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Preventative Medicine

                                                                                                 PM’s

    When most of us hear PM, we think evening, afternoon, work is almost over or fun some just starting, or bedtime.  When my husband (a maintenance man)  hears PM, he think Preventative Maintenance – keep things oiled, lubed, and running well, fix problems BEFORE they occur.  In the heath care system we now have PM’s too – Preventative Medicine.  The medical field has evolved over the last few (hundred) years and we have been able to go from figuring out how to treat disease to now hoping to prevent it.  So you ask, what does this have to do with me?  Recently the US Preventive Services Task Force has released a statement on Screening for and Management of Obesity in Adults.  This statement supports much of what the Bariatric community has been saying for years, it is time to starting addressing Obesity sooner rather than later.

The recommendations set forth by this statement state that at a BMI of 30 you are considered Obese and your physician should enter into a discussion with you regarding your weight and treatment options. Although this statement is very broad and basic, it is important that it is heard.  This statement addresses obesity as being a disease that deserves to be a top priority and not a secondhand thought with regards to a person’ health.   Most people are aware of the negative effects obesity can have on a person’s health, including increased blood pressure, heart disease, high cholesterol, arthritis, and even an increased risk of certain cancers.  By starting the conversation with patient’s prior to these co-morbid conditions we may be able to decrease the occurrence.  Also, early intervention may be able to stop a patient from becoming morbidly obese (BMI greater than 40, or 35 with co-morbid conditions.)  This small step can lead to a healthy lifestyle change for many Americans, you can read the full statement at:  http://www.uspreventiveservicestaskforce.org/uspstf11/obeseadult/obesers.htm.  You may also view a discussion regarding this by Dr Boyce and another physician Dr Sayre at http://youtu.be/cgz24zWZ-P0.  I have also attached an overview of the recommendations.  I hope each of you has a great summer, and remember the PM’s to stay healthy and fit.

Screening for and Management of Obesity in Adults Clinical Summary of U.S. Preventive Services Task Force Recommendation.

Population: Adults aged 18 years or older

Recommendation:  

Screen for obesity. Patients with a body mass index (BMI) of 30 kg/m2 or higher should be offered or referred to intensive, multicomponent behavioral interventions. Grade: B.

Screening Tests: 

Body mass index is calculated from the measured weight and height of an individual. Recent evidence suggests that waist circumference may be an acceptable alternative to BMI measurement in some patient subpopulations.

Time of Screening:  

No evidence was found about appropriate intervals for screening.

Interventions:

1. Intensive, multicomponent behavioral interventions for obese adults include the following components:

2. Behavioral management activities, such as setting weight-loss goals.

3. Improving diet or nutrition and increasing physical activity.

4. Addressing barriers to change.

5. Self-monitoring.

6. Strategizing how to maintain lifestyle changes.

Balance of Harms and Benefits:

Adequate evidence indicates that intensive, multicomponent behavioral interventions for obese adults can lead to weight loss, as well as improved glucose tolerance and other physiologic risk factors for cardiovascular disease.

Inadequate evidence was found about the effectiveness of these interventions on long-term health outcomes (for example, mortality, cardiovascular disease, and hospitalizations).

Adequate evidence indicates that the harms of screening and behavioral interventions for obesity are small. Possible harms of behavioral weight-loss interventions include decreased bone mineral density and increased fracture risk, serious injuries resulting from increased physical activity, and increased risk for eating disorders.

Other Relevant USPSTF Recommendations:

Recommendations on screening for obesity in children and adolescents can be found at http://www.uspreventiveservicestaskforce.org.

For a summary of the evidence systematically reviewed in making these recommendations, the full recommendation statement, and supporting documents, please go to http://www.uspreventiveservicestaskforce.org.

Disclaimer: Recommendations made by the USPSTF are independent of the U.S. government. They should not be construed as an official position of the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services.

 

Sarah Grimes, RN, CBN
Bariatric Coordinator

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