Kathleen M. McTigue, MD, MPH; Russell Harris, MD, MPH; Brian Hemphill, MD, MPH; Linda Lux, MPA; Sonya Sutton, BSPH; Audrina J. Bunton, BA; Kathleen N. Lohr, PhD
Obesity poses a considerable and growing health burden. This review examines evidence for screening and treating obesity in adults.
MEDLINE and Cochrane Library (January 1994 through February 2003).
Systematic reviews; randomized, controlled trials; and observational studies of obesity's health outcomes or efficacy of obesity treatment.
Two reviewers independently abstracted data on study design, sample, sample size, treatment, outcomes, and quality.
No trials evaluated mass screening for obesity, so the authors evaluated indirect evidence for efficacy. Pharmacotherapy or counseling interventions produced modest (generally 3 to 5 kg) weight loss over at least 6 or 12 months, respectively. Counseling was most effective when intensive and combined with behavioral therapy. Maintenance strategies helped retain weight loss. Selected surgical patients lost substantial weight (10 to 159 kg over 1 to 5 years). Weight reduction improved blood pressure, lipid levels, and glucose metabolism and decreased diabetes incidence. The internal validity of the treatment trials was fair to good, and external validity was limited by the minimal ethnic or gender diversity of volunteer participants. No data evaluated counseling harms. Primary adverse drug effects included hypertension with sibutramine (mean increase, 0 mm Hg to 3.5 mm Hg) and gastrointestinal distress with orlistat (1% to 37% of patients). Fewer than 1% (pooled samples) of surgical patients died; up to 25% needed surgery again over 5 years.
Counseling and pharmacotherapy can promote modest sustained weight loss, improving clinical outcomes. Pharmacotherapy appears safe in the short term; long-term safety has not been as strongly established. In selected patients, surgery promotes large amounts of weight loss with rare but sometimes severe complications.
Only studies for which the difference in mean weight loss could be calculated are included. Error bars represent 95% CIs and are presented for studies in which those data were available. Data presented are as close as possible to 1-year follow-up. An asterisk indicates that the difference was statistically significant ( < 0.05) but there were insufficient data to calculate CIs. B = behavioral therapy; D = diet; E = exercise; EP = exercise program; EQ = exercise equipment; L = lottery entry; MR = meal replacement; SES = socioeconomic status. +++ = high intensity; ++ = moderate intensity; + = low intensity.
Table 2 Top.
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Appendix Table 1.
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Appendix Table 3.
Only studies for which the difference in mean weight loss could be calculated are included; each arm is represented by a data point. Error bars represent 95% CIs and are presented for studies in which those data were available. Intensity of co-interventions was not assessed because most trials provided insufficient information for evaluation. An asterisk indicates that the difference was statistically significant ( < 0.05) but there were insufficient data to calculate CIs. B = behavioral therapy; BID = twice daily; D = diet; E = exercise; QD = daily; TID = 3 times daily.
Appendix Table 4 Top.
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Appendix Table 4 Middle B
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Appendix Table 5.
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McTigue KM, Harris R, Hemphill B, Lux L, Sutton S, Bunton AJ, et al. Screening and Interventions for Obesity in Adults: Summary of the Evidence for the U.S. Preventive Services Task Force. Ann Intern Med. 2003;139:933-949. doi: 10.7326/0003-4819-139-11-200312020-00013
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Published: Ann Intern Med. 2003;139(11):933-949.
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