A US task force is urging doctors to prescribe obese patients intense changes to their diets, exercise habits and overall lifestyles in guidelines released today.
Nearly 40 percent of Americans have a body mass index (BMI) of 30 or greater, making them clinically obese and at risk of all manner of diseases, including heart failure, diabetes and cancer.
Obesity has been classified an epidemic for years, yet the number of people who are overweight or obese in the US has continuously risen.
Diet and exercise have long been the most commonly suggested ‘treatments’ for obesity, but the new report notes that they have been treated as just that – suggestions – by doctors and patients alike.
Instead, the US Preventive Services Task Force (USPSTF) wants tools and check-ins to be standardized and for doctors to treat diet and exercise like medical prescriptions.
The US Preventive Services Task Force is urging doctors to prescribe better diets and exercise to obese patients. Staying in close contact with patients is key to keeping them on track
Doctors have identified two clear main culprits in the American obesity epidemic.
Our diets are full of fat and sugar but lack nutritional value and our lifestyles are too sedentary.
Some men and women are genetically predisposed to obesity, but improved diets and consistent physical activity have been shown time and time again to combat the condition.
In 2012, the USPSTF issued guidance for doctors to advise their overweight and obese patients to work out and eat healthier. Doctors were supposed to check in regularly with patients, and keep up with them for at least year.
But an editorial accompanying the new report, authored by Dr Debra Haire-Joshu and Dr Felicia Hill-Briggs of Washington University in St Louis and Johns Hopkins, respectively, suggests that clinicians and their patients haven’t kept the bargain.
In an effort to work out the best possible approach to fighting obesity, the USPSTF conducted studies on four different methods: behavior-based weight loss, behavior-based weight loss maintenance, weight loss programs based on drug therapy, and weight loss maintenance based on the same.
The results were, unsurprisingly, that any and all of these methods were better than doing nothing (as measured against the placebo or control groups).
But there was a much higher rate of negative side effects for those that the took weight loss drugs.
Depending on the medication, patients experienced everything from anxiety and mood swings to dizziness and nausea and stomach cramping and incontinence.
Behavioral changes to their diets and physical activity, on the other hand, were very safe.
The USPSTF underscored the importance that these changes be ‘intensive,’ however, meaning that these patients need to making constant, consistent adjustments to a healthier lifestyle.
This of course presents challenges, even in the best of circumstances.
It’s recommended that patients and doctors meet once a month for one to two years for ‘check-ins.’
But with busy schedules on both sides, this schedule isn’t very well adhered to.
And that only applies to patients with access to a provider in the first place.
Obesity is especially prevalent among low-income and minority populations, who also have the least access to health care.
‘Behavioral obesity interventions need to extend beyond the walls of the primary care clinic to reach populations in which obesity is most prevalent,’ wrote Dr Hill-Briggs and Dr Haire-Joshu.
‘Effective behavioral weight loss interventions require regular contact with increased treatment intensity associated with greater weight loss.’
But, as they note, most Americans only spend a few hours a year with clinicians – a far cry from ‘regular contact.’
In order to implement the multidisciplinary, consistent approach the USPSTF is urging, patients will undoubtedly need support from outside their doctors’ offices.
‘Recognition of the significant role multidisciplinary and lay interventionists play in delivery of behavioral weight loss interventions compels us to broaden reimbursement to those who can implement evidence-based treatment,’ Dr Hill Briggs and Dr Haire-Joshu wrote.
They added that we need to ‘advance multisector partnerships and broad public health approaches to treat obesity, prevent weight gain, and sustain healthy weight beyond primary care,’ to keep patients from slipping through the cracks between appointments.