Dec. 1, 2003 -- It looks like screenings could be on the way fo
Dec. 1, 2003 -- It looks like screenings could be on the way for one of America's biggest health problems: obesity. The U.S. Preventive Services Task Force now recommends that doctors screen all adults for obesity and offer obese patients intensive counseling and behavioral interventions to lose weight.
Obesity is a risk factor for an array of potentially fatal health problems including:
- Heart disease
- Diabetes
- High blood pressure
An estimated 97 million adults in the U.S. are overweight or obese.
The task force has set out specific guidelines (updated from 1996) on how to determine obesity. It recommends using BMI (body mass index, a calculation of weight and height). Under the guidelines, a person with a BMI between 25 and 29.9 is considered overweight and a person with a BMI greater than 30 is obese. Higher BMIs are associated with increasing numbers of health problems.
Centrally located body weight (the "apple" body shape) is a risk factor for heart disease independent of obesity. Therefore, the task force also suggests using waist measurement as an indicator of stomach fat and cardiovascular risk. Guidelines show that men having a waist measurement greater than 40 inches and women having a waist measurement greater than 35 inches have an increased risk of developing heart disease.
The recommendations are published in the Dec. 2 issue of Annals of Internal Medicine.
The USPSTF found that doctors often don't address weight problems with their patients. It recommended screening for obesity after reviewing published studies on weight-loss interventions done in primary care doctors' offices. The studies showed that counseling, which educates patients to change their diet and exercise habits, combined with behavioral strategies are the most effective interventions. However, the USPSTF notes that this combination therapy works best when it is done regularly (more than once a month for at least three months).
The USPSTF suggests doctors discuss with their obese patients the benefits of intense counseling and behavioral therapy to promote weight loss. According to the task force, persons that are overweight should be told that health risks in this weight range begin to increase. They also say that evidence for effective treatment of overweight individuals is lacking.
While there are mixed opinions regarding routine screening for obesity using BMI, several groups that support periodic screening include The American Academy of Family Physicians, The American College of Preventive Medicine, and the American Academy of Family Physicians.
