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These scenarios outline the clinical implications of obesity, its assessment and the options for its management, including dietary, pharmacological and surgical.


Birkmeyer NJ, Dimick JB, Share D et al; Michigan Bariatric Surgery Collaborative (2010) Hospital complication rates with bariatric surgery in Michigan. JAMA 304: 435–42

Caleyachetty R, Barber TM, Mohammed NI et al (2021) Ethnicity-specific BMI cutoffs for obesity based on type 2 diabetes risk in England: A population-based cohort study. Lancet Diabetes Endocrinol 9: 419–26

Cao P, Song Y, Zhuang Z et al (2021) Obesity and COVID-19 in adult patients with diabetes. Diabetes 70: 1061–9

Das G (2021) Liralutide for overweight and obesity. Practical Diabetes 38: 7–9

Davies MJ, Aroda VR, Collins BS et al (2022) Management of hyperglycemia in type 2 diabetes, 2022. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care 45: 2753–86

Dyson PA, Twenefour D, Breen C et al (2018) Diabetes UK evidence-based nutrition guidelines for the prevention and management of diabetes. Diabet Med 35: 541–7

ElSayed NA, Aleppo G, Aroda VR et al; American Diabetes Association (2023) 8. Obesity and weight management for the prevention and treatment of type 2 diabetes: Standards of Care in Diabetes – 2023. Diabetes Care 46(Suppl 1): S128–39

Evert AB, Dennison M, Gardner CD et al (2019) Nutrition therapy for adults with diabetes or prediabetes: A consensus report. Diabetes Care 42: 731–54

Garvey WT, Frias JP, Jastreboff AM et al; SURMOUNT-2 investigators (2023) Tirzepatide once weekly for the treatment of obesity in people with type 2 diabetes (SURMOUNT-2): A double-blind, randomised, multicentre, placebo-controlled, phase 3 trial. Lancet 402: 613–26

Golay A, Ybarra J (2005) Link between obesity and type 2 diabetes. Best Pract Res Clin Endocrinol Metab 19: 649–63

Husain M, Birkenfeld AL, Donsmark M et al; PIONEER 6 investigators (2019) Oral semaglutide and cardiovascular outcomes in patients with type 2 diabetes. N Engl J Med 381: 841–51

Isaman DJ, Rothberg AE, Herman WH (2016) Reconciliation of type 2 diabetes remission rates in studies of Roux-en-Y gastric bypass. Diabetes Care 39: 2247–53

Knowler WC, Barrett-Connor E, Fowler SE et al; Diabetes Prevention Program Research Group (2002) Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 346: 393–403

Lean ME, Leslie WS, Barnes AC et al (2018) Primary care-led weight management for remission of type 2 diabetes (DiRECT): An open-label, cluster-randomised trial. Lancet 391: 541–51

Lean MEJ, Leslie WS, Barnes AC et al (2019) Durability of a primary care-led weight-management intervention for remission of type 2 diabetes: 2-year results of the DiRECT open-label, cluster-randomised trial. Lancet Diabetes Endocrinol 7: 344–55

Marshall SM (2018) The bark giving diabetes therapy some bite: The SGLT inhibitors. Diabetologia 61: 2075–8

Mingrone G, Panunzi S, De Gaetano A et al (2012) Bariatric surgery versus conventional medical therapy for type 2 diabetes. N Engl J Med 366: 1577–85

Nash J (2015) The obesity epidemic: Are emotions the “elephant in the room”? Diabetes & Primary Care 17: 21–5

Nash J (2017) Non-hunger eating: How to tackle it in time-limited consultations using the Eating Blueprint approach. Journal of Diabetes Nursing 21: 100–2

Nauck MA, Meier JJ (2019) Management of endocrine disease: Are all GLP-1 agonists equal in the treatment of type 2 diabetes? Eur J Endocrinol 181: R211–34

NICE (2020) Liraglutide for managing overweight and obesity [TA664].

NICE (2022a) Type 2 diabetes in adults: management [NG28].

NICE (2022b) Obesity: identification, assessment and management [CG189].

NICE (2023) Semaglutide for managing overweight and obesity [TA875].

Pearson S, Kietsiriroje N, Ajjan RA (2019) Oral semaglutide in the management of type 2 diabetes: A report on the evidence to date. Diabetes Metab Syndr Obes 12: 2515–29

Schauer PR, Kashyap SR, Wolski K et al (2012) Bariatric surgery versus intensive medical therapy in obese patients with diabetes. N Engl J Med 366: 1567–76

SIGN (2017) Pharmacological management of glycaemic control in type 2 diabetes [SIGN guideline 154].

Sun F, Chai S, Li L et al (2015) Effects of glucagon-like peptide-1 receptor agonists on weight loss in patients with type 2 diabetes: A systematic review and network meta-analysis. J Diabetes Res 2015: 157201

Thondam S, Wilding J (2012) Treatment of diabetes through targeting weight loss. In: Vora J, Buse J (editors). Evidence-based Management of Diabetes. TFM Publishing, Shrewsbury

Wardle A, Nageswaran H, Hewin D (2011) GPs should be aware of the complications of bariatric surgery. Guidelines in Practice 14: 45–53

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