Intensive counseling recommended for the obese: U.S. preventive services task force.(Clinical Rounds)

A new recommendation from the U.S. Preventive Services Task Force may help physicians help their patients tackle obesity.

The task force now recommends that physicians screen their adult patients for obesity and offer intensive counseling, or refer obese patients for it, to promote weight loss. intensive counseling includes at least two individual or group counseling sessions on diet and exercise monthly for at least 3 months (Ann. Intern. Med. 138[11]:930-49, 2003).

"Obesity is a chronic disease," said Dr. Morton A. Stenchever, professor and chair emeritus of obstetrics and gynecology at the University of Washington in Seattle. "You can't just treat it with one treatment."

Screening for obesity can be done in one of two ways: by calculating body mass index (BMI) or by assessing centrally located body weight, the task force recommendations say.

Patients with a BMI of 2529.9 are considered overweight; those with a BMI of more than 30 are considered obese.

Centrally located body weight, which can be assessed by measuring waist circumference, can help screen for cardiovascular disease, the task force said. Men with waist circumferences of more than 40 inches and women with waist circumferences of more than 35 inches have an increased risk for cardiovascular disease. This waist circumference-based increase in risk may not hold for people with a BMI of more than 35, the recommendations note.

The task force also concluded that there was insufficient evidence to recommend for or against the use of moderate- to low-intensity counseling--monthly or less frequent--to promote weight loss in obese adults. Further, it could not recommend for or against the use of counseling of any intensity to promote sustained weight loss in overweight adults.