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

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Colleagues, the following is FYI and does not necessarily reflect my own

opinion. I have no further knowledge of the topic.

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Public release date: 4-Apr-2005

http://www.eurekalert.org/pub_releases/2005-04/acop-agt033005.php

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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 ls 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.

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