November 15, 2013
News Review From Harvard Medical School -- Guidelines Push Doctors to Assist Weight Loss
New guidelines aim to promote a more active role for doctors in treating obesity. The Obesity Society, American Heart Association and American College of Cardiology developed the guidelines. Journals of these groups published the guidelines this week. The guidelines are based on the latest research about which patients can benefit from weight loss and what works best to accomplish that. The guidelines summarize what research has shown about how weight loss can reduce the risks of heart disease, diabetes and early death. Some people who are overweight but otherwise healthy may not need to lose. The guidelines say doctors should assess each patient. They should develop individual plans to help those who can benefit from weight loss. Plans should include diet, exercise and counseling to help people change behavior. No specific diet is recommended. The aim should be a weight loss of 5% to 10% within 6 months. The most successful programs include multiple in-person meetings with a weight-loss coach. Some people may benefit from surgery to help with weight loss. HealthDay News wrote about the guidelines November 12.
By Mary Pickett, M.D.
Harvard Medical School
What Is the Doctor's Reaction?
New guidelines have Americans thinking about heart and artery disease prevention. So far, news programs have mostly focused on advice that would expand the use of cholesterol drugs called statins. That, my fellow Americans, is the easy part.
The new guidelines also advise patients who are overweight or obese. This is the most up-to-date guideline on obesity treatment, so it is worthy advice.
The guidelines come from the American Heart Association, the American College of Cardiology and the Obesity Society.
Your height and weight can be used to calculate your body mass index (BMI). It is worth calculating your BMI once a year, to know whether you are in a normal weight category (BMI less than 25), overweight (25 to 29.9), or obese (30 or higher).
If you are overweight and gaining, you have a higher risk of heart attack, stroke and type 2 diabetes. If you are obese, you also have a higher likelihood of dying early. As your weight increases, so does your risk. Reducing your weight will reduce your risk. This is hard work, but in this way your health is something you can control.
What Changes Can I Make Now?
Overweight: If you are overweight, your degree of risk depends on other factors. Some people who are overweight do not need to lose weight. If you are overweight but have no other risks, you will do fine if you can keep from gaining further.
What risks matter? You should make a weight-loss plan if you are overweight and have any of these other risks:
- High blood pressure
- Cholesterol problems (usually, an LDL cholesterol above 160)
- High blood sugars (pre-diabetes or diabetes)
- Large waist size. For women, a waist that is 35 inches or more is high risk. For men, the number is 40 inches or more. The guideline recommends that you measure your waist yearly.
Overweight with risks, or obesity: If you do have one of the risks listed above, or if you are obese, make these plans for weight loss:
- Cut calories. For most people, reducing your current calorie intake by 500 to 750 calories a day will result in an appropriate pace of weight loss. Diets that cut calories much further are not recommended.
- Almost any popular diet that restricts the way you eat can help you to lose weight. Examples include low-carb diets, a high-fat or "paleo" diet, high-protein "Zone" diet, vegan diet, low-fiber diet or low-calorie Mediterranean diet. Make sure your diet fits reasonably well with your food preferences. The guideline does not specify a "best" diet, except to note it should have an appropriate calorie limit.
- The most effective way to lose weight quickly is with a 6-month structured program of diet, exercise and behavior training. These programs have the best chance for success if they involve face-to-face meetings with trained coaches (or health professionals). There should be at least 14 meetings. These programs can be hard to find, but they are likely to result in weight loss of 5% to 10% of body weight. A "next best" option may be an electronic system that allows you to report in and receive feedback often about your progress.
- Exercise plans that include 200 to 300 minutes of brisk walking or more rigorous exercise every week are the most successful for helping people lose weight and keep it off.
- After you have lost weight, you need to maintain the loss. Keep up your diet and exercise. Do weekly weight checks. Review your efforts each month with your coach or doctor.
- Medicines have a limited role in weight loss, but may be worth using. Use prescription medicines approved by the Food and Drug Administration for weight loss. Stay away from over-the-counter products, online products or supplements.
- If you are very obese (BMI above 35), particularly if you have other health risks related to obesity, talk with your doctor about the idea of obesity surgery. For you, the benefits of obesity surgery may outweigh the risks.
What Can I Expect Looking to the Future?
If you lose 3% to 5% of your body weight, you can expect to be rewarded with:
- A lower triglyceride level
- Lower blood sugar numbers
- Lower hemoglobin A1C (this is a measure of control in diabetes or pre-diabetes)
- A lower risk of developing diabetes
If you lose between 5% and 10% of your body weight, you can expect:
- Improved LDL and HDL cholesterol numbers
- A need for less medicine to control blood pressure and blood sugar
- More improvements in your triglycerides and blood sugar