New obesity guidelines: promise and potential.

Obesity is a major contributor to many chronic diseases and, because more than 1 in 3 US adults are obese, 1 a public health challenge. The goal of new obesity guidelines is to help primary care clinicians manage obesity more effectively. Obesity 2 (published as " 2013 ACCF/ AHA/TOS Guidelines for the Management of Overweight and Obesity in Adults " 2) has been long awaited. The expert panel for Obesity 2 was first convened in Sep-tember 2008 by the National Heart, Lung, and Blood Institute (NHLBI) and tasked with updating Obesity 1 (published in 1998 as " Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults—The Evidence Report " 3). In 2013, the NHLBI elected to partner with the American Heart Association and the American College of Cardiology to promote and publish the guidelines. 4 The approach to guideline development followed the Institute of Medicine reports " Clinical Practice Guidelines We Can Trust " 5 and " Finding What Works in Health Care— Standards for Systematic Reviews. " 6 The aim of this stringent methodology was to limit bias and produce trustworthy recommendations. Because of time and cost, the use of this stringent methodology limited both the scope of literature review under consideration (1999-2011) and the number of critical questions. From 23 critical questions suggested, the chosen 5 dealt with risks of overweight and obesity and the benefits of weight loss and evaluated 3 treatment areas— diet, behavioral therapies, and surgery. Questions 1 and 2 were chosen to help clinicians determine the appropriate criteria to guide a weight loss recommendation. Question 1 addressed the degree to which weight loss produces health benefits. Question 2 addressed the health risks of overweight and obesity and sought to determine if the current waist circumference and body mass index (BMI) cutpoints defining persons as overweight (BMI 25-29.9) and obese (BMI Ն30) are appropriate. Question 3 asked which dietary strategies are acceptable for weight loss efforts. Question 4 sought to determine the efficacy of a comprehensive lifestyle intervention approach (diet, physical activity, and behavior therapy) to achieve weight loss and weight loss maintenance. Question 5 addressed the efficacy and safety of various bariatric surgical procedures, including benefits and risks. To conserve resources for questions 3 through 5, questions 1 and 2 used primarily meta-analyses and systematic reviews. Because the questions were limited in number and scope, the recommendations are supplemented …