Try Diet and Exercise First
April 11, 2005
(Ivanhoe Newswire) -- People who want to lose weight should start out with diet and exercise before considering more radical treatments, report the authors of a new clinical practice guideline on the management of obesity.
According to the American College of Physicians guideline, weight-loss drugs should only be considered by people with a body mass index (BMI) of 30 or above and then only after diet and exercise have failed to produce the desired results. Weight-loss surgery should be reserved only for those with BMIs of 40 or above and, again, only after trying diet and exercise first.
The authors note people with BMIs between 30 and 39.9 are considered obese. Those with BMIs topping 40 are considered morbidly obese. Overweight is defined as a BMI between 25 and 29.9. BMI is a measurement of body fat based on a calculation of height and weight.
The guideline identifies six weight-loss drugs that have shown to produce weight loss in clinical studies: sibutramine, orlistat, phentermine, diethylpropion, fluoxetine, and bupropion. Similar medical evidence is lacking for weight loss surgeries, however. The authors note none have undergone rigorous clinical trials where people who received the surgery were compared to a similar group of people who did not receive the surgery. The authors also point out many risks are associated with weight-loss surgery, and the death rate ranges from 0.3 per 100 patients to as high as 1.9 per 100 patients.
Development of the new guideline was funded by the federal Agency for Healthcare Research and Quality and based on a review of the medical evidence on obesity treatments.
SOURCE: Annals of Internal Medicine, 2005;142:525-531
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