Task force urges doctors to screen for obesity

Physicians should screen all adult patients for obesity during office visits and either refer them to a comprehensive weight-management program or offer one, the U.S. Preventive Services Task Force says in recommendations out Monday.

"We found that some weight-loss programs do work, and often the gateway to finding the right program can be through your physician," says David Grossman, a member of the task force and medical director of preventive care at Group Health Cooperative in Seattle.

Many doctors check weight and height but don't calculate body mass index, which takes those numbers into account, he says. People with a BMI of 30 or greater are considered obese; that's usually 30 or more pounds over a healthy weight.

Physicians should tell patients if they are at a normal weight, overweight or obese, he says. The new guidelines don't spell out how often that should be done, but Grossman suggests at least once a year.

About a third (36%) of U.S. adults are obese, which puts them at an increased risk of type 2 diabetes, heart disease, stroke, some types of cancer and other chronic illnesses. Recent projections suggest 42% of Americans may end up obese by 2030 if the trend is not reversed.

After reviewing 58 weight-loss studies, the task force found that there is enough scientific evidence to show that moderate to high-intensity comprehensive behavioral weight-loss programs with 12 to 26 sessions in the first year are effective.

The best programs often include both group and individual sessions and focus on setting weight-loss goals, improving diet and physical activity, and helping patients monitor food intake and exercise.

Physicians can refer patients to registered dietitians, exercise physiologists, personal trainers and others who direct such programs, Grossman says. "Some commercial and non-profit weight-management programs offer many of these features."

The studies show that comprehensive programs can lead to a loss of about 6% of patients' starting weights, or roughly 9 to 15 pounds, the panel says. Losing even that much may reduce their risk factors for heart disease, the panel says in its advice, which was published online in Annals of Internal Medicine.

If you're obese, losing 5% of your weight is "doing your body a favor," Grossman says.

Obesity experts applaud the move. "The task force's recommendations are right on target," says Thomas Wadden, director of the Center for Weight and Eating Disorders at the University of Pennsylvania's Perelman School of Medicine.

"However, before primary-care doctors tell all obese patients that they need to lose weight -- which most are painfully aware of -- they should ask patients, 'What are your thoughts about your weight?'

"Doctors should listen respectfully, offer assistance to those who wish to lose weight and educate others about the relationship between their weight and health."

Obesity expert Donna Ryan of the Pennington Biomedical Research Center in Baton Rouge calls the report a positive step: "It may lead to (insurance) reimbursements and access to intensive lifestyle therapy."

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