New Guidelines for Assessing Adiposity

The rate of obesity in the United States has reached the epidemic level despite efforts by healthcare providers and patients to improve health-related behaviors and increased efforts to better understand its pathophysiology. “Assessment for excess adiposity is of critical importance,” says Marc-Andre Cornier, MD. To address the issue of assessing adiposity, the American Heart Association (AHA) released a scientific statement to help clinicians. The statement, which was published in the November 1, 2011 issue of Circulation, provides practical guidance for clinical researchers who seek to identify precise measurements for their patients. It also provides recommendations for clinicians who care for patients whose excess weight is a clinical problem. “Before clinicians can recommend treatment options or talk to patients about obesity prevention, they need to know whether a patient is obese,” says Dr. Cornier, who was the lead author of the AHA scientific statement. He adds that there are also new Medicare guidelines for covering obesity treatment that require clinicians to identify whether or not patients are obese. Medicare will cover provider visits for weight loss counseling in patients who screen “positive” for obesity. Reviewing the Methodologies for Assessing Adiposity Healthcare providers and systems are not regularly assessing for excess adiposity with even the simplest, least costly methods, says Dr. Cornier. “Most methods for assessing excess adiposity are not ready for routine clinical use,” he says. “Measuring BMI and waist circumference is currently best to assess adiposity. These are strategies all clinicians should be practicing on a regular basis for patients. Other newer, complex, and more expensive tools are currently available, but physicians need to do a better job utilizing...
Symptom Duration in Lumbar Disc Herniation

Symptom Duration in Lumbar Disc Herniation

A lumbar disc herniation occurs when part of the jellylike material in the center of a disc between two vertebrae in the lower back forces its way through a weakened area of the disc and pushes on a nerve. Patients with lumbar disc herniation usually experience significant back pain and radiating leg pain, numbness, and even weakness. Studies have shown that symptomatic lumbar disc herniation affects 1% to 2% of Americans at some point in their lives, most often in their 30s or 40s. Typically, symptoms of lumbar disc herniation improve within 6 to 8 weeks. Treatments usually involve nonsurgical approaches at first, such as medications, patient education and counseling, and physical therapy. Current guidelines recommend that surgery be considered only for patients who experience pain beyond a reasonable course of non-operative therapy. Others who may be considered for surgery on a more emergent basis include those who have progressive muscle weakness in the legs, or loss of bladder or bowel control from nerve compression. Symptom Duration in Disc Herniation In a study published in the October 19, 2011 Journal of Bone and Joint Surgery, my colleagues and I observed 1,192 patients enrolled in the Spine Patient Outcomes Research Trial, which was conducted at 13 spinal practices in 11 states. Patients were aged 18 or older and suffered from various symptoms of lumbar disc herniation. They were assigned to undergo either operative treatment or non-operative treatment. At different intervals after receiving treatment, we compared outcomes of patients who had symptoms for 6 months or less to those who had symptoms lasting longer than 6 months prior to enrollment in...