Doctors urged to be 'gateway' for obesity tests, treatments

Some diets work, and doctors need to tell patients that.

Physicians should screen all adult patients for obesity during office visits and either refer obese patients to comprehensive weight-management programs or offer them one, says the U.S. Preventive Services Task Force in new recommendations announced Monday.

"We found that some weight-loss programs do work, and often the gateway to finding the right program can be through your physician," says David Grossman, a member of the task force and medical director of preventive care at Group Health Cooperative in Seattle.

Many doctors check patients' weight and height but don't calculate their patients' body mass indexes (BMI), a number that takes into account height and weight, he says.

People who have a BMI of 30 or greater are considered obese; that's usually about 30 or more pounds over a healthy weight.

Physicians should tell patients if they are at a normal weight, overweight or obese, he says. The new guidelines don't spell out how often this should be done, but Grossman suggests at least once a year.

About a third (36%) of adults in this country are obese, which puts them at an increased risk of type 2 diabetes, heart disease, stroke, some types of cancer, sleep apnea and many other debilitating and chronic illnesses. Recent projections suggest that 42% of Americans may end up obese by 2030 if something isn't done to reverse the trend.

In its 2003 recommendation, the task force advised primary-care providers to screen for obesity, but these new guidelines give specifics on the type of weight-control interventions that are the most effective.

After reviewing 58 weight-loss studies, the task force found that there is adequate scientific evidence to show that moderate to high-intensity comprehensive behavioral weight-loss programs with 12 to 26 sessions in the first year can help people lose weight.

The best programs often include both group and individual sessions and focus on setting weight-loss goals, improving diet and physical activity, and helping patients monitor food intake and exercise.

"These types of programs really focus on changing your lifestyle," Grossman says. Physicians can refer patients to registered dietitians, exercise physiologists, personal trainers and others who direct weight-loss programs, he says. "Some commercial and non-profit weight-management programs offer many of these features."

The studies show that comprehensive programs can lead to a loss of about 6% of obese patients' starting weight, or roughly 9 to 15 pounds, the panel says. That amount of weight loss may reduce their risk factors for heart disease, the panel says in its recommendations, published online in the Annals of Internal Medicine.

If you're obese and you "lose 5% of your weight, you're doing your body a favor," Grossman says.

The panel says there was insufficient data for it to recommend the use of current medications for weight loss.

Obesity experts are applauding this move. Thomas Wadden, director of the Center for Weight and Eating Disorders at the University of Pennsylvania's Perelman School of Medicine, says, "The task force's recommendations are right on target. However, before primary-care doctors tell all obese patients that they need to lose weight � which most are painfully aware of � they should ask patients, 'What are your thoughts about your weight?'

"Doctors should listen respectfully, offer assistance to those who wish to lose weight and educate others about the relationship between their weight and health."

Wadden says the recommendations "complement those of the Centers for Medicaid and Medicare Services, which recently recommended that obese seniors, in primary-care practices, be provided 14 sessions of lifestyle intervention over six months to help them lose weight and improve their health."

Patrick O'Neil, president of the Obesity Society, a group of weight-control researchers, says, "Obesity is a complex condition, and lifestyle change is difficult." Successful treatment often requires experts in the areas of nutrition, exercise and psychology working with patients over multiple sessions, he says.

"We've come a long way in understanding that obesity is not something that an individual can manage with willpower," adds obesity researcher Donna Ryan, professor emeritus at the Pennington Biomedical Research Center in Baton Rouge.

"We know from many large research studies that intensive lifestyle intervention works. But it has been difficult to get these interventions imbedded in the health care system because they were not reimbursed," she says.

"This is a step in the right direction. It may lead to reimbursements, and patients who suffer from obesity will have access to intensive lifestyle therapy and the benefits it brings."

This is the same task force that grabbed headlines this month by suggesting that healthy postmenopausal women not take daily low doses of vitamin D and calcium to prevent bone fractures. It also advised against PSA (prostate-specific antigen) tests to screen healthy men and told women 50-74 to have a mammogram every other year, not annually.