PPRNet Practice Guidelines
Obesity and Nutrition Counseling
Practice
guideline
Diagnosis of obesity:
In adults with BMI of at least 30 kg/m2
In children or adolescents with BMI >= 95th percentile for age and gender on CDC growth charts
The U.S. Preventive Services
Task Force recommends that clinicians screen all adult patients for obesity and
offer intensive counseling and behavioral interventions to promote sustained
weight loss for obese adults or refer them to other clinicians for these
services. The USPSTF found good
evidence that body mass index (BMI), calculated as weight in kilograms divided
by height in meters squared, is reliable and valid for identifying adults at
increased risk for mortality and morbidity due to overweight and obesity.
In adults, whose risks of adverse effects of obesity are directly related to BMI, overweight is defined as a BMI between 25 and 30 kg/m2 and obesity as a BMI greater than 30 kg/m2. Data documenting these associations are not available for children, and overweight is defined as a BMI greater than the 85th percentile and obesity as a BMI greater than the 95th percentile.
Additional
resources:
USPSTF Recommendations and Rationale
Obesity
Education Initiative BMI
Calculator
NIH Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults
Practice
guideline:
Blood glucose screening in patients with BMI of at least 30 kg/m2
Patients at increased risk for cardiovascular disease may benefit most from screening for type 2 diabetes, since management of cardiovascular risk factors leads to reductions in major cardiovascular events. In addition, clinicians should be alert to symptoms suggestive of diabetes (i.e., polydipsia and polyuria) and test anyone with these symptoms. In 2003, the USPSTF concluded that the evidence was insufficient to determine the benefit of screening adults for type 2 diabetes. There is an update currently underway which may lead to a more specific recommendation.
Additional
resources:
USPSTF
Recommendations and Rationale
NIH Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults
Nutrition Counseling
Practice
guideline:
Diet and nutrition counseling should be offered and documented in patients with histories of obesity, hypertension, hyperlipidemia, diabetes, coronary heart disease, other atherosclerotic disease or cerebrovascular disease
The
USPSTF recommends intensive behavioral dietary counseling for adult patients
with known risk factors for cardiovascular and diet-related chronic disease. The
USPSTF found good evidence that medium- to high-intensity counseling
interventions can produce medium-to-large changes in average daily intake of
core components of a healthy diet (including saturated fat, fiber, fruit, and
vegetables) among adult patients at increased risk for diet-related chronic
disease. Intensive counseling interventions that have been examined in
controlled trials among at-risk adult patients have combined nutrition education
with behavioral dietary counseling provided by a nutritionist, dietitian, or
specially trained primary care clinician (e.g., physician, nurse, or nurse
practitioner).
Additional
resources:
USPSTF Recommendations and Rationale
Obesity
Education Initiative Tip Sheets