Assess lifestyle, comorbidities and willingness to change

• Make an initial assessment, then use clinical judgement to investigate comorbidities and other factors to an appropriate level of detail, depending on the person, the timing of the assessment, the degree of overweight or obesity, and the results of previous assessments.​

• Manage comorbidities when they are identified; do not wait until the person has lost weight.

• Offer people who are not yet ready to change the chance to return for further consultations when they are ready to discuss their weight again and willing or able to make lifestyle changes. Give them information on the benefits of losing weight, healthy eating and increased physical activity.​

• Recognise that surprise, anger, denial or disbelief about their health situation may diminish people's ability or willingness to change. Stress that obesity is a clinical term with specific health implications, rather than a question of how people look; this may reduce any negative feelings.

During the consultation

•  Assess the person's view of their weight and the diagnosis, and possible reasons for weight gain.​

• Explore eating patterns and physical activity levels.​

• Explore any beliefs about eating and physical activity and weight gain that are unhelpful if the person wants to lose weight.​

• Be aware that people from certain ethnic and socioeconomic backgrounds may be at greater risk of obesity, and may have different beliefs about what is a healthy weight and different attitudes towards weight management.​

• Find out what the person has already tried and how successful this has been, and what they learned from the experience.Assess the person's readiness to adopt changes.Assess the person's confidence in making changes.​

• Give people and their families and/or carers information on the reasons for tests, how the tests are done and their results and meaning. If necessary, offer another consultation to fully explore the options for treatment or discuss test results.​

• Take measurements (see identifying people who are overweight or obese in this pathway) to determine degree of overweight or obesity and discuss the implications of the person's weight.

• Then, assess:

• any presenting symptoms
• any underlying causes of being overweight or obese
  eating behaviours
• any comorbidities (for example type 2 diabetes, hypertension, cardiovascular disease, osteoarthritis, dyslipidaemia and sleep apnoea)
• any risk factors assessed using lipid profile (preferably done when fasting), blood
• pressure measurement and HbA1c measurement
• the person's lifestyle (diet and physical activity)
• any psychosocial distress
• any environmental, social and family factors, including family history of overweight and obesity and comorbidities
• the person's willingness and motivation to change lifestyle
• the potential of weight loss to improve health
• any psychological problems
• any medical problems and medication
• the role of family and care workers in supporting individuals with learning disabilities to make lifestyle changes.

Consider referral to tier 3 (specialist) services

Consider referral to tier 3 services if:

• the underlying causes of being overweight or obese need to be assessed]​

• the person has complex disease states and/or needs that cannot be managed adequately

• in tier 2 (for example, the additional support needs of individuals with learning disabilities)​

• conventional treatment has been unsuccessful​

• drug treatment is being considered for a person with a BMI more than50 kg/m2​

• specialist interventions (such as a very low-calorie diet) may be needed or​

• surgery is being considered.