With more American adults qualifying as obese than ever before, doctors should be screening all adult patients for unhealthy weight, says a government panel.
The U.S. Preventive Services Task Force (USPSTF) recommended on Monday that all adults be examined for obesity during their checkups. That means doctors should measure patients’ weight and height and calculate their body mass index, or BMI, which indicates whether a person is at a healthy weight (BMI of less than 25), overweight (25 or higher) or obese (30 or higher).
While many physicians measure their patients’ weight at regular checkups, surprisingly few go the extra step and calculate BMI. Only about 40% of doctors measure BMI, and 33% talk to their patients about weight loss, according to a recent survey conducted by the American Academy of Family Physicians.
That may have something to do with the fact that most doctors aren’t trained to address obesity specifically, and find it a difficult subject to broach with patients who might be sensitive about their weight. Physicians themselves may also be influenced by their own size; a study in January showed that heavier doctors were less likely to talk to their patients about losing weight than slimmer physicians.
When faced with obese patients, doctors also have trouble giving them specific weight-loss advice, since the effectiveness of various treatments can vary greatly from one patient to the next. What works for some — certain diets, or an exercise program — may not be realistic for others. Doctors would rather address specific health problems for which there are more clear cut treatment paths and less ambiguity about the outcome.
Some physicians leave the problem to the patient. “Doctors tend to shoo away people who have obesity,” Dr. Scott Kahan, who directs a clinic for weight loss at George Washington University, told the Associated Press. “They say, ‘Don’t come back to me and tell me your back hurts or you have acid reflux or high cholesterol until you will do something about it.”
In its new recommendation, published in the Annals of Internal Medicine, the USPSTF provides doctors with more specific guidance about handling obesity. The first step is for doctors to take height and weight measurements and calculate BMI at every physical. That way, they can monitor changes in weight over time, and keep patients on track.
For patients whose BMI is 30 or higher, the task force advises physicians to refer them to weight-loss programs that use multicomponent behavioral interventions — in other words, those that combine nutritional counseling with exercise and support groups. In reviewing current studies on such programs, the government panel found that on average, they helped participants lose up to 11 lbs. over a year, or 4% of their starting weight. Even such seemingly modest reductions in initial weight can significantly improve health for obese people.
Overall, the task force found that the best weight-loss programs include 12 to 26 sessions of behavioral counseling during the first year; help patients self-monitor their eating and exercise, using food diaries or a pedometer, for instance; focus on setting realistic weight-loss goals; and help patients understand what may be preventing them from meeting those goals.
The panel found also that weight-loss drugs were effective, but didn’t lead to long-lasting weight loss and, therefore, stopped short of recommending them for obese patients.
The first step in helping more patients shed extra pounds is to give them the information they need. Physicians should tell patients what their BMI is — and if the doctor doesn’t mention it, patients should ask — and let them know whether they’re at a normal weight or not. They can then talk with them about diet, exercise and other lifestyle habits, and help patients understand how obesity affects their health. For obese patients who want to lose weight, doctors can steer them in the right direction. “[O]ften the gateway to finding the right program can be through your physician,” Dr. David Grossman, a member of the USPSTF and medical director of preventive care at Group Health Cooperative in Seattle, told USA Today.
The task force hopes the new guidelines will encourage more doctors to involve themselves in discussing weight problems with their patients, especially since those who talk about their weight with their doctors are more likely to do something about it. Any helpful action is needed: the latest figures estimate that 42% of the U.S. adults will be obese by 2030, leading to increases in chronic weight-related conditions like Type 2 diabetes, heart disease, stroke, sleep apnea and cancer.
The USPSTF’s guidelines could also help patients afford the types of programs that can help them drop extra weight. “This is a step in the right direction. It may lead to reimbursements, and patients who suffer from obesity will have access to intensive lifestyle therapy and the benefits it brings,” Dr. Donna Ryan, a professor emeritus at Pennington Biomedical Research Center, told USA Today.