• USPSTF Recommends Intensive Behavioral Intervention for Obesity

    September 26, 2018, 08:42 am News Staff – On Sept. 18, the U.S. Preventive Services Task Force (USPSTF) posted a final recommendation statement and final evidence summary on behavioral weight loss interventions to prevent obesity-related morbidity and mortality in adults.

    Based on its review of the evidence, the USPSTF recommended that clinicians offer or refer adults with a body mass index (BMI) of 30 (calculated as weight in kilograms divided by height in meters squared, or kg/m2) or higher to intensive, multicomponent behavioral interventions -- a "B" recommendation.

    "The task force found that intensive, multicomponent behavioral programs are safe and effective, can help patients lose and maintain weight loss, and reduce risk of diabetes in people with elevated glucose levels," said USPSTF member Chyke Doubeni, M.D., M.P.H., in a news release. "There are many programs available, and one method or type of program isn't necessarily right for everyone. We encourage people to talk to their clinician about what might work best for them."

    The task force said these programs commonly include multiple group sessions (at least 12 sessions or more in the first year) and help patients make healthy eating choices, encourage them to increase physical activity and help them monitor their own weight.

    several women with obesity participating in group session

    "Intensive, multicomponent behavioral interventions combine interventions such as counseling on nutrition and increased physical activity," said USPSTF Vice Chair and family physician Alex Krist, M.D., M.P.H., in the release. "They can be conducted in group or classroom-style sessions that are led by a moderator, use face-to-face counseling or use technology-based interventions like smartphone applications and social networks."

    This final recommendation statement is consistent with the task force's Feb. 20 draft recommendation and its 2012 final recommendation, which the AAFP supported at the time.

    Story Highlights

    Scope of Review

    The USPSTF commissioned a systematic evidence review to update its 2012 final recommendation on screening for obesity in adults, reviewing evidence on interventions for weight loss or weight loss maintenance that can be provided in or referred from a primary care setting.

    Surgical weight loss interventions and nonsurgical weight loss devices (e.g., gastric balloons) were considered outside the scope of the primary care setting.

    Specifically, the task force reviewed evidence on four types of interventions: behavior-based weight loss (80 trials), behavior-based weight loss maintenance (nine trials), pharmacotherapy-based weight loss (32 trials) and pharmacotherapy-based weight loss maintenance (three trials).

    Thirty trials examined the harms of behavior-based weight loss and weight maintenance interventions, and 33 trials and two observational studies assessed the harms of pharmacotherapy-based weight loss and weight maintenance interventions.

    Overall, the task force found "adequate evidence that intensive, multicomponent behavioral interventions in adults with obesity can lead to clinically significant improvements in weight status and reduce the incidence of type 2 diabetes among adults with obesity and elevated plasma glucose levels; these interventions are of moderate benefit." In addition, adequate evidence showed that behavior-based weight loss maintenance interventions are of moderate benefit.

    The USPSTF also found adequate evidence that the harms of intensive, multicomponent behavioral interventions in adults with obesity are small to none, leading task force members to conclude with moderate certainty that offering or referring adults with obesity to intensive behavioral interventions or behavior-based weight loss maintenance interventions has a moderate net benefit.

    Response to Public Comment

    A draft version of the final recommendation statement was available for public comment on the USPSTF's website from Feb. 20 to March 19.

    In response to some commenters, the task force expanded the description of behavioral counseling interventions in the Clinical Considerations section.

    Additionally, per commenters' requests, in the Discussion section, the USPSTF clarified why patients who are overweight but not obese weren't included in the final recommendation statement, expanded the description of harms of behavioral counseling interventions and pharmacotherapy, and added information on the limitations of pharmacotherapy trials.

    Up Next

    The AAFP's Commission on Health of the Public and Science plans to review the USPSTF's final recommendation statement and evidence summary and determine the Academy's stance on the recommendation.

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