associated diseases. Acta Pharmaceutica Sinica, 13(6), 2403. Visit Source.
• Kim, J. U. (2020). Optimal diet strategies for weight loss and weight loss maintenance. Journal of Obesity and Metabolic Syndrome, 30(1), 20-31. Visit Source.
• Klein, S., Gastaldelli, A., Yki-Järvinen, H., & Scherer, P.E. (2022). Why does obesity cause diabetes? Cell Metabolism, 34(1), 11–20. Visit Source.
• Kong, Y., Yang, H., Nie, R., Zhang, X., Zuo, F., Zhang, H., & Nian, X. (2025).  Obesity: Pathophysiology and therapeutic interventions. Molecular Biomedicine, 6(25). Visit Source.
• Lim, R.B. (2025). Metabolic and bariatric operations: Early morbidity and mortality. UpToDate. Retrieved January 4, 2026. Visit Source.
• Liu, X., He, M., & Li, Y. (2024). Adult obesity diagnostic tool: A narrative review. Medicine, 103(17), e37946. Visit Source.
• Lopez, P., Taaffe, D. R., Galvão, D. A., Newton, R. U., Nonemacher, E. R., Wendt, V. M., Bassanesi, R. N., Turella, D. J. P., & Rech, A. (2022). Resistance training effectiveness on body composition and body weight outcomes in individuals with overweight and obesity across the lifespan: A systematic review and meta‐analysis. Obesity Reviews, 23(5), e13428. Visit Source.
• Masood, B., & Moorthy, M. (2023). Causes of obesity: A review. Clinical Medicine, 23(4), 284-291. Visit Source.
• Meijer, P., Lam, T. M., Vaartjes, I., Moll van Charante, E., Galenkamp, H., Koster, A., Van den Hurk, K., Den Braver, N. R., Blom, M. T., De Jong, T., Grobbee, D. E., Beulens, J. W., & Lakerveld, J. (2024). The association of obesogenic environments with weight status, blood pressure, and blood lipids: A cross-sectional pooled analysis across five cohorts. Environmental Research, 256, 119227. Visit Source.
• Mikkelsenfi, M., Wilsgaard, T., Grimsgaard, S., Jacobsen, B. K., & Hopstock, L. A. (2025). Tracing obesity from parents to adult offspring: The Tromsø Study 1994–2016. Journal of Obesity, 2025, 8834694. Visit Source.
• Nadolsky, K., Garvey, W. T., Agarwal, M., Bonnecaze, A., Bartolome Burguera, Chaplin, M. D., Griebeler, M. L., Harris, S. R., Schellinger, J. N., Simonetti, J., Srinath, R., & Volkan Yumuk. (2025). American Association of Clinical Endocrinology Consensus Statement: Algorithm for the evaluation and treatment of adults with obesity/adiposity-based chronic disease – 2025 Update. Endocrine Practice 31(11),1351-1394. Visit Source.
• Norton, J., Foy, A., Ba, D. M., Liu, G., Leslie, D., Zhang, Y., & Naccarelli, G. V. (2024). Obese patients with new onset atrial fibrillation/flutter have higher risk of hospitalization, cardioversions, and ablations. American Heart Journal Plus: Cardiology Research and Practice, 40, 100375. Visit Source.
• Novo Nordisk. (2025). Wegovy prescribing information. [Package insert]. Visit Source.
• Papatriantafyllou, E., Efthymiou, D., Zoumbaneas, E., Popescu, C. A., & Vassilopoulou, E. (2022). Sleep deprivation: Effects on weight loss and weight loss maintenance. Nutrients, 14(8), 1549. Visit Source.
• Public Education Committee. (2021). Bariatric surgery procedures. American Society for Metabolic and Bariatric Surgery. Visit Source.
• Taira, K. G., Wang, M., Guo, W., Kam, O., & Kaufmann, T. (2024). Association of cellulitis with obesity: Systematic review and meta-analysis. JMIR Dermatology, 7, e54302. Visit Source.
• Tasali, E., Wroblewski, K., Kahn, E., Kilkus, J, & Schoeller, D.A. (2022). Effect of sleep extension on objectively assessed energy intake among adults with overweight in real-life settings: A randomized clinical trial. JAMA Internal Medicine, 182(4), 365–374. Visit Source.
• UpToDate Lexidrug. (2026a).  Liraglutide: Drug information. UpToDate. Visit Source.
• UpToDate Lexidrug. (2026b).  Semaglutide: Drug information. UpToDate. Visit Source.
• UpToDate Lexidrug. (2026c). Tirzepatide: Drug information. UpToDate. Visit Source.
• UpToDate Lexidrug. (2026d). Orlistat: Drug information. UpToDate. Visit Source.
• UpToDate Lexidrug. (2026e). Phentermine: Drug information. UpToDate. Visit Source.
• UpToDate Lexidrug. (2026f). Phentermine and topiramate: Drug information. UpToDate. Visit Source.
• UpToDate Lexidrug. (2026g). Naltrexone and bupropion: Drug information. UpToDate. Visit Source.
• U.S. Department of Agriculture (USDA). (2026). Dietary guidelines for americans. U.S. Department of Agriculture. Visit Source.
• Voelker, R. (2025). Medications for obesity. JAMA, 333(1), 96. Visit Source.
• Ward, Z. J., Willett, W. C., Hu, F. B., Pacheco, L. S., Long, M. W., & Gortmaker, S. L. (2022). Excess mortality associated with elevated body weight in the USA by state and demographic subgroup: A modelling study. EClinicalMedicine, 48, 101429. Visit Source.
• Wajid, I., Vega, A., Thornhill, K., Jenkins, J., Merriman, C., Chandler, D., Shekoohi, S., Cornett, E. M., & Kaye, A. D. (2023). Topiramate (Topamax): Evolving role in weight reduction management: A narrative review. Life, 13(9), 1845. Visit Source.
• Wharton, S., Lingvay, I., Bogdanski, P., Duque do Vale, R., Jacob, S., Karlsson, T., Shaji, C., Rubino, D., & Garvey, W.T. (2025). Oral semaglutide at a dose of 25 mg in adults with overweight or obesity. New England Journal of Medicine, 393(11), 1077-1087. Visit Source.
• World Health Organization (WHO). (2025). Obesity and overweight. World Health Organization. Visit Source.