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Guidelines

Overweight and obesity management in print

The condensed version of the Systematic Evidence Review, called the Executive Summary, which included recommendations and a treatment algorithm, was published online in November of 2013

The Obesity Society has published in full the Systematic Evidence Review and corresponding set of treatment recommendations: Guidelines (2013) for Managing Overweight and Obesity in Adults, first published online in November 2013.

The condensed version of the Systematic Evidence Review, called the Executive Summary, which included recommendations and a treatment algorithm, was published online in November of 2013 by all three cooperating organizations who helped develop the report: The Obesity Society (TOS), The American Heart Association (AHA) and the American College of Cardiology (ACC).

According to Drs Donna Ryan (Associate Editor-in-Chief, Obesity) and Martica Heaner (Managing Editor, Obesity), the society decided to support the publication in print of a version of all the evidence as they believe this reference report represents a “landmark in the field by virtue of the stringent methodology and painstaking approach used to produce evidence statements that are trustworthy”.

“Weight loss isn’t about will power. It’s about behaviours around food and physical activity, and getting the help you need to change those behaviours,” said Ryan, co-chair of the writing committee and professor emeritus at Louisiana State University’s Pennington Biomedical Research Center in Baton Rouge, LA.

The guideline report is based on a systematic evidence review that summarises the current literature on the risks of obesity and the benefits of weight loss, as well as knowledge on diets for weight loss, the efficacy and effectiveness of comprehensive lifestyle interventions on weight loss and weight loss maintenance and the benefits and risks of bariatric surgery.

In addition, the publication includes a treatment algorithm for teh management of this hronic disease as a model for primary care of patients with overweight and obesity (Figure 1).

Figure 1: Treatment algorithm - Chronic disease management model for primary care of patients with overweight and obesity

The report recommends that healthcare providers calculate BMI at annual visits or more frequently, and use the BMI cut points to identify adults who may be at a higher risk of heart disease and stroke because of their weight. The report also presents evidence showing that the greater the BMI, the higher the risk of coronary heart disease, stroke, type 2 diabetes and all-cause mortality.

The guidelines also recommend healthcare providers develop individualised weight loss plans that include three key components: a moderately reduced calorie diet, a programme of increased physical activity and the use of behavioural strategies to help patients achieve and maintain a healthy body weight.

 “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 and effective programs will eventually be reimbursed by all third-party payers,” she added.

Medicare began covering behavioural counselling for patients affected by obesity in 2012, based on available evidence at that time. Under the Affordable Care Act, most private insurance companies are expected to cover behavioural counselling and other treatments for obesity by 2014.

Other key recommendations include:

  • Tailoring dietary patterns to a patient’s food preferences and health risks. For example, a patient with high blood cholesterol would benefit most from a low-calorie, lower-saturated fat diet including foods that they find appealing.
  • Focusing on achieving sustained weight loss of 5 percent to 10 percent within the first six months. This can reduce high blood pressure, improve cholesterol and lessen the need for medications to control blood pressure and diabetes. Even as little as 3 percent sustained weight loss can reduce the risk for the development of type 2 diabetes as well as result in clinically meaningful reductions in triglycerides, blood glucose and other risk factors for cardiovascular disease.
  • Advising adults with a BMI of 40 or higher and patients with a BMI of 35 or higher who have two other cardiovascular risk factors such as diabetes or high blood pressure, that bariatric surgery may provide significant health benefits. The guideline does not recommend weight loss surgery for people with a BMI <35 and does not recommend one surgical procedure over another.

“Healthcare providers should do more than advise patients affected by obesity or overweight to lose weight – they should be actively involved and help their patients reach a health body weight,” said Ryan.

The obesity guideline is one of four cardiovascular disease prevention guidelines being released by the American Heart Association and American College of Cardiology. Other guidelines address lifestyle management, cholesterol and cardiovascular risk assessment.

The obesity treatment recommendations are based on the latest scientific evidence from 133 research studies.

To view the guidelines in full, please click here

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