For preventing health problems in obese patients, intensive behavioral interventions focused on improving things like eating and exercise habits may be the best prescription, U.S. doctors advise.
Obese adults should receive counseling and other programs to help them stick to a healthy diet, maintain or increase physical activity, and understand and address obstacles to weight loss, according to recommendations issued today by the U.S. Preventive Services Task Force (USPSTF).
This advice isn't new. The Task Force made similar recommendations in 2012. But recent research confirms that behavioral approaches really can help people achieve meaningful weight loss and better health, said Task Force member Dr. Chyke Doubeni of the University of Pennsylvania Perelman School of Medicine in Philadelphia.
"The additional evidence shows that obesity continues to impact many Americans and that interventions to promote healthy diet and exercise work," Doubeni said by email.
"This recommendation re-emphasizes that clinicians can really help adults with obesity by offering or referring them to intensive, multicomponent behavioral interventions," Doubeni added. "These interventions — which can include things like group counseling, one-on-one counseling in-person, and online resources — have been proven to help people lose weight and be healthier, so we continue to recommend that clinicians offer or refer their patients to them."
More than 35 percent of men and 40 percent of women are obese in the U.S., the Task Force notes in its recommendations published in JAMA.
Obesity is linked to many chronic health problems including diabetes, heart disease, joint damage, mobility limitations, and certain cancers. People with obesity also have a greater risk of premature death than individuals with a healthy weight.
Weight loss interventions tested in recent studies varied widely in how they were provided and in the frequency and duration of treatment sessions, said Dr. Erin LeBlanc of the Kaiser Permanente Center for Health Research Northwest in Portland. Some interventions involved group counseling while others used individual sessions, for example, and certain programs were led by nutritionists while others relied on primary care providers.
"However, specific weight loss messages and behavior change techniques were consistent across the trials," LeBlanc, author of an evidence review accompanying the recommendations, said by email.
"Most of the interventions involved group, individual, and technology-based education and counseling that was designed to help participants achieve a five percent or greater weight loss through a combination of dietary changes (including specific caloric goals) and a gradual increase in physical activity (generally promoting at least 150 minutes of moderate-intensity activity per week)," LeBlanc said.
While these efforts can translate into meaningful weight loss for some people, it's not a one-size-fits-all fix, said Dr. Susan Yanovski, author of an accompanying editorial and co-director of the Office of Obesity Research with the National Institutes of Health in Bethesda, Maryland.
"Some individuals with obesity don't respond to even the best behavioral treatment with enough weight loss to improve health," Yanovski said by email.
"Obesity medications added to behavioral treatment can be helpful for some patients," Yanovski added. "In addition, patients with severe obesity may benefit from bariatric surgery, which has been shown to improve a number of obesity-related medical conditions."
There's less evidence that weight-loss drugs work, however, and they can have dangerous side effects, the Task Force notes in its recommendation statement.
"Lifestyle intervention through diet, exercise, and behavioral modifications are the first-line cornerstones of obesity management approaches, said Debra Haire-Joshu of the Brown School and the School of Medicine at Washington University in St. Louis.
"Weight loss medications and bariatric surgery are additional strategies which can be combined with behavioral intervention to reduce food intake and increase physical activity," Haire-Joshu, author of an accompanying editorial, said by email. "Primarily medication and surgery offer options for patients who have been unable to successfully lose weight or maintain a goal weight and/or are exhibiting health problems related to their weight."
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