I quickly glanced at the first 2014 issue of JAMA before I returned to the office on January 2. And there was the first article to deal with weight… It was titled ” New obesity guidelines: promise and potential”. As we go back to our regular lives after the nutritional and alcohol excesses of the holiday, it seems most appropriate that we consider the major contributor to chronic disease: obesity. One in three US adults are obese.
There are new obesity guidelines to help physicians manage obesity more effectively. They were formed by an expert panel which first started their ponderous work in September 2008 and finally at the end of 2013 published what is now termed “Obesity 2″ guidelines for the management of overweight and obesity in adults. Here is a brief summary of their recommendations:
Recommendation 1 – Identifying patients who need to lose weight.
They continued to use BMI and waist circumference to identify those who are overweight or obese. An adult who has a BMI between 25 and 29.9 is considered overweight and an adult who has a BMI of 30 or higher is considered obese. Individual waist circumference is also important because abdominal fat is a predictor of risk for obesity-related diseases. If your waist circumference is more than 35 inches this adds to your risks from excessive weight. In general the greater the BMI and waist circumference, the greater the risk of cardiovascular disease, type 2 diabetes, and all-cause mortality.
Recommendation 2 – Counseling about the benefits of weight loss.
The panel stated that sustained weight loss of as little as 3 to 5% is likely to result in clinically meaningful reductions in levels of triglycerides, blood glucose, and hemoglobin A-1 C and in the risk of developing type 2 diabetes. Greater amounts of weight loss will reduce blood pressure, improve levels of low density and high density lipoprotein cholesterol, and reduce the need for medications to control blood pressure, blood glucose levels, and lipid levels as well as further reduce levels of triglycerides and blood glucose. The panel states that weight-loss can provide benefit for obese and overweight patients with only one additional risk factor and that one factor can simply be an increased weight circumference.
Recommendation 3 – Dietary therapy for weight loss.
The panel’s recommendations emphasize that there is no ideal diet for weight loss and that there is no evidence of superiority for any of the myriad diets they reviewed. Their primary recommendation is that a diet should achieve reduced caloric intake as part of a comprehensive lifestyle intervention (that includes exercise)
Recommendation 4 -Lifestyle intervention and counseling.
Obese or overweight individuals should enroll in comprehensive lifestyle interventions for weight-loss that should be delivered for six months or longer. The gold standard of therapy is on-site and high-intensity sessions (14 sessions or more in six months) provided in individual or groups by a trained interventionist. And further therapy should continue for a year or more. (They hope that payers will recognize the value of well-run programs that use this approach. They did state that lesser intensity approaches delivered electronically have not shown the same amount of weight loss and health benefits.)
Recommendation 5 – Bariatric surgery.
The Obesity 2 panel has advised practitioners to suggest to patients who are either obese with a BMI at or over 40 or at or over 35 with additional obesity related health conditions that they consider undergoing bariatric surgery by experienced bariatric surgeons.
Oy, this is a lot to consider for one third of our population. I was overwhelmed when I read this. I also lost my appetite for my next meal… But I thought I should share this with my patients and readers. Hopefully this will help to exhort all of us to maintain a lifestyle with appropriate caloric intake, and exercise in this new year.