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USPSTF Recommendation on Behavioral Weight Loss to Prevent Obesity-Related Morbidity
Study Questions:
More than 35% of men and 40% of women in the United States are obese. What is the US Preventive Services Task Force (USPSTF) updated recommendation on screening for obesity in adults?
Methods:
The USPSTF reviewed the evidence on interventions (behavioral and pharmacotherapy) for weight loss or weight loss maintenance that can be provided in or referred from a primary care setting. Most interventions lasted for 1-2 years, and the majority had at least 12 sessions in year 1. About 33% had a core phase (3-12 months) followed by a support or maintenance phase (9-12 months). Interventions provided tools to support weight loss or weight loss maintenance (e.g., pedometers, food scales, or exercise videos). Surgical weight loss interventions and nonsurgical weight loss devices (e.g., gastric balloons) were considered to be outside the scope of the primary care setting.
Results:
The USPSTF 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. They found adequate evidence that behavior-based weight loss maintenance interventions are of moderate benefit as well. The USPSTF found adequate evidence that the harms of intensive, multicomponent behavioral interventions (including weight loss maintenance interventions) in adults with obesity are small to none.
Conclusions:
The USPSTF recommends that clinicians offer or refer adults with a body mass index (BMI) of ≥30 kg/m2 to intensive, multicomponent behavioral interventions.
Perspective:
The recent USPSTF recommendations provide good support for the primary care physicians to partner with nonphysician providers for the prevention of cardiovascular disease and diabetes. They recommend screening of all adults ages 40-70 years who are overweight or obese. Those with risk factors for diabetes (gestational or family history of diabetes, polycystic ovarian syndrome, high-risk racial/ethnic groups) should be considered for screening at a younger age or with normal BMI. All patients with prediabetes and diabetes should be provided intensive behavioral counseling. Patients with hypertension and/or dyslipidemia who are overweight or have BMI ≥30 kg/m2 should be provided or referred to intensive behavioral counseling.
Clinical Topics: Cardiovascular Care Team, Diabetes and Cardiometabolic Disease, Dyslipidemia, Prevention, Exercise, Hypertension
Keywords: Actigraphy, Blood Glucose, Body Mass Index, Body Weight, Counseling, Diabetes Mellitus, Type 2, Dyslipidemias, Exercise, Gastric Balloon, Hypertension, Metabolic Syndrome, Obesity, Overweight, Physicians, Primary Care, Polycystic Ovary Syndrome, Primary Health Care, Primary Prevention, Risk Factors, Weight Loss
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