USPSTF Recommendation for Management of Obesity in Adults

The U.S. Preventive Services Task Force (USPSTF) issues recommendations on the effectiveness of specific clinical preventive services for patients without related signs or symptoms. These recommendations, which do not consider costs associated with them, are based on the evidence of both the benefits and harms of the service and a determination of the balance between the two.

The USPSTF recently updated its 2003 recommendation statement on screening for obesity and overweight in adults. The update was reported online in Annals of Internal Medicine [2012;157(5):1-6]..

In the United States, the prevalence of obesity is >30% in adult men and women. Obesity is associated with numerous comorbidities including an increased risk for coronary heart disease, type 2 diabetes mellitus, some types of cancer, gallstones, and disability. These chronic conditions are responsible for higher use of healthcare services and costs among patients who are obese.

Obesity is also associated with an increased risk for death, particularly in adults <65 years of age. Leading causes of death in adults with obesity include ischemic heart disease, diabetes, respiratory diseases, and cancer. Weight loss in obese adults is associated with a lower incidence of health issues and death.

The task force found adequate evidence that intensive, multicomponent behavioral interventions for adults with obesity can lead to an average weight loss of 4 to 7 kg (8.8-15.4 lb), and can also improve glucose tolerance and other physiologic risk factors for cardiovascular disease. However, there was inadequate direct evidence about the effectiveness of the interventions on long-term health outcomes such as death, cardiovascular disease, and hospitalizations.

There is adequate evidence that the harms associated with screening and providing behavioral interventions aimed at the management of obesity are no greater than small.

The USPSTF concludes with “moderate certainty that screening for obesity in adults has a moderate net benefit. There is also a benefit to offering or referring obese adults to intensive behavioral interventions to improve weight status and other risk factors for important health outcomes.”

The report continued with a review of trials of various behavioral interventions for obese adults. The trials were generally of high quality; 24% were rated as good quality. Participants had a mean body mass index (BMI) ranging from 25 to 39 kg/m²; average baseline BMI across all trials was 31.9 kg/m².

According to the analysis, most of the trials showed that behavioral interventions had a statistically significant effect on weight loss at 12 to 18 months. Patients in control groups lost minimal or no weight, compared with patients in intervention groups who lost 1.5 to 5 kg (3.3-11.0 lb), or 4% of baseline weight. Patients who participated in intervention programs with a greater number of sessions showed more weight loss; those who participated in 12 to 26 intervention sessions in the first year lost 4 to 7 kg (8.8-15.4 lb), or 6% of baseline weight, compared with patients who participated in intervention programs with <12 session per year who lost 1.5 to 4 kg (3.3-8.8 lb), or 2.8% of baseline weight.

Interventions that combined pharmacologic agents with behavioral interventions also resulted in both weight loss and improvement in physiologic outcomes. However, due to concerns about potential harms and a lack of long-term data, the USPSTF does not recommend use of medications in combination with behavioral strategies for the management of obesity in adults.

The revised recommendation from the USPSTF is that clinicians should screen for obesity. Patients with a BMI of ³30 kg/m² should be referred to intensive, multicomponent behavioral interventions.