According to published data, nearly 155 million adults in the United States are classified as being either overweight (having a BMI of 25 to 29.9 kg/m2) or obese (having a BMI of 30 kg/m2 or higher). “Health-care providers are on the front line of the obesity epidemic,” explains Donna H. Ryan, MD. “Greater efforts are needed to identify patients who need to lose weight for cardiovascular reasons. As clinicians, we’re in a prime position to direct successful weight loss efforts.”
According to Dr. Ryan, behaviors around food and physical activity and getting patients the help they need to change these behaviors are paramount to weight loss. “Losing weight is a complex issue that goes beyond a person’s willpower,” she says. “We need to do more than simply advise obese and overweight patients to lose weight. We need to be actively involved to help patients reach a healthier body weight, and that’s not necessarily a so-called ‘normal’ body weight.”
In 2013, the American Heart Association, American College of Cardiology, and Obesity Society released comprehensive treatment recommendations to help healthcare providers tailor weight loss treatments to adults who are overweight or obese. The guidelines address five specific areas of obesity, including:
1) The identification of who needs to lose weight.
2) How much weight patients should lose.
3) Diets to consider for weight loss.
4) Expected weight loss with lifestyle interventions.
5) Patients who should be considered for bariatric surgery.
According to the guidelines, healthcare providers should calculate BMI at annual visits or more frequently and use BMI and waist circumference (WC) cutpoints to identify adults who may be at a higher risk of cardiovascular disease (CVD) and stroke because of their weight (see Table, available online only at www.physweekly.com/weight). Research shows that higher BMI and WC each correlate with an increased risk of coronary heart disease, stroke, type 2 diabetes, and death from any cause.
Dr. Ryan, who served as co-chair of the guidelines writing committee, says that healthcare providers must individualize weight loss plans. “A moderately reduced-calorie diet, a program of increased physical activity, and use of behavioral strategies to help patients achieve and maintain a healthy body weight are critical components,” she says. Collaboration with trained healthcare professionals—such as registered dietitians, behavioral psychologists, or other trained weight loss counselors—is necessary to improve the likelihood of achieving these goals.
“We need to do more than simply advise obese and overweight patients to lose weight.”
Many diet strategies have been shown to be effective for weight loss, but there is no “magic” diet that works for everyone. “Efforts are needed to tailor diets to each person’s food preferences and health risks,” says Dr. Ryan. “For example, hypertensive patients may benefit most from a low-calorie, lower-saturated fat diet rich in fruits and vegetables, which also includes foods that they find appealing.”
Weight loss counseling should focus on patients who need to lose weight because obesity puts them at higher risk for CVD. “The most effective behavior change programs include at least 14 in-person meetings for 6 months and then continue for at least a year,” says Dr. Ryan (Table). “Internet and phone-based weight loss programs are other options for weight loss, but research shows that they’re not always as effective as face-to-face programs.”
The guidelines recommend that clinicians focus on achieving a sustained weight loss of 5% to 10% of their weight within the first 6 months. Doing so can reduce high blood pressure, improve cholesterol, and lessen the need for medications to control blood pressure and diabetes. “Even as little as 3% sustained weight loss can improve blood glucose and triglycerides,” adds Dr. Ryan. “Greater weight loss further improves other cardiovascular risk factors as well. This means that patients may not need to achieve a BMI of 25 kg/m2 or less to achieve significant health benefits.”
Adults with a BMI of 40 kg/m2 or higher and those with BMIs of 35 kg/m2 or higher who have another CVD risk factor or comorbidity should be advised that bariatric surgery may provide significant health benefits and referred to an experienced bariatric surgeon for counseling and evaluation. The guideline does not recommend weight loss surgery for people with a BMI under 35 kg/m2. It also does not recommend one surgical procedure over another.
“The guidelines offer scientific evidence showing that medically supervised weight loss works and can reduce risk factors for CVD,” Dr. Ryan says. “It’s hoped that the guidelines will be more fully embraced by clinicians and that effective programs
Readings & Resources (click to view)
Jensen MD, Ryan DH, Apovian CM, et al. 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Obesity Society. J Am Coll Cardiol. 2013 Nov 7 [Epub ahead of print]. Available at: http://content.onlinejacc.org/article.aspx?articleid=1770219.
Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of obesity in the United States, 2009-2010. NCHS Data Brief. 2012:1-8.
Flegal KM, Carroll MD, Kit BK, Ogden CL. Prevalence of obesity and trends in the distribution of body mass index among US adults, 1999-2010. JAMA. 2012;307:491-497.
Avenell A, Brown TJ, McGee MA et al. What interventions should we add to weight reducing diets in adults with obesity? A systematic review of randomized controlled trials of adding drug therapy, exercise, behaviour therapy or combinations of these interventions. J Hum Nutr Diet. 2004;17:293-316.
Pi-Sunyer X, Blackburn G, Brancati FL et al. Reduction in weight and cardiovascular disease risk factors in individuals with type 2 diabetes: one-year results of the look AHEAD trial. Diabetes Care. 2007;30:1374-1383.
Wing RR, Lang W, Wadden TA et al. Benefits of modest weight loss in improving cardiovascular risk factors in overweight and obese individuals with type 2 diabetes. Diabetes Care. 2011;34:1481-1486.