As per STS/SCAI/PCNA/AATS/AHA/ACC 2014 guidelines, advise lifestyle modifications, including daily physical activity and weight management, in all patients with stable ischemic heart disease. B Patients with cardiovascular disease, heart failure: As per HFSA/ACC/AHA 2022 guidelines, encourage healthy lifestyle habits, such as regular physical activity, maintaining normal weight, and healthy dietary patterns, to reduce future risk of HF in the general population. B As per ESC 2021 guidelines, counsel against sedentary habits and obesity to prevent or delay the onset of HF. B As per ACE/AACE 2016 guidelines, do not offer weight loss for the expressed purpose of preventing cardiovascular events or to extend life in patients with congestive HF, although evidence suggests that weight loss can improve myocardial function and congestive HF symptomatology in the short term. D Patients with cardiovascular disease (cardiac arrhythmia): offer orlistat and lorcaserin as the preferred weight-loss medications in patients with a history or risk of cardiac arrhythmia. B Be cautious when using naltrexone ER/bupropion ER, liraglutide 3 mg, and phentermine/topiramate ER with careful monitoring of HR and rhythm. A Patients with diabetes mellitus, screening: As per ADA 2023 guidelines: Measure height and weight and calculate BMI at annual visits or more frequently. Assess weight trajectory to inform treatment considerations. Ensure privacy during weighing. B Consider monitoring and evaluating weight more frequently based on clinical considerations, such as the presence of comorbid HF or significant unexplained weight gain or loss. C Consider obtaining inpatient evaluation if a deterioration of medical status is associated with significant weight gain or loss, especially focused on associations between medication use, food intake, and glycemic status. C As per ACE/AACE 2016 guidelines, evaluate patients with T2DM for the presence of overweight or obesity. B Patients with diabetes mellitus, lifestyle changes: https://web.pathway.md/diseases/recZS2sHS2211WWaQ 14/29 6/30/23, 1:22 AM Obesity Pathway As per ADA 2023 guidelines, refer adult patients with overweight or obesity at high risk of T2DM to an intensive lifestyle behavior change program to achieve and maintain a weight reduction of at least 7% of initial body weight through a healthy reduced-calorie diet and 150 minute/week of moderate-intensity physical activity. A Show 10 more As per ACE/AACE 2016 guidelines: Offer lifestyle therapy, including a reduced-calorie healthy meal plan and a physical activity program incorporating both aerobic and resistance exercise, with a goal of 10% weight loss B to prevent progression to diabetes in patients with overweight or obesity and with either metabolic syndrome or prediabetes or patients identified to be at high risk of T2DM based on validated risk-staging paradigms. A Offer lifestyle therapy to achieve 5-15% weight loss as needed to achieve targeted lowering of HbA1c in patients with overweight or obesity and T2DM. Consider offering weight-loss therapy regardless of the duration or severity of T2DM, both in newly diagnosed patients and in patients with a longer-term disease on multiple diabetes medications. A Patients with diabetes mellitus, pharmacotherapy: As per ADA 2023 guidelines, take into account the medication's effect on weight when choosing glucose-lowering medications in patients with T2DM and overweight/obesity. B Show 3 more As per ACE/AACE 2016 guidelines, consider offering phentermine/topiramate ER, liraglutide 3 mg, or orlistat, in conjunction with lifestyle therapy, to achieve 10% weight loss in patients at risk for future T2DM. B Show 4 more As per ES 2015 guidelines, consider initiating antidiabetic medications having additional actions to promote weight loss (such as GLP-1 analogs or SGLT-2 inhibitors) in addition to metformin in patients with obesity/overweight and T2DM. C Show 4 more Patients with diabetes mellitus, bariatric surgery: As per ADA 2023 guidelines, offer metabolic surgery in patients with T2DM and a BMI 40 kg/m ( 37.5 kg/m in Asian American individuals) and in adult patients with BMI 35.0-39.9 kg/m (32.5-37.4 kg/m in Asian American individuals) not achieving durable weight loss and improvement in comorbidities (including hyperglycemia) with nonsurgical methods. A Show 4 more As per ASA/OMA/ASMBS/OS/ACE/AACE 2020 guidelines: Consider offering bariatric surgery in patients with a BMI 35 kg/m and T2DM or high risk for T2DM (insulin resistance, prediabetes, and/or metabolic syndrome). C Consider offering bariatric surgery in patients with a BMI of 30-34.9 kg/m and T2DM with inadequate glycemic control despite optimal lifestyle and medical therapy. C As per ACE/AACE 2016 guidelines, consider offering bariatric surgery, preferably Roux-en-Y gastric bypass, sleeve gastrectomy, or biliopancreatic diversion in patients with obesity (BMI https://web.pathway.md/diseases/recZS2sHS2211WWaQ 15/29 6/30/23, 1:22 AM Obesity Pathway 30 kg/m ) and diabetes failed to achieve targeted clinical outcomes following lifestyle therapy and weight-loss medications. B Patients with diabetes mellitus (post-bariatric care): offer long-term medical and behavioral support and obtain routine micronutrient, nutritional, and metabolic status monitoring in patients undergoing metabolic surgery. B Show 2 more Patients with nonalcoholic fatty liver disease, lifestyle changes: As per AASLD 2023 guidelines: Offer a diet leading to a caloric deficit in patients with nonalcoholic fatty liver disease with overweight or obesity. Encourage diets with limited carbohydrates and saturated fat and enriched with high fiber and unsaturated fats (such as the Mediterranean diet) when possible due to their additional cardiovascular benefits. E Encourage increasing physical activity to the extent possible in patients with nonalcoholic fatty liver disease. Consider providing individualized prescriptive exercise recommendations to increase sustainability and benefits independent of weight loss. E As per AASLD/AACE 2022 guidelines, offer lifestyle changes in patients with excess adiposity and nonalcoholic fatty liver disease with a goal of at least 5% (preferably 10%) weight loss for liver histologic and cardiometabolic benefit. Advise participating in a structured weight loss program, when possible, tailored to the patient's lifestyle and personal preferences. B Show 2 more As per AGA 2021 guidelines, offer lifestyle modifications, including diet and exercise, to achieve weight loss in all patients with nonalcoholic fatty liver disease. Recognize that weight loss 5% of total body weight can decrease hepatic steatosis, weight loss 7% of total body weight can lead to NASH resolution, and weight loss 10% of total body weight can result in fibrosis regression or stability. E Show 6 more As per AASLD 2018 guidelines: Offer weight loss to reduce hepatic steatosis, achieved either by a hypocaloric diet alone or in conjunction with increased physical activity. Strive for a 7-10% weight loss to improve the majority of the histopathological features of NASH, including fibrosis. E Advise exercising to prevent or reduce hepatic steatosis in adult patients with nonalcoholic fatty liver disease. E As per ACE/AACE 2016 guidelines: Offer lifestyle interventions involving calorie restriction and moderate-to-vigorous physical activity targeting 4-10% weight loss in patients with overweight or obesity and nonalcoholic fatty liver disease. A Consider advising a Mediterranean dietary pattern or meal plan for improving hepatic steatosis, independent of weight loss. B As per EASO/EASD/EASL 2016 guidelines, set a 7-10% weight loss as the target of most lifestyle interventions in patients with overweight/obesity to improve liver enzymes and histology. https://web.pathway.md/diseases/recZS2sHS2211WWaQ 16/29 6/30/23, 1:22 AM Obesity Pathway B Show 4 more Patients with nonalcoholic fatty liver disease, pharmacotherapy: As per AASLD/AACE 2022 guidelines, offer weight loss pharmacotherapy as adjunctive therapy to lifestyle modifications in patients with obesity and nonalcoholic fatty liver disease or NASH with a goal of at least 5% (preferably 10%) weight loss for histologic and cardiometabolic benefit when this is not effectively achieved by lifestyle modification alone. B Show 2 more As per ACE/AACE 2016 guidelines, consider offering orlistat, C liraglutide, B and bariatric surgery C in addition to lifestyle changes for weight loss as high as 10-40% of body weight to decrease hepatic inflammation, hepatocellular injury, and fibrosis. B Patients with nonalcoholic fatty liver disease, bariatric surgery: As per AASLD 2023 guidelines, consider offering bariatric surgery as a therapeutic option in patients meeting the criteria for metabolic weight loss surgery, as it effectively resolves nonalcoholic fatty liver disease or NASH in most patients without cirrhosis and reduces mortality from CVD and malignancy. E As per AASLD/AACE 2022 guidelines, consider offering bariatric surgery as an option to treat nonalcoholic fatty liver disease C and improve cardiometabolic health B in patients with nonalcoholic fatty liver disease and a BMI of 35 kg/m , or 32.5 kg/m in Asian populations, particularly if T2DM mellitus is present. Consider performing bariatric surgery as an option in patients with a BMI of 30-34.9 kg/m , or 27.5-32.4 kg/m in Asian populations. C Show 3 more As per AASLD 2018 guidelines: Consider offering foregut bariatric surgery in otherwise eligible patients with obesity and nonalcoholic fatty liver disease or NASH. E Insufficient evidence to recommend foregut bariatric surgery as a specific treatment option for NASH. I As per EASO/EASD/EASL 2016 guidelines, recognize that bariatric surgery reduces liver fat by improving obesity and diabetes, reduces NASH progression, and improves histological lesions of NASH, including fibrosis. B Patients with chronic liver disease: As per AACE 2016 guidelines: Be cautious when using weight-loss medications in patients with hepatic impairment, and avoid using these medications in patients with severe hepatic impairment (Child-Pugh score > 9). B Adjust doses of certain medications in patients with moderate hepatic impairment, specifically, the dose of naltrexone ER/bupropion ER not to exceed 1 tablet (8 mg/90 mg) in the morning, and the dose of phentermine/topiramate ER not to exceed 7.5 mg/46 mg/day. B Patients with cholelithiasis: maintain a high index of suspicion for cholelithiasis in patients undergoing weight-loss therapy, regardless of the treatment modality. Be cautious when using https://web.pathway.md/diseases/recZS2sHS2211WWaQ 17/29 6/30/23, 1:22 AM Obesity Pathway liraglutide 3 mg in high-risk patients. Offer a slower rate of weight loss, an increase in dietary fat, or administration of UDCA as preventive measures. A Patients with gastroesophageal reflux disease, weight loss: As per ACG 2021 guidelines, offer weight loss to improve GERD symptoms in patients with overweight or obesity. B As per ACE/AACE 2016 guidelines: Offer weight loss with the goal of 10% of body weight in patients with overweight or obesity and gastroesophageal reflux. A Prescribe PPIs during weight loss interventions in patients with overweight or obesity and persistent gastroesophageal reflux symptoms. A Patients with gastroesophageal reflux disease, bariatric surgery: As per ACG 2021 guidelines, consider offering Roux-en-Y gastric bypass as an option to treat GERD in patients with obesity eligible for bariatric surgery and willing to accept its risks and requirements for lifestyle alterations. C As per ACE/AACE 2016 guidelines: Consider offering Roux-en-Y gastric bypass as the bariatric surgery procedure of choice in patients with obesity and moderate-to-severe gastroesophageal reflux symptoms. C Do not use intragastric balloons for weight loss in patients with established gastroesophageal reflux. D Patients with kidney disease (renal impairment): consider offering weight-loss medications with appropriate cautions in patients with mild (50-79 mL/min) and moderate (30-49 mL/min) renal impairment. Do not exceed the dose of naltrexone ER/bupropion ER of 8 mg/90 mg BID and the dose of phentermine/topiramate ER of 7.5 mg/46 mg/day in patients with moderate renal impairment. C Show 3 more Patients with kidney disease (nephrolithiasis): Prefer naltrexone ER/bupropion ER, lorcaserin, and liraglutide 3 mg in patients with a history, or at risk, of nephrolithiasis. B Be cautious when using phentermine/topiramate ER and orlistat in patients with a history of nephrolithiasis. A Patients with urinary incontinence: offer weight-loss therapy aiming at losing 5-10% of body weight in female patients with overweight or obesity and stress urinary incontinence. A Patients with hypoventilation syndrome (evaluation): consider measuring arterial partial pressure of CO rather than serum bicarbonate or SpO for the diagnosis of obesity hypoventilation syndrome in patients with obesity and sleep-disordered breathing with a high pretest probability of having obesity hypoventilation syndrome. C Show 2 more Patients with hypoventilation syndrome (weight loss): consider offering weight loss interventions producing sustained weight loss of 25-30% of actual body weight to achieve https://web.pathway.md/diseases/recZS2sHS2211WWaQ 18/29 6/30/23, 1:22 AM Obesity Pathway resolution of hypoventilation in patients with obesity hypoventilation syndrome. C Patients with hypoventilation syndrome (respiratory support): consider initiating positive airway pressure therapy during sleep in stable ambulatory patients with obesity hypoventilation syndrome. C Show 2 more Patients with obstructive sleep apnea: offer weight-loss therapy, including lifestyle interventions and additional modalities as needed (including phentermine/topiramate ER or bariatric surgery), aiming at losing at least 7-11% body weight in patients with overweight or obesity and obstructive sleep apnea. A Patients with asthma: offer weight loss with lifestyle interventions and additional treatment modalities as needed (including bariatric surgery) aiming at losing at least 7-8% body weight in patients with overweight or obesity and asthma. A Patients with female infertility: consider offering weight loss (targeting 10% body weight) as part of the initial management to improve fertility in female patients with overweight or obesity and infertility. B Patients with polycystic ovary syndrome, lifestyle changes: As per ACOG 2018 guidelines: Offer exercise therapy and dietary changes to reduce diabetes risk in patients with PCOS. A Offer weight loss to improve pregnancy rates, decrease hirsutism, and improve glucose tolerance and lipid levels in patients with PCOS. B As per SOGC 2018 guidelines: Consider offering weight loss through exercise and lifestyle modifications with a target of BMI < 35 kg/m and/or 5-10% of body weight if overweight for restoring ovulatory cycles and achieving pregnancy in patients with overweight and PCOS. B Refer patients with morbid obesity (BMI 40 kg/m ) to qualified providers for expert advice about safe weight loss strategies and pregnancy risk in this condition. B As per ACE/AACE 2016 guidelines, offer lifestyle therapy with the goal of achieving 5-15% weight loss to improve hyperandrogenism, oligomenorrhea, anovulation, insulin resistance, and hyperlipidemia in patients with overweight or obesity and PCOS. A As per RCOG 2014 guidelines, offer lifestyle changes (including diet, exercise, and weight loss), preceding and/or accompanying pharmacological treatment, for improvement of long-term outcomes in patients with PCOS. B As per ES 2013 guidelines, consider offering calorie-restricted diet and exercise therapy in adolescent and adult patients with PCOS and overweight or obesity. C Patients with polycystic ovary syndrome, pharmacotherapy: As per ESE 2020 guidelines, consider offering metformin in patients with PCOS presenting with metabolic syndrome features. C As per SOGC 2018 guidelines: https://web.pathway.md/diseases/recZS2sHS2211WWaQ 19/29 6/30/23, 1:22 AM Obesity Pathway Consider adding metformin to clomiphene citrate in patients with clomiphene resistance aged > 28 years and having visceral obesity (waist-to-hip ratio > 0.85). B Recognize that metformin combined with clomiphene citrate may increase ovulation and pregnancy rates but does not significantly improve the live birth rate over that of clomiphene citrate alone. A As per ACE/AACE 2016 guidelines, consider offering orlistat, metformin, or liraglutide, alone or in combination, for weight reduction or improving PCOS manifestations (including insulin resistance, glucose tolerance, dyslipidemia, hyperandrogenemia, oligomenorrhea, and anovulation) in patients with overweight or obesity and PCOS. B As per ES 2013 guidelines, avoid using metformin as first-line therapy for obesity in patients with PCOS. D Patients with polycystic ovary syndrome, bariatric surgery: As per ACE/AACE 2016 guidelines, consider offering laparoscopic Roux-en-Y gastric bypass to improve symptoms, including restoration of menses and ovulation, in selected patients with obesity and PCOS. C As per RCOG 2014 guidelines, consider offering bariatric surgery if standard weight loss strategies have failed in patients with PCOS and morbid obesity (BMI 40 kg/m or 35 kg/m with a high-risk obesity-related condition). C Patients with male hypogonadism: As per ESE 2020 guidelines, emphasize the importance of weight loss to restore eugonadism in patients with obesity and biochemical and clinical hypogonadism. (Ungraded) Consider initiating testosterone treatment, aiming at testosterone levels in the normal range, on an individual basis if weight loss cannot be achieved and if clinical and biochemical hypogonadism persists. B Show 2 more As per AACE 2016 guidelines, offer weight-loss therapy in male patients with increased waist circumference or obesity and hypogonadism. B Aim at > 5-10% weight loss for significant improvement in serum testosterone. B Show 2 more Patients with thyroid disorders: treat overt hypothyroidism (elevated TSH and decreased free T4) in patients with obesity, irrespective of antibodies. B Show 2 more Patients with growth hormone abnormalities: do not use GH therapy to treat obesity in patients with normal GH levels. D Patients with chronic inflammatory diseases: Consider preferring corticosteroid-sparing therapies (such as NSAIDs and DMARDs) when possible in patients with chronic inflammatory diseases (such as rheumatoid arthritis) and obesity, because corticosteroids commonly produce weight gain. C Consider preferring antihistamines with less CNS activity (less sedation) to limit weight gain in patients with obesity. C Patients with osteoarthritis: https://web.pathway.md/diseases/recZS2sHS2211WWaQ 20/29 6/30/23, 1:22 AM Obesity Pathway Offer weight-loss therapy aiming at losing 10% of body weight for symptomatic and functional improvement and reduction in compressive forces during ambulation in patients with overweight or obesity and OA involving weight-bearing joints, particularly the knee. Offer a physical activity program in combination with weight-loss therapy. A Offer weight-loss therapy before and after total knee replacement. B Patients with critical illness: recognize that critically ill patients with obesity experience more complications than patients with optimal BMI levels. Obtain nutritional assessment and develop a nutrition support plan within 48 hours of ICU admission. B Show 3 more Patients with glaucoma: Prefer liraglutide 3 mg, orlistat, and lorcaserin in patients with a history, or at risk of, glaucoma. B Be cautious when using naltrexone ER/bupropion ER. Avoid using phentermine/topiramate ER in patients with glaucoma. B Patients with seizure/epilepsy: prefer phentermine/topiramate, lorcaserin, liraglutide, and orlistat in patients with a history, or at risk, of seizure/epilepsy. B Avoid using naltrexone ER/bupropion ER in these patients. Patients with anxiety/depression: offer a structured lifestyle intervention in patients with overweight or obesity and depression interested in losing weight. A Show 3 more Patients with substance use disorder: Consider preferring orlistat or liraglutide 3 mg in patients with obesity and alcohol or other addictions. B Avoid using lorcaserin (abuse potential due to euphoria at suprapharmacologic doses) and naltrexone ER/bupropion ER (lowers seizure threshold) in patients with alcohol abuse. Do not use naltrexone ER/bupropion ER during alcohol withdrawal. D Patients on opioids: prefer phentermine/topiramate ER, lorcaserin, liraglutide 3 mg, and orlistat in patients requiring chronic administration of opioids or opioid medications. Do not use naltrexone ER/bupropion ER in these patients. B Patients on oral contraceptives: consider preferring oral contraceptives over injectable medications in patients with a BMI > 27 kg/m with comorbidities or BMI > 30 kg/m seeking contraception, due to weight gain with injectables. Ensure that the patient is well-informed about the risks and benefits. C Patients on psychotropic medications: As per AACE 2016 guidelines, offer a structured lifestyle intervention to promote weight loss or prevent weight gain in patients with psychotic disorders being treated with antipsychotic drugs. A Show 2 more As per ES 2015 guidelines: https://web.pathway.md/diseases/recZS2sHS2211WWaQ 21/29 6/30/23, 1:22 AM Obesity Pathway Ensure a shared decision-making process providing patients with quantitative estimates of the expected weight effect of antidepressant or antiepileptic drugs to make an informed decision about drug choice when indicated. Take into consideration the expected length of treatment. B Prefer weight-neutral antipsychotic alternatives over weight gain-causing agents when clinically indicated. Take into consideration the weight gain potential when choosing an antiepileptic drug. B Patients on antiretroviral drugs: consider monitoring the weight and waist circumference in patients on antiretroviral therapy due to unavoidable weight gain, weight redistribution, and associated cardiovascular risk. C 10. Patient education General counseling: As per AACE 2016 guidelines, advise female patients with overweight or obesity when appropriate that they are at increased risk for infertility and, if seeking assisted reproduction, inform of lower success rates of these procedures regarding conception and the ability to carry the pregnancy to live birth. B As per ACC 2014 guidelines, counsel adult patients with obesity or overweight that the greater the BMI, the greater the risk of CVD, T2DM, and all-cause mortality. B Show 2 more 11. Follow-up and surveillance Monitoring of pharmacotherapy: As per ES 2020 guidelines, consider reassessing the lipid profile to evaluate the risk of CVD and pancreatitis in patients with obesity on weight loss pharmacotherapy. C As per AACE 2016 guidelines: Monitor all patients undergoing weight-loss therapy for mood disorders, depression, and suicidal ideation. B Monitor patients receiving glyburide, orlistat, or incretin-based therapies, such as GLP-1 receptor agonists or DPP4 inhibitors, for the development of pancreatitis. B Withhold glyburide, orlistat, and incretin-based therapies in case of prior or current pancreatitis. B As per ES 2015 guidelines, consider assessing efficacy and safety at least monthly for the first 3 months, then at least every 3 months in all patients on weight-loss medications. C Show 2 more Maintenance of weight loss: Refer patients with overweight and obesity losing weight to long-term ( 1 year), comprehensive weight-loss maintenance programs. A https://web.pathway.md/diseases/recZS2sHS2211WWaQ 22/29 6/30/23, 1:22 AM Obesity Pathway Offer face-to-face or telephone-delivered weight-loss maintenance programs for weight-loss maintenance to provide regular contact (monthly or more frequently) with a trained interventionist helping participants engage in high levels of physical activity (200-300 min/week), monitor body weight regularly (weekly or more frequently), and consume a reduced-calorie diet (needed to maintain lower body weight). A 12. Quality improvement Use of nonjudgmental language: use person-centered, nonjudgmental language fostering collaboration between patients and health care professionals, including people-first language (such as "person with obesity" rather than "obese person"). B Clinical findings Symptoms Past medical history Back pain Attention deficit hyperactivity disorder Depression Binge eating disorder Exercise intolerance Circadian rhythm sleep disorder Fatigue Cushing's syndrome Joint pain Diabetes mellitus type 2 Sleeping disorder Dyslipidemia Medication history GERD Hypertension Anticonvulsants Hypogonadism Antidepressants Hypothyroidism Antipsychotics Metabolic syndrome Corticosteroids Neuropsychiatric disorder Hormonal contraceptives OA Obstructive sleep apnea Anthropomorphic exam PCOS BMI Prediabetes waist circumference Social history Integument exam Diet high in simple carbohydrates Acanthosis nigricans Fast eating Fast food consumption Frequent eating Higher stress levels Increased sitting time Increased television watching https://web.pathway.md/diseases/recZS2sHS2211WWaQ 23/29 6/30/23, 1:22 AM Obesity Pathway Physical inactivity Short sleep Respiratory exam Dyspnea Studies 2023 EXTUB-OBESE In critically ill patients with obesity undergoing extubation, noninvasive ventilation was superior to oxygen therapy with respect to the rate of treatment failure within 3 days. Audrey De Jong et al. Lancet Respir Med. 2023 Jun. 2022 VI-0521 in Obese Adolescents (mid-dose) In adolescents with obesity, mid-dose phentermine/topiramate was superior to placebo with respect to reduction in BMI at week 56. Aaron S Kelly et al. NEJM Evid. 2022 Jun. Show 11 more References 1. W Timothy Garvey, Jeffrey I Mechanick, Elise M Brett et al. AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS AND AMERICAN COLLEGE OF ENDOCRINOLOGY COMPREHENSIVE CLINICAL PRACTICE GUIDELINES FOR MEDICAL CARE OF PATIENTS WITH OBESITY. Endocr Pract. 2016 Jul;22 Suppl 3 1 203. Open 2. Zobair M Younossi, Kathleen E Corey, Joseph K Lim. AGA Clinical Practice Update on Lifestyle Modification Using Diet and Exercise to Achieve Weight Loss in the Management of Nonalcoholic Fatty Liver Disease: Expert Review. Gastroenterology. 2021 Feb;160 3 912 918. Open 3. Paul A Heidenreich, Biykem Bozkurt, David Aguilar et al. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2022 Apr 1;101161CIR0000000000001063. Open 4. American College of Obstetricians and Gynecologists' Committee on Practice Bulletins Gynecology. ACOG Practice Bulletin No. 194 Polycystic Ovary Syndrome. Obstet Gynecol. 2018 Jun;131 6):e157-e171. Open 5. Stephan C Bischoff, Johann Ockenga, Ahad Eshraghian et al. Practical guideline on obesity care in patients with gastrointestinal and liver diseases Joint ESPEN/UEG guideline. Clin Nutr. 2023 Apr 10;42 6 987 1024. Open 6. Jensen MD, Ryan DH, Apovian CM et al. 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart https://web.pathway.md/diseases/recZS2sHS2211WWaQ 24/29 6/30/23, 1:22 AM Obesity Pathway Association Task Force on Practice Guidelines and The Obesity Society. Circulation. 2014 Jun 24;129 25 Suppl 2 S102 38. Open 7. Apovian CM, Aronne LJ, Bessesen DH et al. Pharmacological management of obesity: an endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2015 Feb;100 2 342 62. Open 8. Busetto L, Dicker D, Azran C et al. Practical Recommendations of the Obesity Management Task Force of the European Association for the Study of Obesity for the Post-Bariatric Surgery Medical Management. Obes Facts. 2017;10 6 597 632. Open 9. R Pasquali, F Casanueva, M Haluzik et al. European Society of Endocrinology Clinical Practice Guideline: Endocrine work-up in obesity. Eur J Endocrinol. 2020 Jan;182 1 G1 G32. Open 10. Virginia A Moyer, U.S. Preventive Services Task Force. Screening for and management of obesity in adults: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2012 Sep 4;157 5 373 8. Open 11. Jeffrey I Mechanick, Caroline Apovian, Stacy Brethauer et al. Clinical Practice Guidelines for the Perioperative Nutrition, Metabolic, and Nonsurgical Support of Patients Undergoing Bariatric Procedures 2019 Update: Cosponsored by American Association of Clinical Endocrinologists/American College of Endocrinology, The Obesity Society, American Society for Metabolic and Bariatric Surgery, Obesity Medicine Association, and American Society of Anesthesiologists. Obesity Silver Spring). 2020 Apr;28 4 O1 O58. Open 12. Kenneth Cusi, Scott Isaacs, Diana Barb et al. American Association of Clinical Endocrinology Clinical Practice Guideline for the Diagnosis and Management of Nonalcoholic Fatty Liver Disease in Primary Care and Endocrinology Clinical Settings: Co-Sponsored by the American Association for the Study of Liver Diseases AASLD . Endocr Pract. 2022 May;28 5 528 562. Open 13. Legro RS, Arslanian SA, Ehrmann DA et al. Diagnosis and treatment of polycystic ovary syndrome: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2013 Dec;98 12 4565 92. Open 14. Sarah E Hampl, Sandra G Hassink, Asheley C Skinner et al. Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents With Obesity. Pediatrics. 2023 Feb 1;151 2):e2022060640. Open 15. Phillipa Hay, David Chinn, David Forbes et al. Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the treatment of eating disorders. Aust N Z J Psychiatry. 2014 Nov;48 11 977 1008. Open 16. Steven E. Kahn, Cheryl A.M. Anderson, John B. Buse et al. Standards of Care in Diabetes 2023. Diabetes Care. 2023 Jan;46 Supplement_1 S1 S291. Open 17. Mary E Rinella, Brent A Neuschwander-Tetri, Mohammad Shadab Siddiqui et al. AASLD practice guidance on the clinical assessment and management of nonalcoholic fatty liver disease. Hepatology. 2023 Feb 3. Open 18. Mary O'Kane, Helen M. Parretti, Jonathan Pinkney et al. British Obesity and Metabolic Surgery Society Guidelines on perioperative and postoperative biochemical monitoring and micronutrient replacement for patients undergoing bariatric surgery 2020 update. Obes Rev. 2020 Nov; 21 11 e13087. Open 19. Eduardo Grunvald, Raj Shah, Ruben Hernaez et al. AGA Clinical Practice Guideline on Pharmacological Interventions for Adults With Obesity. Gastroenterology. 2022 Nov;163 5 1198 1225. Open https://web.pathway.md/diseases/recZS2sHS2211WWaQ 25/29 6/30/23, 1:22 AM Obesity Pathway 20. US Preventive Services Task Force, Grossman DC, Bibbins-Domingo K et al. Screening USPSTF for Obesity in Children and Adolescents: US Preventive Services Task Force Recommendation Statement. JAMA. 2017 Jun 20;317 23 2417 2426. Open 21. US Preventive Services Task Force, Curry SJ, Krist AH et al. Behavioral Weight Loss Interventions to Prevent Obesity-Related Morbidity and Mortality in Adults: US Preventive Services Task Force Recommendation Statement. JAMA. 2018 Sep 18;320 11 1163 1171. Open 22. American Psychiatric Association. Treatment of patients with eating disorders,third edition. American Psychiatric Association. Am J Psychiatry. 2006 Jul;163 7 Suppl):4 54. Open 23. Connie B Newman, Michael J Blaha, Jeffrey B Boord et al. Lipid Management in Patients with Endocrine Disorders: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2020 Dec 1;105 12):dgaa674. Open 24. Williams B, Mancia G, Spiering W et al. 2018 ESC/ESH guidelines for the management of arterial hypertension. Eur Heart J. 2018 Sep 1;39 33 3021 3104. Open 25. Thiruvengadam Muniraj, Lukejohn W Day, Levi M Teigen et al. AGA Clinical Practice Guidelines on Intragastric Balloons in the Management of Obesity. Gastroenterology. 2021 Apr;160 5 1799 1808. Open 26. Philip O Katz, Kerry B Dunbar, Felice H Schnoll-Sussman et al. ACG Clinical Guideline for the Diagnosis and Management of Gastroesophageal Reflux Disease. Am J Gastroenterol. 2021 Nov 22. Open 27. No authors listed. Guideline: Sugars Intake for Adults and Children. Geneva: World Health Organization; 2015. Open 28. David S Smithson, Tannys D R Vause, Anthony P Cheung. No. 362 Ovulation Induction in Polycystic Ovary Syndrome. J Obstet Gynaecol Can. 2018 Jul;40 7 978 987. Open 29. Babak Mokhlesi, Juan Fernando Masa, Jan L Brozek et al. Evaluation and Management of Obesity Hypoventilation Syndrome. An Official American Thoracic Society Clinical Practice Guideline. Am J Respir Crit Care Med. 2019 Aug 1;200 3):e6-e24. Open 30. European Association for the Study of the Liver EASL , European Association for the Study of Diabetes EASD , European Association for the Study of Obesity EASO . EASL EASD EASO Clinical Practice Guidelines for the management of non-alcoholic fatty liver disease. J Hepatol. 2016 Jun;64 6 1388 402. Open 31. Theresa A McDonagh, Marco Metra, Marianna Adamo et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2021 Sep 21;42 36 3599 3726. Open 32. Royal College of Obstetricians and Gynaecologists. Long-term Consequences of Polycystic Ovary Syndrome. Green-top Guideline No. 33. RCOG. 2014 Nov. Open 33. Fihn SD, Blankenship JC, Alexander KP et al. 2014 ACC/AHA/AATS/PCNA/SCAI/STS focused update of the guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines, and the American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol. 2014 Nov 4;64 18 1929 49. Open 34. Choban P, Dickerson R, Malone A et al. A.S.P.E.N. Clinical guidelines: nutrition support of hospitalized adult patients with obesity. JPEN J Parenter Enteral Nutr. 2013 Nov;37 6 714 44. Open https://web.pathway.md/diseases/recZS2sHS2211WWaQ 26/29 6/30/23, 1:22 AM Obesity Pathway 35. Chalasani N, Younossi Z, Lavine JE et al. The diagnosis and management of nonalcoholic fatty liver disease: Practice guidance from the American Association for the Study of Liver Diseases. Hepatology. 2018 Jan;67 1 328 357. Open 36. US Preventive Services Task Force, Karina W Davidson, Michael J Barry et al. Screening for Prediabetes and Type 2 Diabetes: US Preventive Services Task Force Recommendation Statement. JAMA. 2021 Aug 24;326 8 736 743. Open 37. Doreen M Rabi, Kerry A McBrien, Ruth Sapir-Pichhadze et al. Hypertension Canada's 2020 Comprehensive Guidelines for the Prevention, Diagnosis, Risk Assessment, and Treatment of Hypertension in Adults and Children. Can J Cardiol. 2020 May;36 5 596 624. Open 38. Vivek Kumbhari, David E Cummings, Anthony N Kalloo et al. AGA Clinical Practice Update on Evaluation and Management of Early Complications After Bariatric/Metabolic Surgery: Expert Review. Clin Gastroenterol Hepatol. 2021 Aug;19 8 1531 1537. Open 39. Erik Stenberg, Luiz Fernando Dos Reis Falc o, Mary O'Kane et al. Guidelines for Perioperative Care in Bariatric Surgery: Enhanced Recovery After Surgery ERAS Society Recommendations: A 2021 Update. World J Surg. 2022 Apr;46 4 729 751. Open 40. American College of Obstetricians and Gynecologists Committee on Practice Bulletins Obstetrics. Obesity in Pregnancy: ACOG Practice Bulletin, Number 230. Obstet Gynecol. 2021 Jun 1;137 6):e128-e144. Open 41. No authors listed. Use of non-sugar sweeteners: WHO guideline. Geneva: World Health Organization; 2023. Open 42. Paul K Whelton, Robert M Carey, Wilbert S Aronow et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension. 2018 Jun;71 6):e13-e115. Open 43. Xavier Pi-Sunyer. The Medical Risks of Obesity. Postgrad Med. 2009 Nov;121 6 21 33. Open 44. Zachary J Ward, Sara N Bleich, Angie L Cradock et al. Projected U.S. State-Level Prevalence of Adult Obesity and Severe Obesity. N Engl J Med. 2019 Dec 19;381 25 2440 2450. Open 45. Luca Montesi, Marwan El Ghoch, Lucia Brodosi et al. Long-term weight loss maintenance for obesity: a multidisciplinary approach. Diabetes Metab Syndr Obes. 2016 Feb 26;9 37 46. Open 46. Yu Chung Chooi, Cherlyn Ding, Faidon Magkos. The epidemiology of obesity. Metabolism. 2019 Mar;92 6 10. Open 47. Maliha Agha, Riaz Agha. The rising prevalence of obesity: part A impact on public health. Int J Surg Oncol N Y . 2017 Aug;2 7):e17. Open 48. Eline S van der Valk, Mesut Savas, Elisabeth F C van Rossum. Stress and Obesity: Are There More Susceptible Individuals?. Curr Obes Rep. 2018 Jun;7 2 193 203. Open 49. Guglielmo Beccuti, Silvana Pannain. Sleep and obesity. Curr Opin Clin Nutr Metab Care. 2011 Jul;14 4 402 12. Open 50. Uwe Wollina, Alberto Goldman. Management of stretch marks (with a focus on striae rubrae). J Cutan Aesthet Surg. Jul-Sep 2017;10 3 124 129. Open https://web.pathway.md/diseases/recZS2sHS2211WWaQ 27/29 6/30/23, 1:22 AM Obesity Pathway 51. M A Roosen, D Safer, S Adler et al. Group dialectical behavior therapy adapted for obese emotional eaters; a pilot study. Nutr Hosp. Jul-Aug 2012;27 4 1141 7. Open 52. Bruce M Wolfe, Elizaveta Kvach, Robert H Eckel. Treatment of Obesity: Weight Loss and Bariatric Surgery. Circ Res. 2016 May 27;118 11 1844 55. Open 53. John P.H. Wilding, D.M., Rachel L. Batterham et al. Once-Weekly Semaglutide in Adults with Overweight or Obesity. N Engl J Med. 2021 Feb 10. Open 54. Writing Committee for the PROBESE Collaborative Group of the PROtective VEntilation Network PROVEnet) for the Clinical Trial Network of the European Society of Anaesthesiology, Thomas Bluth, Ary Serpa Neto et al. Effect of Intraoperative High Positive End-Expiratory Pressure PEEP With Recruitment Maneuvers vs Low PEEP on Postoperative Pulmonary Complications in Obese Patients: A Randomized Clinical Trial. JAMA. 2019 Jun 18;321 23 2292 2305. Open 55. M S Kristensen, W H Teoh, S S Rudolph et al. A randomised cross-over comparison of the transverse and longitudinal techniques for ultrasound-guided identification of the cricothyroid membrane in morbidly obese subjects. Anaesthesia. 2016 Jun;71 6 675 83. Open 56. Satya Krishna Ramachandran, Amy Cosnowski, Amy Shanks et al. Apneic oxygenation during prolonged laryngoscopy in obese patients: a randomized, controlled trial of nasal oxygen administration. J Clin Anesth. 2010 May;22 3 164 8. Open 57. Sascha Tafelski, Hailong Yi, Fakher Ismaeel et al. Obesity in critically ill patients is associated with increased need of mechanical ventilation but not with mortality. J Infect Public Health. Sep-Oct 2016;9 5 577 85. Open