On June 17, 1998, the first federal clinical guidelines on obesity were released. They were issued by the National Heart, Lung, and Blood Institute (NHLBI) in cooperation with the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Both agencies are divisions of the National Institutes of Health (NIH). The AOA distributed a press release, supporting the guidelines, to the national media and several health organizations.

The NHLBI guidelines are incorporated in a comprehensive report on the health and economic costs of obesity. The report includes:

The objective of the guidelines is to provide clinical practitioners with evidence-based strategies for identifying, evaluating, and treating overweight and obese individuals. The guidelines were developed by an expert panel, which included primary care physicians, epidemiologists, clinical nutritionists, exercise physiologists, and psychologists. The panel reviewed scientific literature, published between 1980-1997, regarding evidence on overweight and obesity. Its analysis is considered the most extensive review of obesity literature to date. Data from randomized controlled trial studies were used to develop the recommendations in the guidelines.

The national media focused attention on the panel’s decision to lower the body mass index (BMI) at which an individual is considered overweight. By lowering the BMI threshold, from 27 to 25, the number of individuals classified as either overweight or obese increased to 97 million, or 55 percent of the adult American population, from 72 million. This translates into a large population (approximately 25 million persons) who were unaware of being at a higher risk of developing diseases associated with obesity such as hypertension, coronary heart disease, Type 2 diabetes, certain cancers, stroke, respiratory problems, lipid disorders, osteoarthritis, gall bladder disease, and sleep apnea.

The current cost attributable to obesity-related diseases such as these is almost $100 billion per year. AOA Executive Director Morgan Downey pointed out that "health plans do not cover services to prevent or treat obesity." Covering these services, Downey continued, "is essential to both improving health and lowering costs."

The advantages of weight loss for the overweight or obese patient are described in the guidelines and include the lowering of elevated blood pressure, elevated total cholesterol, low-density lipoprotein (LDL) cholesterol, triglycerides, and elevated blood glucose levels in persons with type 2 diabetes. Weight loss also has the beneficial effect of raising low levels of high-density lipoprotein (HDL) cholesterol. The initial goal of weight loss therapy is to reduce baseline body weight by approximately 10 percent. The initial six-month period includes weight loss of one to two pounds per week, with a subsequent strategy based on the amount of weight lost.

Weight Loss Strategies

Strategies for weight loss include dietary therapy, physical activity, behavior therapy, combined therapy (diet, physical activity, and behavior), pharmacotherapy, and surgery. Guidelines for each form of therapy are detailed in regard to effectiveness, appropriate patient population, and potential risks.

Downey congratulated the NIH for issuing comprehensive guidelines that "encourage health professionals to learn more about treating persons with obesity," and offer "effective options for the management of overweight and obese patients, including dietary approaches, increased physical activity, behavior therapy, pharmacotherapy, and surgery."

Although media and public attention were drawn to the change in BMI, the NIH points out that assessment of overweight involves three key measures. Along with BMI, individuals must consider waist circumference measurement and risk factors for diseases associated with obesity.

As announced in our previous newsletter, part of AOAšs National Campaign of Obesity Education declared the third week of September as Weight Wellness Week. AOA has developed for the program a Weight Wellness Profile, which allows individuals to assess the three key measures of overweight that figure in the NHLBI’s new guidelines.

NHLBI recommends that future research be directed at finding the most effective methods of treatment and prevention of obesity, the causes and mechanisms of obesity, the influence of fat distribution on health risks, and the development of better assessment methods of energy intake and energy expenditure.

For more information about the NHLBI guidelines visit the NIH website (www.nih.gov), or write to NHLBI Information Center, P.O. Box 30105, Bethesda, MD 20824-0105.