A peer-reviewed, evidence-based journal that promotes clinical development and metabolic insights in total bariatric patient care for the healthcare professional
Issue link: http://bariatrictimes.epubxp.com/i/763236
C4 Bariatric Times • December 2016 • Supplement C INTrODuCTION The management of patients with overweight and obesity has become both increasingly important to public health and a challenge to current healthcare practice paradigms. Primary care physicians on the frontlines of the obesity epidemic have many new resources at their disposal, including evidence-based guidelines to help formulate practice strategies, innovative new drug and device therapies to combat obesity, and reimbursement options. The purpose of this activity is to describe the key guidelines, treatment options, interdisciplinary care paradigms, and coverage for primary care physicians treating patients with overweight and obesity. OBeSITy GuIDelINeS: APPrOACHeS TO evAluATING PATIeNTS AFFeCTeD By OverweIGHT AND OBeSITy While there are many obesity guidelines currently available for clinicians, the four of key interest to practicing clinicians are as follows: 1) American Heart Association (AHA), the American College of Cardiology (ACC), and The Obesity Society (TOS) or the AHA/ACC/TOS Guidelines, 2) Endocrine Society Clinical Practice Guideline, 3) American Association of Clinical Endocrinologists (AACE) Guidelines, and 4) Obesity Medicine Association (OMA) Obesity Algorithm. These guidelines are summarized in Table 1. 1–6 American Heart Association (AHA), the American College of Cardiology (ACC), and The Obesity Society (TOS) or the AHA/ACC/TOS Guidelines. These guidelines are published and disseminated by the AHA, ACC, and TOS, and were developed together with the National Heart, Lung, and Blood Institute (NHLBI). A 15-member expert panel led the review which adhered strictly to standards for writing guidelines set forth by the Institute of Medicine. 7 Using five (and only five) critical questions, the expert authors approached the subject by reviewing the evidence, crafting statements derived from that evidence, and distilling these findings into five bottom-line key recommendations. Thus, these guidelines must be regarded as authoritative recommendations by leading experts derived from a stringent methodology. These rigorous constraints limited the guidelines to a small number of questions that could be addressed in this way. Thus, these guidelines do not address a number of important questions and topics, including pharmacotherapy for weight loss and the role of behavioral therapies. While these guidelines provide sound, evidence-based guidance on obesity management, they do not address all aspects of the topic. The five key questions addressed by the AHA/ACC/TOS guidelines are summarized in Table 2 with discussion following. The role of body mass index (BMI) in obesity management has come under scrutiny, in particular, whether it was "good enough" as an early metric. 8,9 There is also the possibility that BMI could result in Approaches to Evaluating Patients Affected by Overweight and Obesity Insights into the Patient Population with Obesity: Assessment and Treatment obesity guidelines Scott Kahan, MD, MPH, FTOS Director, National Center for Weight and Wellness; Medical Director, Strategies to Overcome and Prevent (STOP) Obesity Alliance, George Washington University, Washington, D.C.