Treating Obesity—Moving From Recommendation to Implementation

Today 39.6% of adults in the United States are obese, placing them at high risk for chronic disease-related morbidity and mortality.¹ Behavioral weight management is a proven treatment for obesity, with significant benefits associated with a weight loss of 5% to 7%.² The US Preventive Services Task Force (USPSTF) recommendation for “Behavioral Weight Loss Interventions to Prevent Obesity-Related Morbidity and Mortality in Adults,”³ supported by an evidence report and systematic review,⁴ provides evidence for effective programs to reverse obesity and reduce risk for negative health outcomes. The current USPSTF statement “recommends that clinicians offer or refer adults with a body mass index (BMI) of 30 or higher…to intensive, multicomponent behavioral interventions (B recommendation).”³ These interventions “can lead to clinically significant improvements in weight status and reduce the incidence of type 2 diabetes among adults with obesity and elevated plasma glucose levels.”³ This statement updates the 2012 USPSTF recommendation⁵ by further articulating core program elements and structure needed for effective counseling and impact. However, a recent study by Fitzpatrick and Stevens⁶ reported that obesity management in primary care settings remains suboptimal, with underdiagnoses of obesity and declines in weight management counseling from 33% in the 2008-2009 period to 21% in the 2012-2013 period.⁶ Despite evidence that intensive behavioral interventions work, most patients will not receive care that complies with that evidence. A critical priority then is how to promote the implementation and dissemination of evidence-based obesity interventions.