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 Obese adults should receive counseling and other programs to help
them stick to a healthy diet, maintain or increase physical
activity, and understand and address obstacles to weight loss,
according to recommendations issued today by the U.S. Preventive
Services Task Force (USPSTF).
This advice isn't new. The Task Force made similar recommendations
in 2012. But recent research confirms that behavioral approaches
really can help people achieve meaningful weight loss and better
health, said Task Force member Dr. Chyke Doubeni of the University
of Pennsylvania Perelman School of Medicine in Philadelphia.
"The additional evidence shows that obesity continues to impact many
Americans and that interventions to promote healthy diet and
exercise work," Doubeni said by email.
"This recommendation re-emphasizes that clinicians can really help
adults with obesity by offering or referring them to intensive,
multicomponent behavioral interventions," Doubeni added. "These
interventions - which can include things like group counseling,
one-on-one counseling in-person, and online resources - have been
proven to help people lose weight and be healthier, so we continue
to recommend that clinicians offer or refer their patients to them."
More than 35 percent of men and 40 percent of women are obese in the
U.S., the Task Force notes in its recommendations published in JAMA.
Obesity is linked to many chronic health problems including
diabetes, heart disease, joint damage, mobility limitations and
certain cancers. People with obesity also have a greater risk of
premature death than individuals with a healthy weight.
Weight loss interventions tested in recent studies varied widely in
how they were provided and in the frequency and duration of
treatment sessions, said Dr. Erin LeBlanc of the Kaiser Permanente
Center for Health Research Northwest in Portland. Some interventions
involved group counseling while others used individual sessions, for
example, and certain programs were led by nutritionists while others
relied on primary care providers.
"However, specific weight loss messages and behavior change
techniques were consistent across the trials," LeBlanc, author of an
evidence review accompanying the recommendations, said by email.
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"Most of the interventions involved group, individual, and
technology-based education and counseling that was designed to help
participants achieve a five percent or greater weight loss through a
combination of dietary changes (including specific caloric goals)
and a gradual increase in physical activity (generally promoting at
least 150 minutes of moderate-intensity activity per week)," LeBlanc
said.
While these efforts can translate into meaningful weight loss for
some people, it's not a one-size-fits all fix, said Dr. Susan
Yanovski, author of an accompanying editorial and co-director of the
Office of Obesity Research with the National Institutes of Health in
Bethesda, Maryland.
"Some individuals with obesity don't respond to even the best
behavioral treatment with enough weight loss to improve health,"
Yanovski said by email.
"Obesity medications added to behavioral treatment can be helpful
for some patients," Yanovski added. "In addition, patients with
severe obesity may benefit from bariatric surgery, which has been
shown to improve a number of obesity-related medical conditions."
There's less evidence that weight-loss drugs work, however, and they
can have dangerous side effects, the Task Force notes in its
recommendation statement.
"Lifestyle intervention through diet, exercise and behavioral
modifications are the first-line cornerstones of obesity management
approaches, said Debra Haire-Joshu of the
Brown School and the School of Medicine at Washington University in
St. Louis.
"Weight loss medications and bariatric surgery are additional
strategies which can be combined with behavioral intervention to
reduce food intake and increase physical activity," Haire-Joshu,
author of an accompanying editorial, said by email. "Primarily
medication and surgery offer options for patients who have been
unable to successfully lose weight or maintain a goal weight and/or
are exhibiting health problems related to their weight."
SOURCE: http://bit.ly/2NW070s, http://bit.ly/2NYhtdq, http://bit.ly/2NTQDTu,
http://bit.ly/2NTEJsT and http://bit.ly/2NUBb9y JAMA, online
September 18, 2018.
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