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Clinically Speaking: New Guidelines Give Physicians Roadmap for Obesity Treatment

The November Dr. Colquitt2013 release of new guidelines for the management of overweight and obese patients by the American College of Cardiology, the American Heart Associates, and the Obesity Society is a significant step forward in fighting America’s obesity epidemic. The recommendations not only give primary care physicians, many who may not be trained in obesity diagnosis and treatment, a “roadmap” for helping their patients, but the joint effort also marks the first time a nonsurgical society has included bariatric surgery consultation in the disease management model for obesity.

The guidelines urge primary health providers to measure patients’ body mass index (BMI) at least annually and identify those who may be at high risk of heart attack, stroke, or other diseases because of their excess weight. Physicians are encouraged to develop individual weight loss plans for patients who are overweight (with a BMI of 25 or more) or obese (BMI of 30 or higher).

Individual weight loss plans may include lifestyle and behavioral programs that feature a reduced calorie diet, exercise, and counseling.

For morbidly obese patients (BMI over 40 or BMI of 35 with comorbidity), the offer to refer the individual to an experienced bariatric surgeon for consultation and evaluation is suggested as an adjunct to the comprehensive lifestyle intervention.

This recommendation may help dispel misconceptions some physicians have long held about the merit and safety of bariatric surgery. The new guidelines note that bariatric surgery “leads to improvements in both weight-related outcomes and many obesity-related comorbid conditions. The benefit-to-risk ratio may be favorable in appropriately selected patients at high risk for obesity-related morbidity and mortality.” While the new guidelines are an important step in giving primary care physicians a tool to help patients win the war on obesity, there is still much room for improvement. Attitudes towards obesity are still slow to change. More education is needed to help the public, and even physicians, recognize that obesity is a chronic condition that requires lifetime treatment.

It may ultimately be up to patients to arm themselves with information, such as these new guidelines, and demand that their healthcare provider better partner with them in managing their weight and their long-term health.

Mark A. Colquitt, MD, FACS, FASMBS, is Director of Metabolic and Bariatric Surgery at Blount Memorial Hospital in Maryville, Tennessee, and is a bariatric surgeon with Foothills Weight Loss Specialists, a division of Premier Surgical Associates. Colquitt is board certified by the American Board of Surgery. He is a fellow of the American College of Surgeons and of the American Society of Metabolic and Bariatric Surgery and is a member of the Society of American Gastrointestinal and Endoscopic Surgeons. For more information, visit www.foothillsweightloss.com.

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