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New Recommendations on Obesity

Task force takes docs to task

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Updated December 04, 2003

Updated December 04, 2003
The US Preventative Services Task Force (USPSTF) has released a new set of recommendations on identifying and treating obesity, as described in this week's edition of the Annals of Internal Medicine.

The new recommendations were necessitated by the growing obesity problem among Americans, and the general failure of US doctors to urge their patients to lose weight. The USPSTF notes that the prevalence of obesity in US adults has increased from 13% to 31% in just 40 years, and that only 42% of those obese adults have received advice from their doctors on losing weight. Obesity is a major risk factor for heart disease, as well as for a host of other medical disoders, and losing weight can greatly reduce that risk.

The task force recommends that doctors compute their patients' BMI (body mass index) as a starting point, to assess which patients need counseling.

A BMI over 25 indicates you are overweight; a BMI of 30 or higher indicates you are obese. Since BMI is the patient's weight in kilograms divided by height in meters squared, one can readily see why, until now, doctors haven't done the calculations. (Raise your hand if you know your weight in kg or your height in meters.) However, easy-to-use BMI calculators are now readily available. Click here for an easy on-line BMI calculator, based on height in feet and inches, and weight in pounds.

The task force also reports on the effectiveness of various weight loss methods. It reports that diets and drugs yield, on average, only modest weight loss. Surgical approaches, on the other hand, can produce dramatic weight loss - up to hundreds of pounds. There are several surgical approaches to obesity, including gastric bypass and gastric banding. However, surgery carries risk and is expensive, so is generally reserved for those who are extremly obese (BMIs over 40) and thus whose medical risk from obesity is extremely high.

So, once again, doctors are taken to task for failing to counsel their patients on one of the major risk factors for heart disease. In this space DrRich has, on more than one occasion, castigated his fellow physicians for such infractions. But in this case DrRich is willing to cut them a bit of slack. This is because most obese patients know already they are overweight and that being obese is unhealthy. Telling them about it may make them angry or frustrate them, but will probably not enlighten them. Since doctors generally don't have any magic words or methods to make patients lose weight, it is at least a little bit understandable that many of them choose not to make a big deal about it.

Still, it is potentially in the patient's power to lose large amounts of weight, though it usually takes a complete change in lifestyle, attitude, and perhaps personality (i.e., it's much more than just dieting.) For those few patients who have it in them to accomplish this feat, it might be words from a doctor that finally stimulates them to the effort. It is a doctor's job, in this case, to assume the unlikely, and fully inform their patients as to what's at stake.

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