American Society of Bariatric Physicians (ASBP) Algorithm 1 American Society of Bariatric Physicians (ASBP) ASBP Obesity Algorithm: Adult Adiposity Evaluation and Treatment 2013 Citation: SegerJC,HornDB,WestmanEC,LindquistR,ScintaW,RichardsonLA,PrimackC,BrymanDA,McCarthyW,Hendricks E,Sabowitz BN,SchmidtSL,BaysHE.AmericanSocietyofBariatricPhysiciansObesityAlgorithm:AdultAdiposity EvaluationandTreatment2013.www.obesityalgorithm.org (Accessed=[insertdate]) Copyright©2013ASBP:MaynotbereproducedoralteredinanyformwithoutwrittenpermissionfromASBP American Society of Bariatric Physicians (ASBP) Algorithm 2 ASBP Obesity Algorithm: Adult Adiposity Evaluation and Treatment 2013 Disclaimer TheAmericanSocietyofBariatricPhysicians®(ASBP)ObesityAlgorithmwasdevelopedtoassisthealthcare professionalsinmedicaldecisionmaking;however,itisinnowayasubstituteforamedicalprofessional'sindependent judgmentandshouldnotbeconsideredmedicaladvice.Mostofthecontenthereinisbasedonthe medicalliterature andtheclinicalexperienceofobesitymedicinespecialists.Inareasofuncertainty,professionaljudgmentofthe authorswasapplied.TheObesityAlgorithmisaworkingdocumentthatreflectsthestateofthefieldofobesity medicineatthetimeofpublication.Becauserapidchangesinthisareaareexpected, periodicrevisionsareinevitable. Weencouragemedicalprofessionalstousethisinformationinconjunctionwith,andnotasareplacementfor,their bestclinicaljudgment.Thepresentedrecommendationsmaynotbeappropriateinallsituations.Anydecisionby practitionerstoapplytheseguidelinesmustbemadeinlightoflocalresourcesandindividualpatientcircumstances. Permissions TheAmericanSocietyofBariatricPhysicians®(ASBP)ObesityAlgorithmisprotectedbycopyrightandmaynotbe alteredinanyform.Thiscopyrightedmaterialmaybeaccessedforpersonalresearch,scientificand/orinformation purposesonly.Nopartofthisalgorithmmaybedistributedforsaleorysoldinan formorbyanymeanswithoutprior writtenpermissionfromtheSociety. OrderingReprintsand/orRequestingPermissionsforuseofASBP ObesityAlgorithm Forreprintsorotherpermissions,pleasecontact: EͲmail:[email protected] Phone:303.770.2526 Copyright©2013ASBP:MaynotbereproducedoralteredinanyformwithoutwrittenpermissionfromASBP American Society of Bariatric Physicians (ASBP) Algorithm 3 ASBP Obesity Algorithm: Adult Adiposity Evaluation and Treatment 2013 JenniferSeger,MD &DeborahBadeHorn,DO,MPH,FASBP CoͲChairs CoͲauthors: EricC.Westman,MD,MHS DavidA.Bryman DO RichardLindquist,MD,ABFM WilliamMcCarthy,MD WendyScinta,MD,MS EdHendricksMD,FASBP LarryA.Richardson,MD,FASBP BrianN.Sabowitz,MD,FACP CraigPrimack,MD,FACP,FAAP StacyL.Schmidt,PhD HaroldEBaysMD,FTOS,FACE,FNLA Administrativeassistance: LaurieTraetow ,CAE Citation: Seger JC,HornDB,Westman EC,LindquistR,Scinta W,RichardsonLA,PrimackC,BrymanDA,McCarthyW,HendricksE, Sabowitz BN,SchmidtSL,BaysHE.AmericanSocietyofBariatricPhysiciansObesityAlgorithm:AdultAdiposityEvaluation andTreatment2013.www.obesityalgorithm.org (Accessed=[insertdate]) Copyright©2013ASBP:MaynotbereproducedoralteredinanyformwithoutwrittenpermissionfromASBP American Society of Bariatric Physicians (ASBP) Algorithm 4 ASBP Obesity Algorithm: Adult Adiposity Evaluation and Treatment 2013 Purpose • Toprovidecliniciansanoverviewofprinciples importanttothecareofpatientswith increasedbodyfat,baseduponscientific evidence,supportedbythemedicalliterature, andderivedfromtheclinicalexperiencesof membersoftheAmericanSocietyofBariatric Physicians. Copyright©2013ASBP:MaynotbereproducedoralteredinanyformwithoutwrittenpermissionfromASBP American Society of Bariatric Physicians (ASBP) Algorithm 5 ASBP Obesity Algorithm: Adult Adiposity Evaluation and Treatment 2013 Process The ASBP Algorithm was derived from input by volunteer ASBP members consisting of: • Academicians • Clinicians • Clinicaltrialists • Researchers The ASBP Algorithm did not receive industry funding, had no input from industry, and the authors received no payment for their contributions. Copyright©2013ASBP:MaynotbereproducedoralteredinanyformwithoutwrittenpermissionfromASBP American Society of Bariatric Physicians (ASBP) Algorithm 6 ASBP Obesity Algorithm: Adult Adiposity Evaluation and Treatment 2013 Intent of use The ASBP Algorithm 2013 is intended to be a “living document” updated once a year (as needed), and intended as an educational tool to assist in the translation of medical science and the clinical experience of the authors towards assisting clinicians better manage their overweight and obese patients. This algorithm is not intended to be interpreted as “rules” and/or directives regarding medical care of an individual patient. While it is hoped many clinicians may find this algorithm helpful, the final decision regarding the optimal care of the overweight and obese patient is dependent upon the individual clinical presentation, and the judgment of the clinician who is tasked with directing a treatment plan that is in the best interest of the patient. Copyright©2013ASBP:MaynotbereproducedoralteredinanyformwithoutwrittenpermissionfromASBP American Society of Bariatric Physicians (ASBP) Algorithm 7 ASBP Obesity Algorithm: Adult Adiposity Evaluation and Treatment 2013 Contents: • Overall management goals • Obesity classification • Obesity as a disease • Diagnosis • Overall approach • Fat mass disease • Sick fat disease (adiposopathy) • History • Physical exam • Laboratory evaluation • Treatment • Nutritional therapy • Physical activity • Behavior therapy • Weight management pharmacotherapy • Early versus late weight management intervention • Bariatric surgery • Executive summary • References • Disclosures Copyright©2013ASBP:MaynotbereproducedoralteredinanyformwithoutwrittenpermissionfromASBP American Society of Bariatric Physicians (ASBP) Algorithm 8 Reference/s:[200]Copyright©2013ASBP:MaynotbereproducedoralteredinanyformwithoutwrittenpermissionfromASBP American Society of Bariatric Physicians (ASBP) Algorithm 9 Reference/s:[201]Copyright©2013ASBP:MaynotbereproducedoralteredinanyformwithoutwrittenpermissionfromASBP American Society of Bariatric Physicians (ASBP) Algorithm 10 Reference/s:[202]Copyright©2013ASBP:MaynotbereproducedoralteredinanyformwithoutwrittenpermissionfromASBP American Society of Bariatric Physicians (ASBP) Algorithm 11 Reference/s:[201][203]Copyright©2013ASBP:MaynotbereproducedoralteredinanyformwithoutwrittenpermissionfromASBP American Society of Bariatric Physicians (ASBP) Algorithm 12 Reference/s:[1][2][3]Copyright©2013ASBP:MaynotbereproducedoralteredinanyformwithoutwrittenpermissionfromASBP American Society of Bariatric Physicians (ASBP) Algorithm 13 Reference/s:[204]Copyright©2013ASBP:MaynotbereproducedoralteredinanyformwithoutwrittenpermissionfromASBP American Society of Bariatric Physicians (ASBP) Algorithm 14 Reference/s:[200]Copyright©2013ASBP:MaynotbereproducedoralteredinanyformwithoutwrittenpermissionfromASBP American Society of Bariatric Physicians (ASBP) Algorithm 15 Reference/s:[200]Copyright©2013ASBP:MaynotbereproducedoralteredinanyformwithoutwrittenpermissionfromASBP American Society of Bariatric Physicians (ASBP) Algorithm 16 Reference/s:[4][5][6][7][8][9][10] Copyright©2013ASBP:Maynotbereproducedoralteredinanyformwithoutwrittenpermissionfrom ASBP American Society of Bariatric Physicians (ASBP) Algorithm 17 Reference/s:[200]Copyright©2013ASBP:MaynotbereproducedoralteredinanyformwithoutwrittenpermissionfromASBP American Society of Bariatric Physicians (ASBP) Algorithm 18 Reference/s:[11][12]Copyright©2013ASBP:MaynotbereproducedoralteredinanyformwithoutwrittenpermissionfromASBP American Society of Bariatric Physicians (ASBP) Algorithm 19 Reference/s:[13][14]Copyright©2013ASBP:MaynotbereproducedoralteredinanyformwithoutwrittenpermissionfromASBP American Society of Bariatric Physicians (ASBP) Algorithm 20 Reference/s:[13][14]Copyright©2013ASBP:MaynotbereproducedoralteredinanyformwithoutwrittenpermissionfromASBP American Society of Bariatric Physicians (ASBP) Algorithm 21 Reference/s:[13][14]Copyright©2013ASBP:MaynotbereproducedoralteredinanyformwithoutwrittenpermissionfromASBP American Society of Bariatric Physicians (ASBP) Algorithm 22 Reference/s:[6][7][9][10][15]Copyright©2013ASBP:MaynotbereproducedoralteredinanyformwithoutwrittenpermissionfromASBP American Society of Bariatric Physicians (ASBP) Algorithm 23 Reference/s:[6][16][17][18]Copyright©2013ASBP:MaynotbereproducedoralteredinanyformwithoutwrittenpermissionfromASBP American Society of Bariatric Physicians (ASBP) Algorithm 24 Reference/s:[7][9][19][20]Copyright©2013ASBP:MaynotbereproducedoralteredinanyformwithoutwrittenpermissionfromASBP American Society of Bariatric Physicians (ASBP) Algorithm 25 Reference/s:[21][22][23][24][25]Copyright©2013ASBP:Maynotbereproducedoralteredinanyformwithoutwrittenpermissionfrom ASBP American Society of Bariatric Physicians (ASBP) Algorithm 26 Reference/s:[26][27][28]Copyright©2013ASBP:MaynotbereproducedoralteredinanyformwithoutwrittenpermissionfromASBP American Society of Bariatric Physicians (ASBP) Algorithm 27 Reference/s:[29][30][31]Copyright©2013ASBP:MaynotbereproducedoralteredinanyformwithoutwrittenpermissionfromASBP American Society of Bariatric Physicians (ASBP) Algorithm 28 Reference/s:[205]Copyright©2013ASBP:MaynotbereproducedoralteredinanyformwithoutwrittenpermissionfromASBP American Society of Bariatric Physicians (ASBP) Algorithm 29 Reference/s:[32][205]Copyright©2013ASBP:MaynotbereproducedoralteredinanyformwithoutwrittenpermissionfromASBP American Society of Bariatric Physicians (ASBP) Algorithm 30 Reference/s:[15][32][205]Copyright©2013ASBP:MaynotbereproducedoralteredinanyformwithoutwrittenpermissionfromASBP American