Task Force: Obese People Should be Prescribed Major Lifestyle Changes
Obesity has become such a widespread issue in the United States that the U.S. Preventive Services Task Force (USPSTF) recommended in a recent report that people with a body mass index (BMI) of 30 or higher should be prescribed intensive behavioral interventions.
According to data from the U.S. Centers for Disease Control and Prevention (CDC), more than 35% of men and 40% of women in the United States are defined as obese. While an overweight population is quick to undergo weight loss surgery and shell out money on unproven weight loss products, deeper issues are often ignored that spark obesity in the first place.
The USPSTF updated its recommendations from 2012 on screening for obesity in adults, saying that behavior-based weight loss maintenance interventions, including diet changes and increased physical activity, are associated with less weight gain. That’s nothing new for most people, yet it’s a weight loss method that many people brush off and ignore.
This, despite the harsh reality that obesity can kill you or leave you disabled. It puts people at an increased risk for coronary heart disease, Type 2 diabetes, a slew of cancers, and yes, death, particularly among adults younger than 65.
In developing the new recommendations, the task force reviewed the evidence from 83 studies published since 2012 on behavioral and pharmacological interventions for weight loss and weight loss maintenance based upon a primary care setting. The experts did not include surgical weight loss interventions and nonsurgical weight loss devices in the assessment because they are outside the scope of primary care.  
The task force wrote:
“The USPSTF concludes with moderate certainty that offering or referring adults with obesity to intensive, multicomponent behavioral interventions [ie, behavior-based weight loss and weight loss maintenance interventions] has a moderate net benefit.”
Weight loss can be an overwhelming, uphill battle, but shedding even a minimal number of pounds can be significant for health. For example, the U.S. Food and Drug Administration (FDA) considers a weight loss of 5% as clinically important. So, if a person weighs 200 pounds, a 5% weight loss equals 10 pounds.
The majority of behavioral weight loss interventions considered by the USPSTF lasted 1-2 years, and most of the patients had 12 or more sessions in the first year.
The task force also recommended:
- Screening for abnormal glucose (blood sugar) levels and Type 2 diabetes
- Statin use in those at increased risk for cardiovascular disease
- Counseling for quitting smoking
- Aspirin use to prevent cardiovascular disease in certain people
- Behavioral counseling interventions that promote healthy eating and physical activity to prevent cardiovascular disease in adults
The task force said that doctors should recommend these lifestyle changes for obese patients but in many cases, it doesn’t happen. 
Chyke Doubeni, a University of Pennsylvania primary care physician and professor of family medicine and community health who is on the task force, said that:
“…the evidence suggests that primary care doctors are not talking to their patients about obesity and not offering them the services that could be helpful in losing weight and maintaining physical fitness.”
The reason? Well, one possible explanation is a lack of time. Unfortunately, many doctors are quick to push patients out of the examining room after only a few minutes. It’s not that doctors don’t care (though some likely don’t), it’s that there are only so many hours in a day and a waiting room full of patients can put a lot of pressure on a doctor.
Ashley Mason, a behavioral psychologist at the University of California, San Francisco’s Biology and Experience of Eating Lab, remarked:
“Those 14-minute visits with your [primary care physician] aren’t enough time for everything.”
And when an obese patient walks out of their doctor’s office without a game plan for losing weight, they take with them the growing likelihood of developing conditions such as Type 2 diabetes and high blood pressure.
But there’s a way for primary care physicians to work around time limits, said Debra Haire-Joshu, who directs the Center for Obesity Prevention and Policy Research at Washington-University in St. Louis.
Instead of trying to take on the burden of obesity by themselves, primary care physicians should refer these patients to others in the health community, such as dieticians, lifestyle coaches, and psychologists.
“We know what works. Now we’ve got to find a way to deliver something better than what we’re doing right now.”
The task force’s report is published in JAMA.
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