By Iris Mabry-Hernandez, MD, MPH, AHRQ Physician and Don Wright, MD, Deputy Assistant Secretary for Health
Weight management is a priority for agencies across the federal government, state governments, communities, and the health care sector. Nearly 40 percent of U.S. adults have obesity, which increases their risk for serious diseases — including heart disease, type 2 diabetes, and many cancers. In addition, nearly 1 in 3 U.S. adults are overweight.
The U.S. Department of Health and Human Services (HHS) has supported a number of initiatives to reduce obesity and help Americans achieve a healthy weight. Here, we’re highlighting a recent U.S. Preventive Services Task Force (USPSTF) recommendation on behavioral weight loss interventions for adults, as well as healthy lifestyle resources from ODPHP.
The USPSTF is an independent, volunteer panel of national experts in evidence-based preventive medicine. The Agency for Healthcare Research and Quality (AHRQ) provides ongoing scientific, administrative, and dissemination support to the USPSTF.
USPSTF Recommendation on Behavioral Weight Loss Interventions
The USPSTF recently released an updated clinical preventive service recommendation: Weight Loss to Prevent Obesity-Related Morbidity and Mortality in Adults: Behavioral Interventions. It recommends that “clinicians offer or refer adults with a BMI of 30 or higher to intensive, multicomponent behavioral interventions that help people make healthy eating choices, encourage increased physical activity, and help people monitor their own weight.” This recommendation received a grade of B, meaning the USPSTF recommends the service and suggests that primary care clinicians offer or provide it.
What evidence supports this recommendation?
The USPSTF commissioned a systematic review of the scientific evidence to inform its recommendation. The review included 122 randomized control trials and 2 observational studies. It found that behavior-based weight loss interventions had positive associations with weight loss and with lower risk of developing diabetes.
What are intensive multicomponent behavioral interventions?
“Intensive, multicomponent behavioral interventions combine interventions such as counseling on nutrition and increased physical activity,” says Task Force Chair Alex Krist, MD, MPH. “They can be conducted in group or classroom-style sessions that are led by a moderator, use face-to-face counseling, or use technology-based interventions like smartphone applications and social networks.”
The review identified the following characteristics of effective intensive multicomponent behavioral interventions:
- They were designed to help participants achieve or maintain a weight loss of 5 percent or more through a combination of dietary changes and increased physical activity
- Most lasted for 1 to 2 years, and the majority had 12 or more sessions in the first year
- Most focused on problem solving to identify barriers, self-monitoring of weight, peer support, and relapse prevention
- They provided tools to support weight loss or weight loss maintenance (e.g., pedometers, food scales, or exercise videos)
Healthy People 2020 Objectives to Reduce Obesity
Healthy People provides 10-year national objectives for improving the health of all Americans. The USPSTF recommendation aligns with 2 Healthy People 2020 Nutrition and Weight Status objectives:
- Reduce the proportion of adults who are obese (NWS-9)
- Increase the proportion of physician office visits made by adult patients who are obese that include counseling or education related to weight reduction, nutrition, or physical activity (NWS-6.2)
Healthy People data show that, in 2010, only 28 percent of physician office visits by adults who have obesity included counseling or education related to weight reduction, nutrition, or physical activity. Evidence-based strategies like the updated USPSTF recommendation can help support efforts by providers to achieve these national objectives.
Nutrition and Physical Activity Resources from ODPHP
Health care professionals can help patients learn to make healthy choices — and understand why nutrition and physical activity are important for their health. ODPHP has several resources that health care professionals can use in their interactions with patients to complement intensive multicomponent behavioral interventions:
- Dietary Guidelines Tools & Resources
- Move Your Way Campaign Materials (based on the Physical Activity Guidelines)
- Eat Healthy, Be Active Community Workshops
- Nutrition and Physical Activity Resources from healthfinder