Has your primary care physician commented on your weight?  If he or she is like many colleagues in medicine, the answer is no. (And according to at least one recent study, if he or she is overweight they're even less likely to mention weight as an issue). That may change now that the United States Preventive Services Task Force, also known by the acronym I stumble over in this week's PodMed, USPSTF, has issued recommendations regarding screening and management of obesity in adults.  That's an online first publication in Annals of Internal Medicine

First a little background for those who haven't looked at the latest obesity figures (no pun intended) in the United States:  The paper states that since 1976 to 1980, the prevalence of obesity and overweight in the United States have increased by 134% and 48%, respectively. In 2007 to 2008, 40% of men and 28% of women in the United States were overweight and 32% of men and 36% of women were obese. The prevalence of obesity exceeds 30% in most age- and sex-specific groups, with approximately 1 in 20 Americans having a BMI greater than 40.  Yowl!!

We don't have to look very far to discern the many negative consequences of overweight and obesity, including increased risk of diabetes, some types of cancer, which the task force identifies as liver, kidney, breast, prostate, endometrial and colon, but could well include other types, and heart disease.  The USPSTF also mentions that obesity confers an increased risk of osteoarthritis, respiratory and gall bladder disease, as well as disability.

Many great minds have been hard at work trying to figure out how to stem this tide of obesity.  Perhaps enrolling primary care physicians in the act will have an impact.  First, physicians should use BMI to determine whether a patient is overweight or obese, although waist circumference may also be employed, the task force recommends. When a patient is determined to be overweight or obese, patients should be referred to high intensity, comprehensive interventions.  And here's the rub:  turns out that while many physicians may state that weight control is needed, few actually refer their patients for intervention.  

What does such an approach entail? Multifactorial strategies including individual or group counseling sessions, occurring 12-26 sessions in the first year, setting weight loss goals, improving nutrition, increasing physical activity, addressing barriers to change, active use of self-monitoring, and strategizing on how to maintain lifestyle choices are all identified by the USPSTF guidelines.  Whew!  Clearly, referral is required as no primary care physician could keep on top of all of that, but it sounds like it could keep the patient very busy, too. 

What about the role of medications?  Maybe, a lukewarm task force seems to say, citing evidence that both orlistat and metformin can assist behavioral interventions to lose weight but the former sometimes associated with liver disease and the latter used off-label in the application.  No mention of the latest FDA approved weight loss agent, lorcaserin, but that's just been approved, so no surprise there.

In summary, physicians must encourage their patients to lose weight when appropriate, and should emphasize the fact that even modest weight loss will result in improvements in blood sugar and perhaps other conditions such as pain due to osteoarthritis or breathing problems.  Hmmm.  Let's see if this helps.

Other topics this week include, in the same issue of Annals, a look at 'lifelong learning' requirements for physicians, aka: CME, and a lack of efficacy with healthy lifestyle counseling.  In a journal we have never reported on before, a look at osteoporosis screening and management guidelines in men.  That's in the Journal of Clinical Endocrinology and Metabolism.  Until next week, y'all live well.

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