Obesity: The New Chronic Disease?
Updated guidelines encourage PCPs to focus on obesity guideline committee and a professor emeritus at Pennington Biomedical Research Center in Louisiana, admitted the current approach is for PCPs to simply tell patients to lose weight but “they don’t really engage in helping patients achieve weight loss, either through referral or providing counseling or prescribing. They’ve been reluctant … but that’s changing.” What’s not addressed: the reason why some patients make adjustments to lead a healthier lifestyle, but still cannot successfully reach a more optimal weight for their body
By LYNNE JETER
The new obesity guidelines – updated for the first time in 15 years – are geared to primary care providers (PCPs) and offer an algorithm for managing obesity. The protocol for the management of overweight and obese adults is among four updated guidelines commissioned by the National Heart Lung and Blood Institute, and developed by the American Heart Association and the American College of Cardiology to identify at-risk patients The “My Fitness Pal” app allows patients to meet pre-set calorie and exercise and prescribe appropriate goals. interventions. The timing coincides with the American Medical Association’s recent classififrame. cation of obesity as a “disease.” “It’s not as simple as telling a patient, To guide weight management deci‘you need to lose weight,’” said Gus Vicksion-making, an algorithm focuses on the ery, MD, a North Carolina family mediidentification of patients with excess body cine physician. “Sometimes, it takes some weight and those at risk for obesity-related investigating to determine the source. It health problems. might be thyroid issues, or a combination Most information is straightforward: of medical problems. Unfortunately, we • Patients with a BMI of 30 or higher (PCPs) stay so busy … it’s helpful when are considered obese and need treatment. patients come prepared. It’s OK for a pa• Patients with a BMI 25 to 30 are tient to say, ‘I can’t lose weight and I don’t considered overweight and should be know why. It doesn’t always seem to be a treated if they have additional risk factors, matter of willpower.’” such as an elevated waist circumference After Vickery talked to a colleague of 35 inches or more for women, or 40 about the colleague’s doctor-supervised inches or more for men. weight loss clinic focusing on a wellHowever, even though research rounded, low-calorie, low-carbohydrate soundly shows the higher the BMI, the food plan, he ditched his own in-house greater the risk for cardiovascular disease, program and began referring patients diabetes, and cancer, the question about there. One couple, patients of Vickery, the use of BMI as a screening tool has lost a combined 140 pounds in less than drawn debate. a year. Other patients returned to VickHealthcare providers agree that every ery tens of pounds thinner – and much 5 to 10 percent of total body weight lost healthier. is a milestone that reaps health benefits. “My colleague,” said Vickery, “does But with so many diet programs availthe heavy lifting; I monitor the results.” able – the guideline committee reviewed The impetus for the proactive move17 different plans and concurred that as ment of PCPs may be practice for the fulong as there’s a negative energy flow, and ture, when they may be accountable for the intake of calories is reduced daily to patients who haven’t made sincere efforts 1,000 or less, it should work – determining to lose weight to get healthier. Patients the right one, and the amount of weight could eventually be penalized by insurthat’s safe to lose over the course of weeks ers for not taking documented action to and months, has also been the center of achieve a healthier weight. controversy. “I could see (insurers) really increasThe diet, guidelines say, should be a ing people’s premiums if they don’t folcomponent of a comprehensive lifestyle low certain preventive measures in the intervention including physical activity future,” said urologist Stan Sujka, MD, and behavioral changes, delivered by a a partner of Orlando Urology Associates trained counselor. The guidelines suggest in Central Florida. “Unfortunately, we’re that patients meet with the interventionist becoming a society of regulations. A lot of 14 times in the first 6-month period. people don’t seem to want take personal Donna Ryan, MD, co-chair of the (CONTINUED ON PAGE 8) mississippimedicalnews
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