Task Force Recommends Obesity Screening for All Adults
Docs Should Screen for Obesity and Direct Obese Patients to Intensive, Multicomponent Behavioral Interventions
In an update to its 2003 recommendation statement on screening for obesity in adults, the United States Preventive Services Task Force recommends screening all adult patients for obesity. Screening includes measurement of height and weight to ascertain BMI, although measuring waist circumference also is an accepted method. Patients with a BMI of 30 or higher should be offered or referred to intensive, multicomponent behavioral interventions such as group or individual weight-loss counseling sessions. The Task Force found that weight-loss outcomes improved when interventions involved at least 12-26 sessions in the first year. Patients with weight-related health issues (high blood pressure, diabetes) saw weight loss and physiologic improvements when behavioral interventions were combined with orlistat or metformin, However, orlistat has been linked to rare, severe liver disease, and metformin has not been approved by the FDA for use as an obesity treatment. Because of safety concerns and insufficient evidence to determine maintenance of improvement after discontinuing drug treatment, the Task Force did not include use of pharmacological agents in the recommendation. In its previous recommendation, the Task Force recommended interventions for overweight adults with a BMI of between 25 and 29.9. But the results of trials included in the evidence review did not allow the Task Force to determine definitively if interventions for individuals who were overweight but not obese would yield the benefits observed in obese individuals.
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Counseling to Promote a Healthy Lifestyle Not Helpful for All Patients
Task Force Recommendation: Clinicians should selectively provide behavioral counseling in the primary care setting to promote a healthful diet and physical activity rather than incorporating it into the care of all adults in the general population.
Cardiovascular disease is the leading cause of death in the United States. Regardless of their risk status, individuals that follow guidelines for a healthful diet and physical activity can decrease their risk for cardiovascular morbidity and mortality. The United States Preventive Services Task Force reviewed evidence published since its 2002 and 2003 recommendations to determine if primary care-relevant counseling interventions about diet and exercise could change behaviors and improve cardiovascular health among otherwise healthy adults. The Task Force found that medium- to high-intensity behavioral counseling interventions produced small short-term improvements in blood pressure, cholesterol levels, and glucose tolerance. However, available studies rarely involved delivery of the interventions by primary care clinicians. The Task Force recommends that clinicians selectively provide behavioral counseling about diet and activity rather than providing this service to all patients. Issues clinicians should consider include other risk factors for coronary artery disease, a patient’s readiness for change, social support and community resources that support behavioral change, and other health care and preventive service priorities. The Task Force concludes that behavioral counseling may be more effective if delivered in the context of a broader public health intervention that encourages healthy lifestyles (a list of these programs can be found at www.thecommunityguide.org).
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