Screening and interventions for obesity in adults: summary of the evidence for the U.S. Preventive Services Task Force.
BACKGROUND
Obesity poses a considerable and growing health burden. This review examines evidence for screening and treating obesity in adults.


METHODS
MEDLINE and Cochrane Library (January 1994 through February 2003).


METHODS
Systematic reviews; randomized, controlled trials; and observational studies of obesity's health outcomes or efficacy of obesity treatment.


METHODS
Two reviewers independently abstracted data on study design, sample, sample size, treatment, outcomes, and quality.


RESULTS
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.
McTigue
Kathleen M
KM
University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
Harris
Russell
R
Hemphill
Brian
B
Lux
Linda
L
Sutton
Sonya
S
Bunton
Audrina J
AJ
Lohr
Kathleen N
KN
D000328:Adult; D001521:Behavior Therapy; D003376:Counseling; D019317:Evidence-Based Medicine; D006801:Humans; D008403:Mass Screening; D009765:Obesity / Q000517:prevention & control* / Q000628:therapy; D019370:Observation; D016032:Randomized Controlled Trials as Topic; D012196:Review Literature as Topic