The U.S. Preventive Services Task Force (USPSTF) suggested clinicians continue to offer intensive, multicomponent behavioral interventions for adults with obesity in an updated recommendation statement published Sept. 18 in JAMA.
The Class B recommendation—the same grade the USPSTF assigned these approaches in 2012—means the task force “concludes with moderate certainty that offering or referring adults with obesity to intensive behavioral interventions or behavior-based weight loss maintenance interventions has a moderate net benefit.” The statement’s authors said there is adequate evidence that interventions to promote healthy diet and exercise habits provide a moderate benefit with little to no risk of harm.
Because the USPSTF makes recommendations on preventive care services, it focuses only on interventions that can be made in a primary care setting. It considered surgical weight-loss techniques such as bariatric surgery, plus nonsurgical weight-loss devices, to be outside the score of primary care.
However, corresponding author Susan J. Curry, PhD, of the University of Iowa, and colleagues did consider evidence from studies that combined pharmacological approaches with behavioral interventions. They said these patients typically achieved greater weight loss at 12 to 18 months compared with behavioral approaches alone, but pointed out these trials often had strict inclusion criteria and high attrition rates.
“Therefore, it is unclear how well patients tolerate these medications and whether the findings from these trials are applicable to the general U.S. primary care population,” Curry et al. wrote. “In addition, data were lacking about the maintenance of improvement after discontinuation of pharmacotherapy. As a result, the USPSTF encourages clinicians to promote behavioral interventions as the primary focus of effective interventions for weight loss in adults.”
More than 35 percent of men and 40 percent of women in the U.S. are obese, defined by a body mass index (BMI) of 30 or higher. Obesity is a common risk factor for type 2 diabetes and coronary heart disease, along with other conditions.
In studying multicomponent, behavioral interventions, the task force found intervention participants were about twice as likely to lose at least 5 percent of their initial weight compared with control participants. Five percent weight loss has been identified as a clinically meaningful amount by the FDA, Curry and colleagues said.
Pooled results from 67 studies also showed greater weight loss among behavioral intervention groups compared with control groups—an average difference of 2.39 kilograms, or 5.3 pounds. The differences ranged between studies from about 1.1 pounds to 20.5 pounds.
Most of the interventions had a counseling component, with a more intensive phase (three to 12 months) followed by a maintenance period (nine to 12 months) in which counseling sessions were reduced and patients were encouraged to self-monitor their weight with tools such as pedometers, food scales and exercise videos, the authors noted.
The USPSTF writing group said future research should focus on longer-term weight management and health outcomes, as well as comparative effectiveness trials which may provide more evidence on which specific components of interventions work best.
In a related editorial, two researchers said clinical solutions alone may be insufficient for sustained weight loss, particularly because most Americans spend a few hours or less with their doctors each year.
“The use of trained, community-based, lay clinicians to deliver evidence-based interventions in the communities in which people live and work enables treatment to fit the local context and holds more relevance for participants, bypassing barriers inherent to accessing the health care delivery system,” wrote Debra Haire-Joshu, PhD, and Felicia Hill-Briggs, PhD, in JAMA Internal Medicine. “Community systems designed to reinforce primary care guidance for obesity treatment, and also promote healthy choices within the local environment, can play a key role in facilitating weight loss and promoting maintenance of lifestyle changes to prevent weight regain, a common occurrence after treatment.”
Daniel joined TriMed’s Chicago editorial team in 2017 as a Cardiovascular Business writer. He previously worked as a writer for daily newspapers in North Dakota and Indiana.