[PHNUTR-L] ACP guidelines to treat obesity cover diet, exercise, drugs and surgery

[Kathrynne Holden, MS, RD]

Colleagues, the following is FYI and does not necessarily reflect my own
opinion. I have no further knowledge of the topic.
------------------------
Public release date: 4-Apr-2005
http://www.eurekalert.org/pub_releases/2005-04/acop-agt033005.php

Contact: Susan Anderson
sanderson at acponline.org
215-351-2653
American College of Physicians

ACP guidelines to treat obesity cover diet, exercise, drugs and surgery

PHILADELPHIA – (April 5, 2005) New guidelines for management of obesity 
from the American College of Physicians recommend diet and exercise for 
everyone and drugs and surgery only for obese patients who are not able 
to achieve weight-loss goals with diet and exercise alone.

The guidelines, "Pharmacologic and Surgical Management of Obesity in 
Primary Care: A Clinical Practice Guideline from the American College of 
Physicians," were published in the April 5, 2005, issue of Annals of 
Internal Medicine.

People with a body mass index (BMI) over 30 might consider drug therapy 
after an appropriate trial of diet and exercise has failed. Surgery is 
for those with a BMI over 40 who also have obesity-related health 
problems such as high blood pressure, diabetes, or sleep apnea, ACP 
guidelines say.

People with a body mass index from 25-29.9 are considered overweight. 
Those with BMI from 30-39.9 are considered obese; people with a BMI over 
40 are considered morbidly (or extremely) obese. BMI is a measure of 
height and weight. ACP's new guidelines apply to patients with BMI's of 
30 and over.

"BMI should be considered another vital sign," says Vincenza Snow, MD, 
director of clinical programs at ACP. "Patients should know their BMIs 
like they know their age, blood pressure and cholesterol numbers, and 
doctors should track their patients' BMIs like they follow blood pressure."

Weight-Loss Drugs

ACP identifies six drugs that according to valid clinical studies aid 
weight loss: sibutramine, orlistat, phentermine, diethylproprion, and 
fluxotine. When patients and clinicians are making decisions about use 
of these drugs, ACP recommends frank discussions about potential side 
effects and lack of long-term efficacy and safety data. (Most 
weight-loss drugs have no studies beyond one year.) Further, the average 
weight loss at one year is small to moderate, ACP says, and there are no 
data on whether weight loss is maintained after drug therapy is 
discontinued.

"Even with weight-loss drugs and even after surgery, patients must 
change lifestyles, eat properly and exercise," says Snow. "There's no 
magic bullet."

Bariatric Surgery

ACP guidelines discuss several types of obesity (bariatric) surgical 
procedures and cautions that none have randomized, controlled trials 
comparing surgery with non-surgical control groups. Furthermore, all 
have possible side effects, ranging from surgical complications to gall 
bladder disease and digestion difficulties. The ACP guidelines estimate 
that the death rate from bariatric surgery, including in-hospital and 
deaths within 30 days of discharge, ranges from 0.3 in a hundred to as 
high as 1.9 per 100 surgeries.

ACP says that existing evidence shows a technical 'learning curve' in 
bariatric surgical techniques and suggests that doctors and patients 
considering obesity surgery seek highly experienced surgeons and 
surgical centers whenever feasible.

"There are differences among the surgeries, so patients need to 
understand the risks of complications from surgery as well as 
complications further down the road, such as gall bladder disease and 
sometimes re-operation," said Snow.

ACP based its guidelines on an evidence report and background papers 
funded by the Agency for Healthcare Research and Quality. The guidelines 
were developed by ACP's Clinical Efficacy Assessment Subcommittee and 
were passed by the ACP Board of Regents in October 2004.
-- 
Kathrynne Holden, MS, RD < fivestar at nutritionucanlivewith.com >
"Ask the Parkinson Dietitian"  http://www.parkinson.org/
"Eat well, stay well with Parkinson's disease"
"Parkinson's disease: Guidelines for Medical Nutrition Therapy"
http://www.nutritionucanlivewith.com/