Wednesday, June 17, 1998
10:00 AM Eastern Time
Office: (301) 496-4236
First Federal Obesity Clinical Guidelines Released
- Patients should engage in moderate physical activity, progressing to 30 minutes or more
on most or preferably all days of the week.
- Reducing dietary fat alone--without reducing calories--will not produce weight loss.
Cutting back on dietary fat can help reduce calories and is heart-healthy.
- The initial goal of treatment should be to reduce body weight by about 10 percent from
baseline, an amount that reduces obesity-related risk factors. With success, and if
warranted, further weight loss can be attempted.
- A reasonable time line for a 10 percent reduction in body weight is six months of
treatment, with a weight loss of 1 to 2 pounds per week.
- Weight-maintenance should be a priority after the first 6 months of weight-loss therapy.
- Physicians should have their patients try lifestyle therapy for at least 6 months before
embarking on physician-prescribed drug therapy. Weight loss drugs approved by the FDA
for long-term use may be tried as part of a comprehensive weight loss program that includes
dietary therapy and physical activity in carefully selected patients (BMI >30
without additional risk factors, BMI >27 with two or more risk factors) who
have been unable to lose weight or maintain weight loss with conventional nondrug
therapies. Drug therapy may also be used during the weight maintenance phase of
treatment. However, drug safety and effectiveness beyond one year of total treatment have
not been established.
- Weight loss surgery is an option for carefully selected patients with clinically severe obesity
-- BMI of > 40 or BMI of >35 with coexisting conditions
when less invasive methods have failed and the patient is at high risk for obesity-associated
illness. Lifelong medical surveillance after surgery is a necessity.
- Overweight and obese patients who do not wish to lose weight, or are otherwise not
candidates for weight loss treatment, should be counseled on strategies to avoid further
- Age alone should not preclude weight loss treatment in older adults. A careful evaluation of
potential risks and benefits in the individual patient should guide management.
According to NHANES III, the trend in the prevalence of overweight and obesity is upward. The
guidelines note that from 1960 to 1994, the prevalence of obesity in adults (BMI >30)
increased from nearly 13 percent to 22.5 percent of the U.S. population, with most of the increase occurring
in the 1990s.
"There are several possible reasons for the increase," asserted Karen Donato, coordinator of the
Obesity Education Initiative. "When people read labels, they're more likely to notice what's lowfat and
healthy' but may not be looking at calories. Also, more people are eating out and portion sizes have
increased. Another issue is decreased physical activity. So people are consuming more calories and are
less active. It doesn't take much to tip the energy balance," she said.
The upward trend in adult obesity has also been observed in children, notes the report. Since
treatment issues surrounding overweight children and adolescents are quite different from the treatment of
adults, the panel called for a separate guideline for youth as soon as possible. However, a healthy eating
plan and increased physical activity is an important goal for all family members.
With that in mind, the guidelines contain practical information on healthy eating. Based on this
material, the NHLBI has developed consumer tips on shopping, eating, and dining out.
The guidelines have been reviewed by 115 health experts at major medical and professional
societies. They have been endorsed by the coordinating committees of the National Cholesterol Education
Program and the National High Blood Pressure Education Program, the North American Association for the
Study of Obesity, the NIDDK Task force on the Prevention and Treatment of Obesity, and the American
Heart Association. These groups represent 54 professional societies, government agencies, and consumer
organizations. Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight
and Obesity in Adults will be distributed to primary care physicians in the U.S. as well as to other
interested health care practitioners. It is available on the NHLBI Website. Single free copies of the
consumer tips referred to above are available by writing to the NHLBI Information Center, P.O. Box
30105, Bethesda, MD 20824-0105.