番茄社区

People with obesity should be referred to an intensive, behavioral multicomponent intervention, according to the U.S. Preventative Service Task Force (USPSTF).

In the posted to their website, the USPSTF found "adequate evidence" to conclude with "moderate certainty" (Level B) that referring adults with obesity to this type of therapy can facilitate clinically significant amounts of weight loss.

The updated draft statement, which reaffirms a , also called for behavioral-based multicomponent interventions for comorbid type 2 diabetes or elevated blood glucose levels, as well as hypertension and/or dyslipidemia in adults with obesity.

In order to help keep the weight off, the authors also found "adequate evidence" of weight loss maintenance with behavior-based intensive interventions. But the USPSTF statement offered only limited support for drug therapies, relegating them to second-line status and noting a lack of evidence that drug-induced weight loss can be maintained once treatment stops.

"This conclusion is welcome news to millions with the disease of obesity and healthcare professionals who endeavor to improve health and quality of life for their patients," W. Timothy Garvey, MD, chair of the American Association of Clinical Endocrinologists' Obesity Scientific Committee, told 番茄社区. "This does underscore what other professional groups have recommended in the form of evidence-based clinical practice guidelines, as well as the benefits that clinicians have come to observe in their practices regarding structured multi-disciplinary lifestyle interventions."

"An important phrase in the USPSTF recommendation is 'offering or referring.' In our current healthcare system, it can be a challenge to develop and offer intensive multicomponent behavioral interventions, and in this instance the patient should be referred to a healthcare resource that does have this capability," he said.

This type of intervention was also recommended for overweight adults (BMI 25 to <30) with hypertension and/or dyslipidemia or with abnormal blood glucose levels or diabetes. Overweight adults without these comorbidities were recommended to be referred to this intervention on a case-by-case, individualized basis.

Those of a normal weight (BMI 18.5 to <25) with abnormal blood glucose levels or diabetes were also recommended to be referred to behavioral intervention.

Due to the "noninvasive nature" of this type of intervention, the statement determined any possible harms were "small to none."

The authors reviewed 124 studies, which included 89 trials, focused upon behavior-based weight loss and maintenance interventions. A few of the studies also included pharmacotherapies.

A meta-analysis of behavioral therapy trials showed a nearly doubled probability of a 5% total body weight loss over a 12-18 month period compared to controls (RR 1.94, 95% CI 1.70-2.22). This type of intervention was also associated with less weight regain during 12-18 months of maintenance (pooled mean difference -3.5 lb).

"Of the programs we examined, those that combined multiple activities and included group sessions had the strongest effect," said Task Force member Chyke A. Doubeni, MD, MPH, in a statement, also adding "evidence shows that people regain less weight with these types of programs."

The trials assessing pharmacotherapy intervention saw significantly greater weight loss with medications including liraglutide, lorcaserin, naltrexone and bupropion, orlistat, and phentermine-topiramate, compared to placebo (−7.3 to−23.4 lb versus −2.0 to −16.8 lb), with less weight regain over time.

Despite these positive findings, the authors noted that many of these trials had strict requirements for medication compliance and achievement of weight loss goals within these trials and therefore are not generalizable to the primary care population as a whole. The Task Force also addressed a lack of evidence showing weight loss maintenance after pharmacotherapy cessation. "As a result, the USPSTF encourages clinicians to promote behavioral interventions as the primary effective intervention for weight loss in adults," they wrote.

Garvey took issue with the USPSTF's focus on weight loss rather than the consequences of excess weight, and said medications should be part of the treatment strategy for certain patients.

"In light of the , the USPSTF seems to have a different perspective regarding the goals of therapy in patients with obesity and does not consider the role of medications in relationship to obesity pathophysiology," he told 番茄社区. "AACE emphasizes a complication-centric approach to obesity treatment while USPSTF focuses on a weight-centric approach. AACE considers that the goal of therapy in obesity (as with any other chronic disease) is to improve patient health and quality of life through the prevention and treatment of weight-related complications, which are in fact responsible for morbidity and mortality associated with the disease."

Although some patients might be able to achieve adequate weight loss through behavioral interventions alone, Garvey said, some patients will require additional pharmacotherapy to achieve sufficient weight loss, particularly among those with conditions needing greater weight loss such as obstructive sleep apnea, non-alcoholic steatohepatitis, HbA1c control, blood pressure, and dyslipidemia in type 2 diabetes.

The period on this draft recommendation statement is open through March 19th.

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