December 2, 2003
Task Force Recommends that Clinicians Screen Adults for Obesity
The U.S. Preventive Services Task Force today recommended that clinicians screen all adults for obesity and offer obese patients intensive counseling and behavioral interventions to promote sustained weight loss or refer them to other clinicians for these services. These findings are published in the December 2 issue of the Annals of Internal Medicine.
The Task Force based its conclusion on a report from a team led by Kathleen McTigue, M.D., M.P.H., from the Evidence-based Practice Center at RTI International and the University of North Carolina, under contract to the Agency for Healthcare Research and Quality (AHRQ).
Obesity is associated with many significant health problems, including high blood pressure, diabetes, heart disease, premature death, and decreased quality of life. Health care providers should screen for obesity using the body mass index (BMI), which the Task Force said is a valid and reliable screening test. People with a BMI between 25 and 29.9 are considered overweight, and those with a BMI of more than 30 are considered obese. BMI is calculated either as weight in pounds divided by height in inches squared multiplied by 703, or as weight in kilograms divided by height in meters squared. An on-line BMI calculator can be found at http://www.cdc.gov/nccdphp/dnpa/bmi/calc-bmi.htm.
Clinicians may also consider measuring patients for centrally located body weight, which is independently associated with cardiovascular disease, using waist circumference as a measure. Men with waist circumferences greater than 40 inches and women with waist circumferences greater than 35 inches are at increased risk for cardiovascular disease, but these measurements may be inaccurate for people with a BMI greater than 35.
"We need to stem the rising epidemic of obesity in this nation," said Health and Human Services Secretary Tommy G. Thompson. "These findings show that clinicians can have a significant impact on the health of their adult patients by screening for obesity and offering or referring patients to intensive counseling and behavioral interventions."
The Task Force defined intensive counseling for obese patients to include two or more individual or group diet and exercise counseling sessions per month for at least three months. Long-term maintenance interventions following initial weight loss can help sustain weight loss over time.
According to the Task Force, counseling is more effective in helping people lose weight if combined with behavioral interventions that assist people in developing skills, gaining motivation, and building support systems to help them lose weight. Primary care clinicians have an important role in diagnosing obesity and in either providing intensive counseling and behavioral interventions or referring patients to receive those services, they said. Health plan coverage and the use of professionals in other disciplines may help facilitate these interventions.
For obese adults, the Task Force found insufficient evidence to recommend for or against the use of moderate- or low-intensity counseling, which they defined as monthly or less frequently, to promote sustained weight loss. For adults who are overweight but not obese, the Task Force found insufficient evidence to recommend for or against the use of counseling of any intensity and behavioral interventions to promote sustained weight loss. The Task Force did not make a recommendation about screening for obesity in children at this time because the topic is considered so important that it is considering the topic separately for a future report.
Over the past 40 years, prevalence of obesity among adults in the United States has increased from 13 percent to 27 percent. The proportion of adults considered to be overweight has increased from 31 percent to 34 percent. Obesity is more common in women; men are more likely to be overweight. Obesity is especially common in African Americans, Native Americans, Native Hawaiians, and some Hispanic populations.
The Task Force noted that prescription drug therapy and surgery, such as gastric bypass, can be considered for treating obese adults, but only as part of a comprehensive program that also includes intensive counseling and behavioral interventions. Surgical guidelines from the National Institutes of Health restrict bariatric procedures to people with a BMI of 40 or greater or those with a BMI of 35 or greater who have at least one other obesity-related illness. The Task Force noted that the long-term effectiveness and safety of drug therapy and surgery are unknown.
The Task Force, sponsored by AHRQ, is the leading independent panel of private-sector experts in prevention and primary care and conducts rigorous, impartial assessments of the scientific evidence for a broad range of preventive services. Its recommendations are considered the gold standard for clinical preventive services.
The recommendations and materials for screening for obesity in adults will be available after 5 p.m. EST, Dec. 2, on the AHRQ website at http://www.ahrq.gov/clinic/3rduspstf/obesity/obesrr.htm. Previous Task Force recommendations, summaries of the evidence, easy-to-read fact sheets explaining the recommendations, and related materials are available from the AHRQ Publications Clearinghouse by calling 800-358-9295 or sending an e-mail to email@example.com. Clinical information is also available from the National Guideline Clearinghouse at http://www.guideline.gov.
Barbara Najar -- 301-427-1399
AHRQ Public Affairs