New Guidelines Focus on Doctor's Role in Fighting Obesity

Dorian Martin Health Guide
  • Doctors, nutritionists and surgeons need to take note of the new guidelines that have just been announced by The American College of Cardiology and the American Heart Association in an attempt prevent cardiovascular disease. One of the key components guideline is taking a more proactive approach in working with patients who are obese or overweight so they can lose weight.

    The revised guidelines determined that losing weight actually is beneficial for people who have as few as one risk factor for cardiovascular disease. “The key message here is that we know weight loss isn’t just about will power,” Dr. Donna Ryan, co-chair of the committee that wrote the guideline and professor emeritus at Louisiana State University’s Pennington Biomedical Research Center, was quoted as saying in an American Heart Association blog. “It’s about behaviors around food and physical activity, and getting the help you need to change those behaviors.”

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    One of the steps asks medical professionals to treat obesity as a disease and to have a trained health care professional serve as a guide in helping people lose weight. Therefore, the guidelines offer the first-ever roadmap that is designed to help these patients lose weight and then keep the pounds off. The guidelines call for calculating once annually every American’s body mass index, which is based on height and weight and is an indicator of obesity. People who have a body mass index of 30 or higher are considered obese and, according to the guidelines, need to receive treatment.

    The recommendations also include:

    • Matching treatment benefits with risk profiles. The guidelines call for counseling adults who are overweight or obese and have cardiovascular risk factor that making changes in their lifestyle that produce modest and sustained weight loss of 3-5 percent will produce clinically meaningful health benefits. Greater weight loss will lead to greater benefits, such as lowering blood pressure, improving cholesterol levels and reduce the need for medications.
    • Prescribing dietary strategies for weight loss. Another recommendation involves prescribing a diet that will reduce calorie intake for obese or overweight individuals who would benefit from weight loss. The diet should be 1,200-1,500 calories a day for women and 1,500-1,800 calories a day for men. Additionally, health care providers can prescribe should be between a 500-750 calorie a day energy deficit between the amount eaten and the activity done each day in order for the person to lose weight. Health care providers also can prescribe an evidence based diet that restricts certain foods in order to cause this energy deficit. Additionally, when prescribing a calorie-restricted diet, the guidelines encourage the physician to refer the person to a nutritional professional for counseling.
    • Prescribing lifestyle interventions and counseling. These recommendations include encouraging overweight and obese individuals to participate in a comprehensive lifestyle program over at least a six-month period that assists with maintaining a lower-calorie diet and increased physical activity. Additionally, people can be prescribed to attend on-site, high-intensity comprehensive weight loss interventions with a trained interventionist. Another option includes an electronically delivered weight loss program with personalized feedback from a trained interventionist.  Another option involves prescribing some commercial-based programs as long as there is peer-reviewed evidence of the safety and efficacy of the program. In some cases, a very low calorie diet (less than 800 calories a day) maybe prescribed as long as it is offered with assistance by trained practitioners in a medical care setting.  Individuals who have lost weight may be encouraged to participate long-term in a comprehensive weight loss maintenance program.  Additionally, face-to-face or telephone-delivered weight loss maintenance programs may be prescribed.
    • Select patients should be referred for bariatric surgical treatment. The guidelines recommend that adults who have a body mass index that is greater or equal to 40 or a body mass index that is greater or equal to 35 with obesity-related comorbid conditions (such as anemia, diabetes, hypertension and lung restriction) who are motivated to lose weight but who haven’t responded to behavior treatment with sufficient weight loss should be advised that bariatric surgery may be appropriate. Furthermore, the choice of a specific bariatric surgical procedure may be necessitated by the patient’s individual factors.

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    American Heart Association. (2013). New heart disease and stroke prevention guidelines released.

    Jensen, M. D., et al. (2013). 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: A report of the American College of Cardiology/American Heart Association task force on practice guidelines and the obesity society. Circulation.

Published On: November 14, 2013