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 Annals 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."
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 ther
Contact: Susan Anderson
American College of Physicians