Providers Should Screen Adults for Obesity, Refer Obese Patients to Behavioral Therapy, Guidelines Recommend

Health providers should screen all adults for obesity based on their body mass index and refer obese patients to intensive behavioral therapy and counseling, according to guidelines from the U.S. Preventive Services Task Force to be published Tuesday in the Annals of Internal Medicine, the AP/Wall Street Journal reports (AP/Wall Street Journal, 12/2). The guidelines, which are the result of a review of weight-related studies, recommend that obese adults receive therapy at least twice per month for at least three months in either individual or group settings led by health professionals such as psychologists, dieticians or exercise instructors. Under those guidelines, individuals can lose between six and 12 pounds. The task force noted that "even this small weight loss results in measurable health benefits," such as lower blood pressure, improved blood fat levels and a lower risk of diabetes, the Washington Post reports. The task force did not recommend such treatment for people who are overweight but not obese. The task force's report also addresses weight-loss drugs, including the two most commonly prescribed medications, orlistat, marketed as Xenical, and sibutramine, marketed as Meridia. The treatments generally result in a five-pound weight loss that can be sustained for one to two years. The task force said there are "frequent although not usually serious adverse effects," including nausea, high blood pressure and insomnia, related to the medications. In an analysis of surgical weight-loss procedures, which can lead to weight loss of between 20 and 300 pounds, the task force noted that the treatments are expensive and that about 25% of patients require some type of follow-up surgical procedure within three to five years of the initial treatment.

"Our message to physicians is that behavior modification works for obese patients. We have to do something that makes an impact," Alfred Berg, chair of the task force and head of family medicine at the University of Washington, said (Squires, Washington Post, 12/2). Dr. Janet Allan, vice chair of the panel and dean of the University of Maryland School of Nursing, said that obese patients need a support system to encourage healthier eating (AP/Wall Street Journal, 12/2). James Hill, director of the Clinical Nutrition Research Unit at the University of Colorado, said the recommendations "represent a major shift in how the health care system addresses obesity," according to the Post. Judith Stern, professor of nutrition at the University of California-Davis and vice president of the American Obesity Association, said, "This is one area where we absolutely blame the patient. Health insurance doesn't cover obesity treatment, and it doesn't cover obesity drugs. It's like saying that if you smoke and get lung cancer, we won't pay for care" (Washington Post, 12/2). The recommendations are available online.