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AAFP, USPSTF Recommend Screening All Adults for Obesity, Offering Some Patients Lifestyle Intervention
By Matt Brown
"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."
- The AAFP and the U.S. Preventive Services Task Force (USPSTF) recommend 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 a behavioral intervention program.
- According to the USPSTF, the benefit of behavioral counseling interventions for cardiovascular disease prevention in adults without a diagnosis of hypertension, diabetes, hyperlipidemia or cardiovascular disease is small.
- The task force said that clinicians may choose to selectively counsel (healthy, low-risk) patients rather than incorporate counseling into the care of all adults in the general population.
"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.
AAFP Tools for Fighting Obesity
- The AAFP's Americans In Motion -- Healthy Interventions (AIM-HI) program helps family physicians create healthy offices and communities. AIM-HI positions fitness as the treatment of choice for prevention and management of many chronic conditions. AIM-HI offers a number of tools for physicians, such as a Nutrient Deficiency Questionnaire, the AIM-to-Change Toolkit, and the AIM-HI Food & Activity Journal.
- FamilyDoctor.org's Prevention & Wellness page offers patients Academy-approved advice on staying healthy, nutrition, exercise and fitness, as well as emotional well-being. The site also offers patients a body mass index calculator.
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."