The USPSTF on Obesity
The U.S. Preventive Services Task Force recommendations hold a great deal of weight in primary care. Experts, with minimal bias or industry funding, have come together to rigorously review the existing evidence for and against preventive screening and treatment measures. So what does this highly respected organization have to say about obesity?
This receives a Grade B recommendation, meaning that the USPSTF recommends the service and “there is high certainty that the net benefit is moderate or there is moderate certainty that the net benefit is moderate to substantial.” Furthermore, they go on to state, “Adequate evidence indicates that intensive, multi-component behavioral interventions for obese adults can lead to weight loss, as well as improved glucose tolerance and other physiologic risk factors for cardiovascular disease.” (1)
Are we really putting this into practice? Is your medical assistant writing down the BMI of every patient you see… if not are you screening for obesity appropriately? And once you detect it, are you prepared to offer “intensive, multi-component behavioral interventions”?
And yet, in many busy primary care settings, intensive interventions are not happening for all patients (or even the majority of patients) who struggle with obesity. Nevertheless, according to the USPSTF, we need to at least be able to offer or refer patients for these. This does not mean talking briefly about diet and exercise when you see your patient every 6 months. One could argue that “intensive management” means offering at least bimonthly counseling or group meetings. These “high intensity” interventions tend to lead to much greater weight loss than “low intensity” interventions.
In a recently published review by Carvajal et al, the authors found that programs that provided greater than monthly sessions in the first year led to a 4-7kg weightloss, whereas those with less than 12 sessions in a year resulted in only 1.5-4kg of weightloss. (2)
There are a plethora of weight loss programs and groups out there, including Highland’s very own free weight loss class. Check out the patient hand outs section of the website for a sampling of other intensive weight loss interventions to refer patients to.
(1) U.S. Preventive Services Task Force. Screening for and Management of Obesity in Adults: Clinical Summary of U.S. Preventive Services Task Force Recommendation. AHRQ Publication No. 11-05159-EF-3. June 2012. http://www.uspreventiveservicestaskforce.org/uspstf11/obeseadult/obesesum.htm