Being overweight carries increased risks of morbidity and mortality. In practice, it is difficult for such patients to return to 'normal' body weight and it is more realistic to aim for modest degrees of weight loss (5-10% of body weight).

Combining exercise, behavioural therapy or drug treatment with appropriate dietary regimes appears to be better at maintaining weight loss than diet modification alone. However ft]rther studies are needed to define the best approach.

Specific interventions to reduce weight using appropriate dietary regimes and exercise and/or behavioural measures, should be tried for those with a BMJ of 30 kg/M2 or more, and for those with a BMI greater than 25 kg/in2 who have symptoms or risk factors associated with being overweight (non-insulin dependent diabetes, centralisation of body fat, hypertension or hyperlipidaemia). If these approaches fail, adding orlistat is a reasonable option, providing the patient has previously achieved short-term weight loss on diet alone.

For those who are severely obese despite diet modification, exercise, behavioural therapy and drug treatment, surgery (such as gastroplasty) is an effective option.

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