March 06, 2018, 03:35 pm Jennifer Frost, M.D. – (Editor's Note: In accordance with the AAFP's policy on endorsement of clinical practice guidelines developed by external organizations, the AAFP's endorsement of the management of overweight and obesity guideline developed by the American College of Cardiology, the American Heart Association and the Obesity Society referred to below has sunsetted, and the guideline has been removed from the AAFP website.)
The U.S. Preventive Services Task Force (USPSTF) recently posted a draft recommendation and draft evidence review regarding behavioral weight loss interventions to prevent obesity-related morbidity and mortality in adults.
As with most USPSTF draft (and final) recommendations, AAFP News posted an article that summarized the task force's recommendations and offered a family physician's perspective on the issue. In this case, the article sparked a lengthy conversation with different viewpoints, so I would like to clarify a few points.
A family physician who was quoted in the AAFP News story said that in most cases, he does not recommend bariatric surgery or weight control medications for his patients. He was speaking for himself, not on behalf of the AAFP. Many primary care clinicians are not comfortable prescribing anti-obesity medications due to concerns about side effects and uncertainty about the evidence base for their use. The USPSTF reviewed the evidence base for pharmacotherapy and noted that in several studies, pharmacotherapy resulted in improved quality of life, greater weight loss and reduced risk of diabetes. Because of the differences between studies, concerns about reporting and unclear applicability to the primary care setting, however, the USPSTF did not make a recommendation for or against the use of pharmacotherapy as a secondary intervention.
The task force considered surgical interventions and nonsurgical weight loss devices to be outside the scope of the primary care setting.
So, what is the AAFP's stance? The AAFP recognizes the increasing prevalence of obesity in the United States and its association with multiple health problems. In addition to the clinical preventive service recommendation mentioned above, the Academy has endorsed the management guideline developed by the American College of Cardiology, the American Heart Association and the Obesity Society.
Here are some of the key recommendations in that document:
Like the USPSTF recommendation, this guideline focuses on behavioral counseling and lifestyle interventions. Although the comprehensive evidence base for pharmacotherapy was not included in the review for this guideline, it suggests that, "If the patient has been unable to lose weight or sustain weight loss with comprehensive lifestyle intervention and they have a BMI equal to or greater than 30, or equal to or greater than 27 with comorbidity, adjunctive therapies may be considered."
There is no question that treating obesity is a challenge. The AAFP will continue to review evidence as it emerges to assist our members in optimally treating their patients.
Jennifer Frost, M.D., is medical director of the AAFP's Health of the Public and Science Division.
Jennifer Frost, M.D.