HealthDay News — Clinicians should diagnose and treat obesity during every patient visit as they would other chronic diseases, according to new guidelines from the American Heart Association and the American College of Cardiology.
The recommendations are a considerable paradigm shift from the current lax approach of addressing obesity and weight management on case-by-case basis, mostly due to the notoriously tough nature of discussing the topic with patients.
“We hope that by laying out the scientific evidence that medically supervised weight loss works and significantly reduces the risk factors for cardiovascular disease, it will be more fully embraced by patients and doctors,” Donna Ryan, MD, co-chair of the writing committee, said in a statement.
Individuals who need to lose weight and are at risk of cardiovascular disease, type 2 diabetes, and all-cause mortality should be identified on the basis of their BMI and waist circumference (defined as 35 inches and up for women or 40 inches and up for men), Michael D. Jensen, MD, from the Mayo Clinic in Rochester, Minn., and colleagues reported in Circulation.
Overweight (defined as BMI of 25 to 30) and obese adults (BMI of 30 and higher) with cardiovascular risk factors should be advised that lifestyle changes that induce sustained weight loss of 3% to 5% will result in clinically meaningful health benefits, and that greater weight loss will result in greater benefits.
Dietary strategies should be employed for weight loss, including reduced calorie or food intake — creating a 500 to 1,000 calorie per day deficit should elicit weight loss regardless of the diet, according to the researchers. And diets should be based on a patient’s preferences and health status. Consider recommending a DASH diet for patients with hypertension, or a Mediterranean diet for those with other cardiovascular risks, for instance.
Comprehensive lifestyle interventions should be recommended to help with adherence to dietary strategies and increase physical activity — and these recommendations should be delivered by a trained interventionist. Patients should meet with this counsellor 14 times during the first six months of an intervention, and attend follow-up visits for at least one year.
Bariatric surgery should be recommended for eligible patients. These include patients with a BMI of 40 and up, or a BMI of 35 with at least one obesity-related comorbidity when other interventions fail.