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Doctors urged to treat obesity like any other ailment; New guidelines say do whatever it takes to get the pounds off

Originally posted November 13, 2013 by Nanci Hellmich on www6.lexisnexis.com

There’s no ideal diet that’s right for everyone, but that shouldn’t stop the nation’s doctors from helping their heavy patients battle weight issues as aggressively as things like blood pressure, according to new obesity treatment guidelines released Tuesday.

The guidelines, from three leading health groups, say that doctors need to help obese patients figure out the best plan, whether it’s a vegetarian diet, low-sodium plan, commercial weight-loss program or a low-carb diet.

Still, the most effective behavior-change weight-loss programs include two to three in-person meetings a month for at least six months, and most people should consume at least 500 fewer calories a day to lose weight, the recommendations say.

The guidelines are designed to help health care providers aggressively tackle the obesity epidemic. “The overall objective is quite a tall order: to get primary care practitioners to own weight management as they own hypertension management,” says obesity researcher Donna Ryan, co-chairwoman of the committee writing these guidelines for the Obesity Society, American Heart Association and American College of Cardiology.

The recommendations are part of a set of heart disease prevention guidelines released Tuesday.

Nearly 155 million U.S. adults are overweight or obese, which is roughly 35 pounds over a healthy weight. Extra pounds put people at a higher risk of heart disease, stroke, many types of cancer, type 2 diabetes and a host of other health problems.

Health care providers should encourage obese and overweight patients who need to drop pounds for health reasons to lose at least 5% to 10% of their weight by following a moderately reduced-calorie diet suited to their food tastes and health status, while being physically active and learning behavioral strategies.

“The gold standard is an intervention delivered by trained interventionists (not just registered dietitians or doctors) for at least 14 sessions in the first six months and then continue therapy for a year,” says Ryan, a professor emeritus at the Pennington Biomedical Research Center in Baton Rouge. If this kind of intensive therapy is not available, then other types of treatment, such as commercial weight-loss programs or telephone and Web-based programs, are good “second choices,” she says.

Medicare began covering behavioral counseling for obese patients last year, and under the Affordable Care Act, most private insurance companies are expected to cover behavioral counseling and other obesity treatments by next year.

“There is no ideal diet for weight loss, and there is no superiority between the many diets we looked at,” Ryan says. “We examined about 17 different weight-loss diets.”

Pat O’Neil, director of the Weight Management Center at Medical University of South Carolina, says, “The diet you follow is the one that’s going to work for you. That’s good information for the public to have.”

The report advises health care providers to calculate body mass index (a number that takes into account height and weight) at annual visits or more frequently, and use it to identify adults who may be at a higher risk of heart disease and stroke. Evidence shows that the greater the BMI, the higher the risk of coronary heart disease, stroke, type 2 diabetes and death from any cause, the report says. “BMI is a quick and easy first step,” Ryan says.

The guidelines are being published simultaneously in Circulation, a journal of the American Heart Association; the Journal of the American College of Cardiology; and Obesity: Journal of the Obesity Society.