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2018 USPSTF Recommendations on Behavioral Weight Loss Interventions for Obesity

Focus on prevention of obesity-related morbidity and mortality

by Kirti Salunkhe, MD

The Centers for Disease Control (CDC) indicated that the prevalence of obesity in 2015-2016 in US adults was nearly 40% and affected about 93.3 million people.1 In general, obesity rates are higher for African-American and Hispanic men and women than their white counterparts. It is also a disease that is found in greater numbers in the Southern and Midwestern states of the US and tends to increase with age.2 Obesity is associated with many other health conditions such as cardiovascular disease (CVD), coronary artery disease (CAD), stroke, type 2 diabetes (T2D), gallstones, disability, and some types of cancer.1 It should be noted that several of these conditions are preventable and lead to premature mortality (< 65 years).1 The healthcare costs associated with obesity and obesity-related health conditions is estimated annually to be $147 billion, with the medical costs for people who have obesity being nearly $1,500 higher than those of normal weight.3

The United States Preventive Services Task Force (USPSTF)  is an independent panel of national therapeutic experts in disease prevention and evidence-based science and medicine that is supported by the United States Congress and the Agency for Healthcare Research and Quality (AHRQ).4,6 This group seeks to improve the health of Americans by making evidence-based recommendations across various therapeutic areas. These recommendations are regularly updated as the latest data and research findings are published. The USPSTF recently updated its 2012 guidance on Obesity in Adults, and its 2018 recommendations were published in this week’s Journal of the American Medical Association (JAMA).5-6

In the latest recommendation, the USPSTF reviewed the evidence on various types of interventions (both behavioral and pharmacologic) for weight loss or maintenance of weight loss that can be provided, or referred, by the primary care practitioner. The findings stated:6

  • Patients with BMI ≥ 30 kg/m2 should first be offered intensive, multicomponent interventions that include
    • Dietary changes
    • Increased physical activity
    • Behavioral counseling
  • Despite reviewing pharmacologic evidence, USPSTF did not make any recommendations for this type of intervention
  • Surgical weight loss interventions and weight loss devices (e.g. gastric balloons) were not part of this recommendation as they are outside the scope of the primary healthcare provider

The panel, led by Dr. Susan Curry from the University of Iowa, noted that by implementing and regularly following up on multicomponent behavioral interventions of diet, activity, and counseling in people with obesity can lead to clinically significant improvements in weight and reduce the incidence of T2D in these individuals.6

Why is this Clinically Relevant?

  • These federally mandated recommendations underscore the significance and importance of implementing multicomponent lifestyle behavior modifications (diet, physical activity, and counseling) as evidence-based first steps toward stemming the swiftly rising twin epidemics of obesity and T2D
  • Primary care providers (PCPs) are at the forefront of helping patients with obesity improve their health outcomes (both long-term and immediate)
  • PCPs should recognize and identify “at risk” patients (those with BMI ≥ 30 kg/m2) and encourage them to discuss dietary options and guidance with a registered dietitian or nutritionist as well as a lifestyle educator and to recommend physical activity to reduce sedentary activities
    • These first steps are critical to prevent the consequences of chronic disease or to reduce the risk for chronic conditions such as CVD, CAD, T2D, stroke, etc.

View the abstract

Citations

  1. CDC. Obesity. https://www.cdc.gov/obesity/data/adult.html. Accessed September 19, 2018.
  2. Flegal KM, Kruszon-Moran D, Carroll MD, et al. Trends in obesity among adults in the United States, 2005 to 2014. JAMA. 2016;315(21):2284-2291.
  3. Health Affairs. Obesity. https://www.healthaffairs.org/doi/10.1377/hlthaff.28.5.w822. Accessed September 19, 2018.
  4. US Preventative Task Force. Obesity. https://www.uspreventiveservicestaskforce.org/. Accessed September 19, 2018.
  5. Moyer VA, U.S. Preventive Services Task Force. Screening for and management of obesity in adults: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2012;157(5):373-378.
  6. US Preventive Services Task Force. Behavioral Weight Loss Interventions to Prevent Obesity-Related Morbidity and Mortality in Adults US Preventive Services Task Force Recommendation Statement. JAMA. 2018;320(11):1163–1171.

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