Intensive lifestyle changes best for people with BMI above 30, task force says

Sept. 18 (UPI) — People with a body mass index of 30 or higher need intensive behavioral interventions, including diet changes and increased physical activity, according to a U.S. task force’s new recommendations announced Tuesday.

The U.S. Preventive Services Task Force updated its recommendations from 2012 on screening for obesity in adults. The USPSTF also found adequate evidence that behavior-based weight loss maintenance interventions are associated with less weight gain.

A report was published Tuesday in the Journal of the American Medical Association.

The task force, created in 1984, “is an independent group of national experts in prevention and evidence-based medicine that works to improve the health of all Americans by making evidence-based recommendations about clinical preventive services such as screenings, counseling services, or preventive medications,” according to the Agency for Healthcare Research and Quality. Sixteen volunteer members come from the fields of preventive medicine and primary care, including internal medicine, family medicine, pediatrics, behavioral health, obstetrics/gynecology and nursing.

In the United States, more than 35 percent of men and 40 percent of women are defined as obese, according to the Centers for Disease Control and Prevention. The BMI is calculated as weight in kilograms divided by height in meters squared.

Obesity has been found to be associated with health problems that include an increased risk for coronary heart disease, type 2 diabetes, various types of cancer and disability. Particularly among adults younger than 65, obesity is also associated with an increased risk for death.

The task force reviewed the evidence on interventions — behavioral and pharmacotherapy –for weight loss or weight loss maintenance based upon a primary care setting. Surgical weight loss interventions and nonsurgical weight loss devices, such as gastric balloons, were not considered because they are outside the scope of primary care.

“The USPSTF concludes with moderate certainty that offering or referring adults with obesity to intensive, multicomponent behavioral interventions [ie, behavior-based weight loss and weight loss maintenance interventions] has a moderate net benefit,” the task force recommended.

The CDC defines “normal weight” as 18.5 to less than 25 BMI, “overweight” with a BMI of 25 to 29.9 and “obesity” of 30 or higher. Within the “obese” group there is Class 1 of 30-34 BMI, Class 2 of 35 to 39 and Class 3 of 40 or higher.

For a person who is 5 feet 9 inches tall, a BMI of 18.5 to 24.9, which corresponds to 125 pounds to 168 pounds, is considered a healthy weight.

The task force noted the U.S. Food and Drug Administration considers a weight loss of 5 percent as clinically important.

Most intensive behavioral weight loss interventions considered by the USPSTF lasted one to two years, and the majority had 12 or more sessions in the first year.

Also recommended are screening for abnormal blood glucose levels and type 2 diabetes, screening for high blood pressure, statin use in persons at risk for cardiovascular disease, counseling for tobacco smoking cessation, aspirin use in certain persons for prevention of cardiovascular disease and behavioral counseling interventions to promote a healthful diet and physical activity for cardiovascular disease prevention in adults.

“This latest iteration of the USPSTF recommendation reinforces the benefits of comprehensive behavioral treatment for persons with obesity,” Dr. Susan Z. Yanovski, who works at the National Institute of Diabetes and Digestive and Kidney Diseases, wrote in an accompanying editorial in JAMA. “Given the continued epidemic of obesity in the United States, this recommendation is important to the future health of many individuals.

“Clinicians can do their patients a great service by showing respect for their patients’ struggles with weight management, screening for obesity-related comorbidities, and providing treatment for identified conditions regardless of the patient’s motivation for, or success with, weight-loss treatment.”

She noted physicians should monitor other medical conditions and medications “with a goal of minimizing the detrimental influences on weight” and offer treatments “based on shared understanding of the patient’s medical and psychosocial needs and goals.”

And although the recommendations focus on established obesity, she said “research to develop effective prevention strategies throughout the life course, including infancy and early childhood, could ultimately decrease the number of adults who must confront the difficult challenge of losing excess weight.”

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