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Management Guidelines for Overweight and Obesity in Adults

Guideline Watch |
December 4, 2013

Management Guidelines for Overweight and Obesity in Adults

  1. JoAnne M. Foody, MD

A thorough review of the current evidence base informs recommendations regarding dietary, pharmacologic, lifestyle, and surgical interventions.

  1. JoAnne M. Foody, MD

Sponsoring Organization: American College of Cardiology, American Heart Association, The Obesity Society

Target Population: Primary care providers

Background and Objective

These recommendations stem from the work of an Expert Work Group convened by the National Heart, Lung, and Blood Institute to update the 1998 Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults — The Evidence Report. The Work Group developed five critical questions to address in the revision: (1) What are the benefits of losing weight, and how much weight loss is needed to achieve them? (2) Are established cutpoints for overweight and obesity appropriate across different populations? (3) What is the best diet? (4) What is the best lifestyle intervention? (5) What are the benefits and risks of various bariatric surgical procedures?

Key Points

  • All overweight and obese patients should be counseled that losing weight (initial goal, 5%–10% over 6 months) is associated with reductions in LDL, triglycerides, blood glucose, glycated hemoglobin (HgA1c) and diabetes risk, blood pressure, and medication use, as well as increases in HDL (Class I).

  • Measures and cutpoints for identification of patients at increased risk for cardiovascular disease, type 2 diabetes, and all-cause mortality remain unchanged: body-mass index (overweight, ≥25 kg/m2; obese, ≥30 kg/m2) as the first screening step (Class I), and waist circumference (>88 cm in women, >102 cm in men) for further risk assessment (Class IIa).

  • Any prescribed diet should reduce caloric intake (Class I) and be balanced with increased energy demands. Of the myriad diets reviewed, none was found to be ideal for weight loss or superior to any of the others.

  • The most effective comprehensive lifestyle interventions (combining diet, physical activity, and behavioral strategies) are on-site, high-intensity (>14 sessions in 6 months), and delivered in group or individual sessions by a trained interventionist for 1 year or more (Class I).

  • Bariatric surgery may be appropriate in patients with a BMI of ≥40 kg/m2 — or ≥35 kg/m2 with comorbidity — who have not responded to comprehensive lifestyle therapy (Class IIa). The most effective surgical method depends on many clinical variables (Class IIb); physicians should refer patients considering this option to an experienced bariatric surgeon.

What's Changed

Current evidence regarding specific diets, lifestyle interventions, and surgical alternatives is thoroughly reviewed. Evidence for a continuous relationship between BMI and cardiovascular effects has led to some relaxation in the initial weight-loss target (≥5% vs. ≥10%).

Comment

These guidelines continue to emphasize the importance of moderate weight loss in improving cardiovascular outcomes in overweight or obese patients and underline the reality that there is no magic bullet when it comes to weight loss. In particular, the fact that no specific diet or diet plan is recommended sends an important message — many different strategies can be successful, provided that caloric intake is reduced. The authors recognize that integrated, intensive, yearlong lifestyle programs are the most likely to achieve good results and remind clinicians that bariatric surgery should be reserved for patients with a body-mass index of ≥40 without comorbid conditions.

  • Disclosures for JoAnne M. Foody, MD at time of publication Consultant / Advisory board Aegerion; Amarin; Bristol-Myers Squibb; Janssen; Merck; Pfizer; sanofi-aventis Leadership positions in professional societies American College of Cardiology (Cardiosmart, Co-Chair)

Citation(s):

Reader Comments (8)

Jerry Stewart Physician, Internal Medicine, RVPCS Fort Smith, Arkansas

Accurate,succinct and to the point.

Jair García, MD Physician, Internal Medicine, Hospital OCA

Excelent and usefull for us: in Mexico we have the first place in obesity...

afshin Other, Other, fishery research international center

i like information from food microbiology because i work in food microbiology lab thank you

John Gustavo Reyesvilla Méndez Physician, Internal Medicine, Private Practice

Prevention, prevention, prevention, based, mostly, on physical activity and reduction of the amount of energy sources. I would like to thank to your team for all the information timely sent and so easy to read and to understand. So far, i feel satisfied. Go on with sucha a work.

Carol Vassar, MD Physician, Internal Medicine, private practice

yes, prevention

MB CHB Physician, Family Medicine/General Practice, south africa

have not read full article otherwise precise basic information easy to follow

seyus sandi prahulu Medical Student

Sangat bagus sekali

Peter J Macander, MD, PhD, FACC Physician, Cardiology, Galichia Heart Hospital and Medical Group, Wichita, KS 67220

Good succinct summary.

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