2018 USPSTF Behavioral Weight Loss Interventions Recommendations

Obesity is Deadly.¹ Between 2013 and 2014, obesity affected over 40% of women and 35% of men in the US. Obesity carries an increased risk of coronary heart disease, T2DM, cancer, gallstones, disability, and death. Ischemic heart disease, T2DM, respiratory diseases, and cancer are the four leading causes of death in obese individuals. 

USPSTF Update to 2012 Recommendations. The newly updated recommendations are based on review of 89 behavior-based weight loss and weight loss maintenance trials and 35 medication trials. The USPSTF focused on interventions that can be provided in or referred from a primary care setting. Obesity screening was considered a routine part of clinical practice and, therefore, not included. 

Characteristics of Behavioral Interventions. Many of the intensive interventions were intended to help patients achieve or maintain ≥5% weight loss through dietary changes and increased physical activity. Most of the interventions lasted for 1-2 years with the majority having ≥12 sessions in the first year. Most interventions focused on identifying barriers, self-monitoring weight, peer support, and relapse prevention. 

Pharmacologic Interventions. The pharmacotherapy trials reviewed evaluated liraglutide, lorcaserin, naltrexone and bupropion, orlistat, and phentermine-topiramate. Many trials had high dropout rates (≥35% in half of trials) and high adverse event rates. A combination of behavioral and medication interventions resulted in greater weight loss and weight maintenance vs behavioral interventions alone. 

Promote Behavioral Weight Loss Programs in Primary Care. Adults with a BMI ≥30 should be offered or referred to intensive and multicomponent behavioral interventions. There is adequate evidence that shows behavioral weight loss programs have moderate benefit, behavioral weight loss programs are linked to decreased weight and T2DM incidence, and harms of intensive, multicomponent interventions are small to none.