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2 December 2003 | Volume 139 Issue 11 | Pages 933-949
Background: Obesity poses a considerable and growing health burden. This review examines evidence for screening and treating obesity in adults.
Data Sources: MEDLINE and Cochrane Library (January 1994 through February 2003).
Study Selection: Systematic reviews; randomized, controlled trials; and observational studies of obesity's health outcomes or efficacy of obesity treatment.
Data Extraction: Two reviewers independently abstracted data on study design, sample, sample size, treatment, outcomes, and quality.
Data Synthesis: 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.
Conclusions: 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.
Author and Article Information
From University of Pittsburgh, Pittsburgh, Pennsylvania; University of North Carolina School of Medicine, Chapel Hill, North Carolina; and RTI International, Research Triangle Park, North Carolina.
Disclaimer: The authors of this article are responsible for its contents, including any clinical or treatment recommendations. No statement in this article should be construed as an official position from the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services.
Acknowledgments: The authors thank David Atkins, MD, MPH, Medical Officer, Center for Outcomes and Evidence, and Eve Shapiro, Managing Editor, USPSTF, Agency for Healthcare Research and Quality. They also thank Loraine Monroe of RTI International.
Grant Support: This study was developed by the RTI International–University of North Carolina Evidence-based Practice Center under contract to the Agency for Healthcare Research and Quality (contract no. 290-97-0011), Rockville, Maryland. Dr. McTigue was supported by the University of North Carolina Robert Wood Johnson Clinical Scholars Program.
Potential Financial Conflicts of Interest: None disclosed.
Requests for Single Reprints: Reprints are available from the AHRQ Web site at http://www.ahrq.gov/clinic/uspstfix.htm and in print through the AHRQ Publications Clearinghouse (call 1-800-358-9295).
Current Author Addresses: Dr. McTigue: Departments of Medicine and Epidemiology, 3459 5th Avenue, Suite 933 West/MUH, Pittsburgh, PA 15213.
Dr. Harris and Ms. Bunton: Department of Medicine and Cecil G. Sheps Center for Health Services Research, CB #7590, 725 Airport Road, University of North Carolina School of Medicine, Chapel Hill, NC 27599.
Dr. Hemphill: 7725 Pinewood Drive, Albuquerque, NM 87120.
Ms. Lux, Ms. Sutton, and Dr. Lohr: RTI International, 3040 Cornwallis Road, Research Triangle Park, NC 27709-2194. CLINICAL GUIDELINES
Screening and Interventions for Obesity in Adults: Summary of the Evidence for the U.S. Preventive Services Task Force
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