AAFP, USPSTF Recommend Screening All Adults for Obesity, Offering Some Patients Lifestyle Intervention

The AAFP and the U.S. Preventive Services Task Force (USPSTF) recently updated their respective stances on screening for and management of obesity -- recommending that primary care physicians screen all adults for obesity and offer or refer patients with a body mass index (BMI) of 30 kg/m2 or higher to an intensive, multicomponent behavioral intervention program.

According to USPSTF Co-vice Chair Michael LeFevre, M.D., M.S.P.H., of Columbia, Mo., the grade B recommendation is important to family physicians because it is based on a review of the evidence for what really works for treating obesity.

"Most family physicians are already screening for obesity, and they don't need a task force recommendation to put somebody on a scale or, in most circumstances, to calculate a BMI," he said. "The question is, when you know someone is obese, is there something that's been demonstrated to be beneficial in terms of weight loss? … So this particular recommendation endorses that screening test because we did find that moderately to highly intensive interventions do result in weight loss that should have a positive impact on health."

LeFevre said the task force specifically recommends that health care professionals offer or refer obese persons to a comprehensive weight loss and behavior management program that consists of 12-26 sessions in the first year.

"That may include a variety of components, including some group sessions or nutrition counseling or physical activity sessions," he said. "It's not the kind of intervention that very many family physicians are likely to offer within the walls of their practice. Of course, there are some FPs who are doing this, but most of the time, this will require referral to a resource that is able to provide this type of intervention."

The USPSTF also released another final recommendation on behavioral counseling interventions to promote a healthful diet and physical activity for cardiovascular disease prevention in adults without a known diagnosis of hypertension, diabetes, hyperlipidemia or cardiovascular disease.

LeFevre said that, unlike the lifestyle portion of the obesity recommendation, existing evidence indicates that the health benefit of initiating behavioral counseling in the primary care setting to promote a healthful diet and physical activity is small. For that reason, the task force said that clinicians may choose to selectively counsel patients rather than incorporate counseling into the care of all adults in the general population.

"(The obesity and lifestyle interventions recommendations) address similar topics, but in many ways they are different," LeFevre said. "Most family physicians are looking for risk factors for cardiovascular disease, particularly in the context of a checkup, annual exam or when they are attending to preventive considerations, and risk factors for heart disease fall into that category. Obesity is one of those risk factors, but it is also a risk factor for other things: cancer, diabetes, shortened life expectancy in general."

On the flip side, LeFevre said, if an FP doesn't find a particular cardiovascular risk factor to treat, evidence suggests behavioral counseling may be a waste of time.

"The task force found that (behavioral counseling) may have a small impact on factors for cardiovascular disease for healthy patients, but it is small," he said. "Therefore, spending a lot of time doing that with everybody that you see for whom you've not identified a risk factor isn't necessarily going to be the best use of a family physician's time.

"If we are really going to get people to do those things, it takes a fairly intensive intervention to make that happen. So if you're taking the average, low-risk person, your impact on cardiovascular disease by referring people to intensive programs is going to be small."