Why this Guidance Initiative?
As a physician, you are probably aware that we are experiencing an epidemic
of obesity in both adults and children in the U.S. Approximately 50 percent of
women and 59 percent of men age 20 and older are overweight or obese, as are
about one quarter of children and adolescents ages 6 -17236. And
these rates, which are already among the highest in the world, are increasing
rather than decreasing. From a public health perspective, this is alarming.
- Obesity is directly linked to many chronic diseases--such as heart
disease, type 2 diabetes, hypertension, stroke, certain cancers and
osteoarthritis--that are disabling and lead to premature illness and death.
As the obesity rate continues to climb, these related comorbid disease rates
will continue to rise as well.
- Obesity extracts a high toll on human suffering. In addition to increased
incidence of associated disease, the psychosocial effects of obesity can
range from lowered self-esteem to clinical depression. Obese individuals may
suffer job discrimination and other forms of social stigmatization.
- The costs associated with obesity are extremely high. The Institute of
Medicine has calculated the health care cost of obesity to be more than $70
billion annually. This figure includes direct costs such as hospital care
and physician services as well as lost productivity caused by death and
disability from weight-related diseases.
- Historically, physician involvement in the treatment of obesity has been
limited. The achievement of a successful outcome has been difficult. Limited
studies reveal that people who complete nonsurgical weight loss programs and
lose approximately ten percent of their body weight gain one-third of it
back within one year and almost all of it back within five years.
Despite this history, scientific evidence strongly suggests that, in many
cases, obese individuals who lose even relatively small amounts of weight find
that an accompanying comorbid disease or condition is improved, its progression
is slowed, or its symptoms disappear. The evidence further suggests that
improvement in these comorbid conditions will persist if such modest weight loss
The American Obesity Association and Shape Up America!, two
nonprofit organizations whose missions include combating obesity through
education and treatment, have undertaken this joint public health initiative in
an attempt to reverse this upward trend in obesity and obesity-related disease
rates. It is our position that:
- Physicians are in an excellent position to identify and intervene with
patients who are clearly at risk and who could benefit from either
prevention of weight gain or a modest weight reduction.
- Obesity is a chronic disease.
- The underlying causes of obesity are not fully understood, though obesity
appears to be a complex, multifactorial disease involving genetics,
physiology, metabolism, and appetite regulation by the brain, as well as
environmental, psychosocial, and cultural factors. Obesity develops when
energy intake consistently exceeds energy output.
- Obesity can seldom, if ever, be cured, and it should be managed much the
same as any other chronic illness--through treatment that provides long-term
support, education, monitoring, and reinforcement.
The result of this joint initiative is Guidance for Treatment of Adult
Obesity. We hope this document will provide the tools you need to identify and
intervene as appropriate, and provide treatment guidance and support for those
patients who are interested in and can benefit from such intervention. We also
envision that it will provide guidance to insurance companies, companies that
contract with insurers for health insurance, and local, state, and federal
governmental organizations--thereby increasing the percentage of patients who
can obtain responsible and affordable medical treatment of obesity.
Patricia Choban, M.D. Chair, Committee for the Development of Guidance for
Treatment of Adult Obesity
Richard Atkinson, M.D. President, American Obesity Association
Barbara J. Moore, Ph.D. President and CEO, Shape Up America!