Guidelines

Bringing New Obesity Guidelines Home

New obesity guidelines — now five years in the making — are coming home after a painstaking, rigorous process of evidence review. Don’t expect and A to Z cookbook for managing the chronic disease of obesity. The incomplete state of obesity science and the clinical art of obesity disease management isn’t by any means ready for that. What you can expect is a very focused set of guidelines, backed by rigorous evidence review that will change the way physicians routinely treat obesity.

Until now, more often than not, physicians have dealt with obesity by ignoring it or dispensing simplistic advice like “eat less and move more.” What the guidelines will do is provide indisputable evidence to resolve five critical questions for managing the chronic disease of obesity:

  1. What is the health benefit for varying degrees of weight loss?
     
  2. What are the health risks and benefits of different levels of BMI and waist circumference for different groups of patients?
     
  3. What are the merits of different dietary approaches to weight management?
     
  4. What are the benefits and characteristics of effective, intensive lifestyle interventions for obesity?
     
  5. What are the benefits, risks, and predictors of success for different bariatric surgeries in different patient groups?

 
What’s missing is any guidance on drugs for obesity treatment. As disappointing as this is, it’s easy to understand why. When this process started in 2008, FDA was busy rejecting new drugs for treating obesity and removing sibutramine from the market. There wasn’t much to talk about and the future for obesity drugs looked pretty bleak because big pharma pretty much stopped their research programs in obesity.

Over the next five years, things eventually turned around and we now have two new drugs on the market. But the guidelines process is simply too slow and methodical to be able to incorporate definitive guidance on aspects of clinical care that are changing this fast.

So, we won’t have an exhaustive guide for the clinical management of obesity. Clinical practices are evolving too fast for that. What we will have is indisputable guidance on well-established approaches backed by abundant evidence for managing obesity — guidance that will no doubt have a pervasive impact on medical practices and health plans.

For patiently guiding this process to completion, Donna Ryan and Michael Jensen deserve our thanks. It’s been a tedious process that kept changing along the way. Just this month, the NIH, American Heart Association, and American College of Cardiology announced a new approach to implementing guidelines that will take effect with the rollout of the new obesity guidelines.

Expect to see these new guidelines hit the public stage at Obesity Week in November.

Click here to access the overview by Ryan and Jensen in Current Opinion in Endocrinology, Diabetes & Obesity and click here to read about the new process for implementing clinical practice guidelines.

Guidelines, Tuscany, photograph © Harold Neal / flickr

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