U.S. Guidelines Urge More 'Behavior' Counseling for Obese Adults

If your body mass index (BMI) is over 30, which qualifies as obese, you should also get a referral to an intensive weight-loss and exercise program that includes counseling to achieve “behavior change,” according to the latest recommendation by a U.S. panel of public health experts that advises primary care physicians on best practices.

The proposal from the U.S. Preventive Services Task Force (USPSTF) is similar to one made in 2012, with some key additions, including evidence from 83 new studies published since the last recommendation. The USPSTF says it is even more convinced now that intensive weight-loss programs — that last up to two years — work effectively in establishing new behaviors to lose weight and maintain a healthy BMI.

The panel’s updated recommendation comes as the U.S. obesity rate shows no sign of waning. More than 35 percent of men and 40 percent of women in the United States are obese. Obesity is associated with health problems such as increased risk for coronary heart disease, type 2 diabetes, various types of cancer, gallstones, and disability.

“If someone is found to have obesity, their health care professional may suggest that they join a weight management program,” states the USPSTF in its recommendation. “There are many such programs that can help people change behaviors and lose weight. Evidence shows that intensive programs that include a variety of activities can help people manage their weight and help prevent illnesses and deaths related to obesity.”

Most “behavioral interventions” reviewed by the USPSTF encouraged weight self-monitoring and provided tools to support weight loss or weight loss maintenance (such as pedometers, food scales, or exercise videos). Similar behavior-change techniques and messaging were used across all of the reviewed trials. Most trials had about 12 sessions in the first year.

While dieting and regular exercise for those who are moderately overweight may prove successful, such commitments to lifestyle changes are mostly ineffective for those who are severely obese.

Over the past two decades, there have been significant advances in bariatric surgeries, especially with the use of robotic technology to facilitate minimally invasive procedures. But one aspect that has not changed much is the need for patients to reduce calorie intake and consume healthier, smaller meals, according to Anthony Gonzalez, M.D., director of bariatric surgery at South Miami Hospital.

Pre- and post-surgical counseling is a key part of the bariatic surgery program at South Miami Hospital.

“With the patients I see, we’re talking about people who are 100 pounds or more overweight,” says Dr. Gonzalez. “Those patients are going to have some issues, whether they’re social, psychological, emotional and even economical issues — getting a job and getting promoted can be impacted because of obesity. I see a lot of depression, anxiety and panic attacks in these patients.”

Even with the most advanced technology and skilled surgeons, bariatric procedures cannot be successful without the patient making substantial lifestyle changes when it comes to dieting and nutritional choices, says Dr. Gonzalez.

“Nutrition is very important before and after bariatric surgery and patients need to have nutritional counseling prior to surgery, and this counseling continues after surgery,” he says.

According to the USPSTF’s new recommendation, components of an effective anti-obesity counseling program include

• Use of group sessions,
• Providing 12 sessions or more in the first year,
• Helping patients make healthy eating choices,
• Encourage increased physical activity, and
• Helping patients monitor their own weight.