Clinical recommendations issued for obesity management

the Clinical Advisor take:

Despite the prevalence of obesity in the United States, identification and treatment rates for the condition remain low. Primary-care providers should step in and offer treatment and assistance to patients, according to a guideline review published in the Journal of the American Medical Association.

 

In an effort to describe current best practices for assessment and lifestyle management of obesity, Robert F. Kusher, MD, of Northwestern University in Chicago, Ill., and colleagues conducted a systematic evidence review. 

 

The evidence review supports treatment recommendations in five areas: risk assessment, weight loss benefits, diets for weight loss, comprehensive lifestyle intervention approaches, and bariatric surgery.

 

Screening all adults for overweight and obesity is the first step in obesity management, according to the researchers. Primary-care providers should take a detailed medical history to assess for the multiple determinants of obesity, including dietary and physical activity patterns, psychosocial factors, weight-gaining medications, and familial traits. 

 

To identify at-risk patients, focus on the complications of obesity opposed to using body mass index alone.

 

Patients who would benefit from weight loss (either BMI of ≥30 with or without comorbidities, or ≥25 along with one comorbidity or risk factor) should be offered intensive behavioral interventions either by their provider or a referral to a specialist.

 

The most common goal for patients is a weight loss of 5% to 10%. It is not necessary for patients to attain a BMI of less than 25 to achieve health benefits.

 

“If clinicians can identify appropriate patients for weight-loss efforts and provide informed advice and assistance on how to achieve and sustain modest weight loss, they will be addressing the underlying driver of many comorbidities and can have a major influence on patients’ health status,” noted the authors.