Swiss obesity clinical practice guidance.

Abstract

Obesity is a chronic, relapsing, and multifactorial disease that poses a significant public health challenge in Switzerland, where approximately 43% of adults are overweight or obese. This new clinical practice guidance establishes a structured, multidisciplinary framework for healthcare professionals, emphasising that assessment, treatment and care should focus on improving overall health metrics, resolving comorbidities and achieving functional gains, rather than solely on numerical weight loss. Crucially, the guidance mandates a non-stigmatising, empathetic approach to combat weight bias, reduce internalised stigma and build therapeutic trust. Accurate diagnosis and risk stratification begin with measuring body mass index (BMI), using adjusted cutoffs for specific ethnic populations. However, since BMI alone may not fully capture cardiometabolic risk, we recommend integrating waist circumference and body composition analyses. Physicians must conduct a comprehensive assessment to identify mechanical and metabolic comorbidities - spanning cardiometabolic, respiratory, gastrointestinal, musculoskeletal and mental health domains, among others - and systematically evaluate the patient's daily functioning and health-related quality of life. Care is organised across a tiered system. Primary care physicians play a central role in screening, initial management, and long-term monitoring. Patients with a BMI of 35 kg/m² or higher, or those with severe obesity-related complications, should be referred to specialised medical obesity services. The foundation of all weight management is a multimodal lifestyle intervention. This intervention includes medical nutrition therapy favouring minimally processed, nutrient-dense diets, such as the Mediterranean pattern; individualised physical activity plans targeting 150-300 minutes of moderate aerobic exercise per week alongside resistance training; and behavioural strategies, such as cognitive behavioural therapy, to address emotional eating and enhance self-efficacy. When lifestyle modifications are insufficient, adjunctive therapies are indicated. The pharmacological landscape has been revolutionised by incretin-based therapies, notably GLP-1 and dual GIP/GLP-1 receptor agonists (e.g. semaglutide and tirzepatide). These medications produce substantial weight reduction and cardiovascular benefits, although clinicians must carefully navigate current reimbursement criteria. For patients with severe or treatment-resistant obesity, bariatric/metabolic surgery, such as Roux-en-Y gastric bypass and sleeve gastrectomy, offers highly effective, durable outcomes but necessitates lifelong interdisciplinary follow-up. Finally, the guidance highlights the necessity of individualised care for special populations, including tailored strategies for children, reproductive-age women and older adults, for whom preserving muscle mass and bone health is prioritised over absolute weight loss.