New Guidelines: Management of Obesity

The American College of Physicians this month issued clinical guidelines for the pharmacologic and surgical management of obesity. Guidelines were published the April 5 issue of the Annals of Internal Medicine.

"Each year an estimated 300,000 U.S. adults die of obesity-related causes, and the direct cost of obesity and physical inactivity has been estimated at 9.4% of U.S. health care expenditures," write Vincenza Snow, MD from the American College of Physicians, Philadelphia, Pennsylvania, and colleagues. "In response to the increase in obesity, treatments for obesity have become both more numerous and more commonly used." (Medscape Medical News)

"The target audience is all clinicians caring for obese patients, defined as a body mass index of 30 kg/m2 or greater. This guideline is not intended to be used by commercial weight loss centers or for direct-to-consumer marketing by manufacturers and does not apply to patients with body mass indices below 30 kg/m2. "

Especially important in the recommendations are that clincians counsel patients about diet and exercise, and that both physicians and patients determine goals for weight loss, blood pressure, and blood glucose. When these recommendations are not enough, obesity drugs should be considered.

If the patient's BMI is 40 kg/m2 or more, and the patient has other obesity-related conditions such as high blood pressure, diabetes, or sleep apnea, bariatric surgery may be a viable option. However the risks for this surgery should be considered. (Bariatric surgeries have increased substantially. In California, for example, the number of weight-loss surgeries performed increased nearly sixfold, from 1,134 in 1996 to 6,304 in 2000.)

This guideline is based on the evidence report and accompanying background papers developed by the Southern California Evidence-Based Practice Center (EPC).