Editorials

Physicians Need Practical Tools to Treat the Complex Problems of Overweight and Obesity

Am Fam Physician. 2001 Jun 1;63(11):2139-2146.

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The prevalence of overweight and obesity among American adults has been increasing for more than three decades. Approximately 97 million adults—or 55 percent of the adult population—are now considered overweight or obese.1 The increase appears to have occurred across all ages and racial/ethnic groups, and both sexes.1 Obesity in children also has markedly increased, and the increased prevalence, if unchecked, portends an even greater surge in adult obesity in the future.2

Overweight and obesity increase the risk of illness from hypertension, lipid disorders, type 2 diabetes mellitus (formerly known as non-insulin-dependent diabetes), coronary heart disease, stroke, gallbladder disease, osteoarthritis, sleep apnea and other respiratory problems, and certain cancers.3 The total annual cost attributable to obesity-related disease approaches $100 billion in the United States.4

Ironically, a recent survey shows that more than two thirds of adults are trying to lose weight or avoid gaining it. Unfortunately, only 21.5 percent of men and 19.4 percent of women report using the recommended strategies of eating fewer calories and engaging in at least 150 minutes of leisure-time physical activity per week.5 It is imperative that health care practitioners, especially family physicians, counsel patients on the need to modify their eating and physical activity habits to achieve and maintain a healthy weight.

To provide that counsel, however, physicians themselves need help. This issue of American Family Physician contains the American Medical Association's report of the Council on Scientific Affairs entitled “Obesity: Assessment and Management in Primary Care.”6 The report offers recommendations to help family physicians tackle this major public health challenge.

The National Heart, Lung, and Blood Institute (NHLBI) also has been striving to help physicians better assess and treat overweight and obese patients. In June 1998, the NHLBI released an evidence-based report, Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults,3 that was produced in cooperation with the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). The guidelines are based on the most extensive review conducted to date of the scientific evidence on overweight and obesity. The review was undertaken by a 24-member expert panel, which sought to answer 35 key clinical questions about how different treatment strategies affect weight loss and how weight control affects the major risk factors for heart disease and stroke, as well as other chronic diseases and conditions.

The resulting guidelines present a new approach for the assessment of overweight and obesity, and establish principles of safe and effective weight loss. According to the guidelines, the assessment of overweight involves an evaluation of three key measures: body mass index (BMI), waist circumference and a patient's risk factors for diseases and conditions associated with obesity.

The guidelines were endorsed by the coordinating committees of the NHLBI's National Cholesterol Education Program and National High Blood Pressure Education Program, the North American Association for the Study of Obesity, the NIDDK Task Force on the Prevention and Treatment of Obesity and the American Heart Association. Together, these groups represent 54 professional societies, government agencies and consumer organizations.

More recently, the NHLBI, in collaboration with the North American Association for the Study of Obesity, developed an easy-to-use, condensed version of the guidelines. Called The Practical Guide to the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults,7 this tool contains the basic information family physicians need to assess and manage overweight and obese patients. It includes patient information handouts on dietary therapy, including menu plans for 1,200 and 1,600 kcal per day, and tips on healthy shopping and cooking; ideas for patients on how to incorporate at least 30 minutes of moderate-intensity physical activity into their daily routine and reduce their sedentary time; behavior therapy principles that take into account patients' attitudes, beliefs and cultural values; advice on how to create more effective treatment partnerships with patients; and guidance on the appropriate use of pharmacotherapy and weight loss surgery.

This practical guide is available online at the NHLBI's “Aim for a Healthy Weight” Web site at www.nhlbi.nih.gov/guidelines/obesity/practgde.htm. The Web site also offers a set of 150 slides based on the clinical guidelines. More tools are being developed for the Web site, including an electronic textbook that presents the full guidelines in an easy-to-navigate document complete with interactive BMI calculator and menu planner. For information regarding these materials, readers may contact the NHLBI Information Center at 301–592–8573.

Health care practitioners, and family physicians in particular, can make a crucial difference in the fight against overweight and obesity. Research has shown that even a 10 percent decrease in body weight can yield clinical benefits and help allay symptoms of comorbid diseases, but physicians need the means to achieve such a goal. With the clinical guidelines and the practical guide, they can now more easily help patients adopt a healthier lifestyle.

Claude Lenfant, M.D., is director of the National Heart, Lung, and Blood Institute at the National Institutes of Health in Bethesda, Md.

Address correspondence to Claude Lenfant, M.D., NIH National Heart, Lung, and Blood Institute, 31 Center Dr., MSC 2480, Bldg. 31, Rm. 5A52, Bethesda, MD 20892-2480.

REFERENCES

1. Flegal KM, Carroll MD, Kuczmarski RJ, Johnson CL. Overweight and obesity in the United States: prevalence and trends, 1960–1994. Int J Obes Relat Metab Disord. 1998;22:39–47.

2. Troiano R, Flegal KM. Overweight children and adolescents: description, epidemiology, and demographics. Pediatrics. 1998;101(3 pt 2):497–504.

3. National Heart, Lung, and Blood Institute and National Institute of Diabetes and Digestive and Kidney Diseases. Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults. Bethesda, Md.: 1998; NIH publication no. 98–4083.

4. Wolf AM, Colditz GA. Current estimates of the economic cost of obesity in the United States. Obes Res. 1998;6:97–106.

5. Serdula MK, Mokdad AH, Williamson D, Galuska DA, Mendlein JM, Heath GW. Prevalence of attempting weight loss and strategies for control ling weight. JAMA. 1999;282;1353–8.

6. Lyznicki JM, Young DC, Riggs JA, Davis RM. Obesity: assessment and management in primary care. Am Fam Physician. 2001;63:000–00.

7. National Heart, Lung, and Blood Institute and North American Association for the Study of Obesity. The practical guide to the identification, overweight and obesity in adults. Bethesda, Md.: 2000; NIH publication no.00–4084.


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