June 25, 2012 — Clinicians should screen adults for obesity and offer intensive, multicomponent behavioral interventions to those with a body mass index (BMI) of 30 kg/m2 or higher, according to updated guidelines from the US Preventive Services Task Force (USPSTF). The new recommendations, which are an update of the 2003 USPSTF statement, were published online in the June 25 issue of the Annals of Internal Medicine.
"The prevalence of obesity in the United States is high, exceeding 30% in adult men and women," write Virginia A. Moyer, MD, MPH, and colleagues from the USPSTF. "Obesity is associated with such health problems as an increased risk for coronary heart disease, type 2 diabetes mellitus, various types of cancer, gallstones, and disability. These comorbid medical conditions are associated with higher use of health care services and costs among obese patients."
The USPSTF reviewed new evidence regarding potential benefits and harms of screening, as well as the safety and efficacy of nonsurgical weight loss interventions that clinicians could feasibly offer in primary care or by referral to other providers.
Evidence was adequate that intensive, multicomponent behavioral interventions, such as individual or group counseling, for obese adults could result in an average weight loss of 4 to 7 kg (8.8 to 15.4 pounds). In addition, these interventions also appeared to improve glucose tolerance and other physiologic risk factors for cardiovascular disease.
However, direct evidence was inadequate regarding the efficacy of these interventions on long-term health outcomes, such as death, cardiovascular disease, and hospitalizations.
Evidence was adequate to conclude that the harms of screening and providing behavioral interventions for obesity are small.
Therefore, the USPSTF concluded with moderate certainty that screening for obesity in adults has a moderate net benefit and that there is also benefit to offering or referring obese adults to intensive behavioral interventions to improve weight status and other risk factors for important health outcomes.
On the basis of this evidence review, the USPSTF issued a grade B recommendation that clinicians screen adults for obesity. The guidelines also recommend providing patients with a BMI of 30 kg/m2 or higher with intensive, multicomponent behavioral interventions that can be carried out in the primary care setting or via referral.
Compared with the 2003 statement, a change in the updated guidelines is that the USPSTF now found adequate evidence that intensive, multicomponent behavioral interventions for obese adults can also improve glucose tolerance and other physiologic risk factors for cardiovascular disease. Another change in the current guideline is that it applies only to persons with a BMI of at least 30 kg/m2 or higher, and not to overweight adults with a BMI of 25 to 29.9 kg/m2.
"Further research is needed to examine the direct effects of screening for obesity on long-term weight and health outcomes," the statement authors conclude. "More specific areas for further research include determining if weight-loss interventions lead to long-term weight loss and improvements in health outcomes. Studies are needed that reassess the best methods for screening in adults (for example, waist circumference or waist–hip ratio), address weight management in elderly adults and other subpopulations, and examine the cost-effectiveness of behavioral and pharmacologic interventions."
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Ann Int Med. Published online June 25, 2012. Full text
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Cite this: USPSTF Updates Adult Obesity-Overweight Screening Guidelines - Medscape - Jun 25, 2012.