New Federal Updates on the Treatment of Obesity
When I reflect on how most of my patients find me, it has historically been through word of mouth, or if it was from the referral of a physician, it was often because the patient asked for that referral. In my line of work, that can be a troubling statistic. As physicians, it is our job as experts to lead or redirect our patients on the road to better health – regardless of whether or not they initiate the conversation themselves. But, the “weight” conversation can often be a tricky and sensitive one for many primary care providers. More on that in an article I wrote here.
For the first time in nearly two decades, physicians are getting the help they might need in starting the weight-loss dialogue with their patients – in the form of a definitive set of guidelines.
The National Heart, Lung and Blood Institute (NHLBI) has recently issued its road map for the treatment of overweight and obesity – the first time in 15 years since the original set of guidelines was established. Supported by the American College of Cardiology, American Heart Association and the Obesity Society, here’s what those guidelines say:
BMI calculation (determined based on the height and weight of the patient) is considered the first screening step in the weight management discussion and should be calculated at a patient’s annual physical and more frequently, when indicated. With the latest revision to the guidelines however, the BMI “cut-off” for encouraging treatment has moved from 30 to 25 with just one comorbid condition, such as type 2 diabetes or sleep apnea, for example.
Additionally, a circumference of the patient’s waist is to be measured as a means for determining risk factors associated with the development of type 2 diabetes, cardiac disease and overall mortality. That cut-off for recommending treatment is a circumference of greater than 40 inches for a man and greater than 35 inches for a woman.
Primary physicians have also been encouraged to recognize that even slight reductions in excess body weight can yield overall health improvements that matter.
As always, the starting point for recommended weight loss, according to the guidelines, is lifestyle changes such as diet, exercise and behavior modifications. But as many overweight and severely overweight patients well know, telling someone they need to lose weight isn’t enough. So the guidelines now include recommendations on HOW to go about the weight-loss process.
The “gold standard” for this process is now considered to be an on-site, medically-supervised behavior modification program aimed at helping patients learn the tools necessary to make meaningful changes in their diet, exercise and other behaviors – and to give it six months of effort. Because this is such an important place to begin and to offer patients a conveniently located option for their weight management efforts, I have affiliated with Physicians Weight Management Centers of Orange County and serve as its medical director. This program provides a multi-disciplinary and medically-supervised approach to weight loss that has been successfully implemented throughout the United States for more than 20 years.
Finally, the new guidelines acknowledge that for a certain percentage of the severely overweight population, traditional dieting, exercise and behavior modifications don’t always work long-term. For this group of patients, physicians are now advised to refer those with a BMI of 35 or greater (with at least one comorbidity) to an experienced bariatric surgeon for consultation and evaluation. This is an important step for those high-risk patients who need additional support and a more permanent solution to meet their weight-loss needs.
While the most important next phase in the process of making these guidelines “work” is getting them into the hands of primary physicians as a treatment protocol, the fact that they’ve been developed and published is a fantastic sign. It means that the medical community and the government are taking notice of the fact that obesity is a significant contributor to nearly every major disease process and damaging health condition that our bodies can experience. Giving doctors the tools they need in order to reverse the epidemic benefits no one more than the patient and I applaud the NHLBI for the effort.