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USPSTF Recommends Screening and Intervention for Obesity

Implementation of these guidelines is another matter.

The third U.S. Preventive Services Task Force (USPSTF) has been releasing new and updated guidelines during the past 2 years (guidelines homepage ; Journal Watch May 15 2001 ; and Journal Watch Feb 14 2003 ).

USPSTF 3 concludes each of its guidelines with a recommendation, graded as follows:

A -- The intervention is strongly recommended.

B -- The intervention is recommended.

C -- The USPSTF makes no recommendation for or against the intervention.

D -- The intervention is not routinely recommended.

I -- Evidence is insufficient to recommend for or against the intervention.

The USPSTF found good evidence that body-mass index is reliable and valid for identifying adults who are at risk for obesity-related morbidity and mortality (BMI, 30 kg/m²). They also found good evidence that high-intensity counseling (more than 1 session monthly for at least 3 months) about diet and exercise along with behavioral interventions (skill development, motivation, and support strategies) can produce sustained weight loss (i.e., 3-5 kg reduction, maintained for a year or longer). In addition, they noted that sibutramine and orlistat therapy can lead to sustained weight loss of the same magnitude and that, in those with BMIs of 40 or higher, gastric surgeries (e.g., banding) can lead to even greater weight loss. Although the task force did not identify direct evidence of decreased morbidity or mortality related to these interventions, they noted effects on intermediate outcomes, such as lipid levels, that would be expected to affect long-term rates of weight-related morbidity and mortality. Recommendation: B

The task force found insufficient evidence to recommend for or against providing low- or moderate-intensity counseling to obese patients. They also found insufficient evidence to make recommendations regarding overweight adults (BMI, 25-29.9). Recommendation: I

Comment: Despite good evidence, these recommendations will be difficult to implement. First, BMI calculation requires measurement of height, which is not obtained routinely in adults. Second, and more important, medication and surgery are effective, but their use is limited to the severely obese, and surgery is not without risk. In addition, pharmacologic therapies should be given in the context of counseling; however, high-intensity counseling (for which there is the best evidence of efficacy) generally is available only by referral, is of limited availability, and requires substantial patient commitment. Thus, even though it makes sense to screen and intervene, better options for treatment are needed if these recommendations are to have substantial effects on obesity and its consequences.

— Richard Saitz, MD, MPH, FACP, FASAM

Published in Journal Watch General Medicine December 30, 2003

Citation(s):

U.S. Preventive Services Task Force. Screening for obesity in adults: Recommendations and rationale. Ann Intern Med 2003 Dec 2; 139:930-2.

• Original article (Subscription may be required)
• Medline abstract (Free)

McTigue KM et al. Screening and interventions for obesity in adults: Summary of the evidence for the U.S. Preventive Services Task Force. Ann Intern Med 2003 Dec 2; 139:933-49.

• Original article (Subscription may be required)
• Medline abstract (Free)

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