New Guidelines: 65% of Americans Need Help With Weight Loss

Marlene Busko

November 14, 2014

BOSTON, MA — Largely because the criteria have been expanded to include more categories of overweight people and still include all obese people, new weight-loss guidelines issued last year recommend behavioral treatment for 140 million American adults—65% of the population, a new study indicates.

Of these, 116 million would be candidates for adjunctive pharmacotherapy, and 32 million could be considered for bariatric surgery.

This is a "staggering" increase in the number of Americans for whom weight-loss therapies are recommended, Dr June Stevens (University of North Carolina, Chapel Hill), lead author of the research and a coauthor of the 2013 guidelines, told Medscape Medical News during a poster presentation at Obesity Week 2014.

"It points to the need for public-health solutions, because it's going to be very difficult for the medical establishment to deal with this many people. We're going to have to try to do what we can on all fronts," she said.

Dr Donna Ryan (Pennington Biomedical Research Center, Baton Rouge, LA), a coauthor of the guidelines and a spokesperson for the Obesity Society, agrees.

"This huge number of Americans recommended for weight-loss therapy reinforces the need for broad, sweeping transformations in obesity management in the primary-care setting," she said in a statement. "The good news is that there are evidence-based treatments readily available."

Overweight Category Now Includes More People

The guidelines for treating individuals with excess weight that were issued last year by the American Heart Association (AHA), American College of Cardiology (ACC), and the Obesity Society (TOS) (Circulation.2014;129(25 Suppl 2): S102-S138) would recommend weight-loss treatment for 13% more Americans than the previous obesity-treatment guidelines issued in 1998 by the National Heart, Lung, and Blood Institute (NHLBI), according to a new study.

Dr Stevens and colleagues used 6 years of National Health and Nutrition Survey (NHANES) data (from 2007 to 2012) to determine how many adult Americans would need treatment for excess weight based on the 2013 vs 1998 treatment algorithms.

"Both guidelines specified that all obese patients should get weight-loss therapy, but the new guidelines specify treatment for a lot more of the overweight people," Dr. Stevens explained.

Overweight individuals need to have only one as opposed to two cardiovascular risk factors, and one of the risk factors could be extra girth around the waist.

Criteria for Recommending Weight-Loss Treatment in Adults

1998 Guidelines 2013 Guidelines
Obese (BMI >30) Obese (BMI >30)
Overweight (BMI 25–29.9) or large waist (>88 cm in women or >102 cm in men) plus at least 2 of 7 CVD risk factors:
  • Hypertension

  • Impaired fasting glucose

  • Abnormal LDL cholesterol

  • Low HDL cholesterol

  • Men above age 44; women above age 54 or postmenopausal

  • Smoking

  • Family history of premature CHD

Overweight (BMI 25–29.9) plus at least 1 of 4 CVD risk factors:
  • Hypertension

  • Prediabetes or diabetes

  • Dyslipidemia (based on total cholesterol, HDL cholesterol, LDL cholesterol, triglycerides or lipid-lowering medication)

  • Large waist (>88 cm in women or >102 cm in men)

By both sets of criteria, individuals were more likely to be recommended for treatment if they were over 45, male, African American or Mexican American, did not have a college degree, and were insured by Medicaid or Medicare.

Evidence-Based Guide for Diet Drugs Expected Soon

The guidelines are evidence based and are a starting place for appropriate use of weight-loss therapies, Dr Robert Eckel (University of Colorado, Denver), who was not involved in the study, emphasized to Medscape Medical News.

"The recently updated ACC/AHA/TOS Obesity Guideline provides the evidence base we need on whom to evaluate and treat for excessive body fat….They cover the waterfront with evidence-based recommendations for lifestyle management, including behavioral strategies, pharmacotherapy, and metabolic (bariatric) surgery [and] should be the first place to start when recommendations for therapy are needed."

Dr Ryan, too, stressed that the guidelines provide an evidence-based tool to help physicians identify and treat patients who may not have found prior success with diet and exercise alone and may need additional support.

Clinicians will also soon have a new tool to help guide the pharmacological treatment of obesity.

The Endocrine Society, the European Society of Endocrinology, and the Obesity Society expect to issue the first guideline specifically focused on the medical treatment of obesity in January.

Dr Stevens has reported she has no relevant financial relationships. Dr Ryan is a consultant for Novo Nordisk, Vivus, Eisai, Takeda, Janssen, and Scientific Intake. Dr Eckel is a consultant for Novo Nordisk, Esperion, Regeneron/Sanofi and Janssen and has a research grant from Janssen.

Obesity Week 2014: The American Society for Metabolic and Bariatric Surgery and the Obesity Society Joint Annual Scientific Meeting; November 6, 2014; Boston, MA. Abstract T-2772.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.