U.S. panel: Doctors should screen for obesity

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(AP) WASHINGTON - Chances are you know your blood pressure. What about your BMI?

Body mass index signals if you're overweight, obese or just right considering your height. Some doctors have begun calling it a vital sign, as crucial to monitor as blood pressure.

But apparently not enough doctors check: A government panel renewed a call Monday for every adult to be screened for obesity during checkups, suggesting more physicians should be routinely calculating their patients' BMIs.

And when someone crosses the line into obesity, the doctor needs to do more than mention a diet. It's time to refer those patients for intensive nutrition-and-fitness help, say the guidelines issued by the U.S. Preventive Services Task Force.

Don't assume your weight's OK if the doctor doesn't bring it up.

Patients "should be asking what their BMI is, and tracking that over time," says task force member Dr. David Grossman, medical director for preventive care at the Group Health Cooperative in Seattle.

By the numbers: A normal BMI is less than 25. Obesity begins at 30. In between is considered overweight. To calculate yours: http://www.nhlbisupport.com/bmi/.

The advice sounds like a no-brainer, considering the national anxiety about our growing waistlines. Two-thirds of adults are either overweight or obese. Some 17 percent of children and teens are obese, on the road to diabetes, heart disease and other ailments before they're even grown.

The task force has recommended adult obesity screening previously, and similar guidelines urge tracking whether youngsters are putting on too many pounds.

Yet BMI remains a mystery for many people. A 2010 survey of members of the American Academy of Family Physicians found up to 40 percent of those primary care doctors were computing their patients' BMIs. Surveys show only about a third of obese patients recall their doctor counseling them about weight loss, even though people whose doctors discuss the problem are more likely to do something about it.

Doctors can struggle with the pounds, too, and Johns Hopkins University researchers recently reported that overweight physicians were less likely than skinnier ones to advise their patients about weight loss.

Why the reluctance? One reason: Few doctors are trained to treat obesity, they're discouraged by yo-yo dieting but they don't know what to advise, says Dr. Glen Stream, president of the physicians' group. His Spokane, Wash., practice uses electronic medical records that automatically calculate BMI when a patient's height and weight is entered.

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"Our American culture is always looking for an easy fix, a pill for every problem," Stream says. "The updated recommendation is important because it makes clear exactly what doctors should do to help."

In Monday's Annals of Internal Medicine, the task force concluded high-intensity behavioral interventions are the best non-surgical advice for the obese, citing insufficient evidence about lasting effects from weight-loss medications.

The task force's Grossman says a good program:

-Includes 12 to 26 face-to-face meetings over a year, most in the first few months.

-Makes patients set realistic weight-loss goals. Losing just 5 percent of your initial weight - 10 pounds for a 200-pound person - can significantly improve health.

-Analyzes what blocks each patient from reaching those goals. Do they eat high-calorie comfort foods to deal with depression? Spend too much time at a desk job?

-Tailors ways to help people integrate physical activity into their daily routine.

-Requires self-monitoring, such as a food diary or a pedometer to track activity.

Last year, Medicare started paying primary care doctors for obesity screening and weight-loss counseling for seniors for a year, including weekly meetings for the first month.

But many insurance companies don't pay for all the suggested interventions, and comprehensive programs aren't available everywhere, says Dr. Scott Kahan of George Washington University and the STOP Obesity Alliance. He runs a clinic that provides a medical, psychological and nutritional evaluation before tailoring a plan. In other programs, primary care doctors may offer some counseling and send patients to nutritionists or other specialists for extra help.

Another problem: "Doctors tend to shoo away people who have obesity. They say, `Don't come back to me and tell me your back hurts or you have acid reflux or high cholesterol until you will do something about it,'" laments Kahan, who is teaching medical school students to motivate patients.

What about the overweight? The task force said more study is needed on how best to help them.

But in Reno, Nev., Dr. Andy Pasternak calculates BMI for every patient at his family medicine practice - and particularly targets the overweight in their 40s and younger for fitness counseling. He says if they wait until they're heavier or older to get active, arthritis exacerbated by the pounds will be another barrier.

Patients seldom know what their BMI should be, but "at least twice a day people say, `What should be my optimal weight?'" Pasternak says.

He thinks saying to lose 60 pounds is too discouraging: "What I try to get them to focus on is: How much are you working out? How many servings of vegetables do you get a day?"

[docww]

In my experience counseling patients to help them eat less and exercise more has been an utter failure when it comes to obesity. That's because these recommendations are based on flawed science.

We now know that excessive fructose mainly from sugar and HFCS is the driving force behind insulin resistance and central (abdominal) obesity. When you have insulin resistance and consume carbohydrates, especially from grains, your brain is subjected to magnified glucose spikes. Because high levels of glucose are toxic to nerve cells, over time these glucose spikes can trigger a condition called Carbohydrate Associated Reversible brain syndrome or CARB syndrome. People with CARB syndrome can develop up to 22 brain dysfunction symptoms that interfere with their ability to function.

Because the brain plays a key role in regulating total body fat stores, they start to store extra fat even when they lose lean body mass from dieting. BMI will not show this worrisome shift in body composition so it's much better to rely on body composition readings.

Foods that contain sugar, HFCS and grain-based carbohydrates—the core of the typical American diet, are truly toxic and they should be avoided by anyone who wants to maintain good health and optimal brain function. Much of our obesity is now driven by this pathological process, not excessive calories and lack of exercise.

[jtdev1]

You don't need to "Screen" for it, Just open your eyes and you can see the fat people.

Or

Just walk into Walmart and see 90% of the people in there are morbidly obese.

[djseavy]

Ok - the doctor does the screening and advises the patient to correct their diet and get exercise. The outcome is much the same as when a doctor advises a patient to stop smoking, drinking, etc. In one ear and out the other. With the exception of medical conditions that cause someone to be overweight - the majority of people who are overweight bring it on themselves. Many in our society are simply lazy and eat like hogs. All the counseling and screening in the world isn't going to make a bit of difference unless and until people start to take care of their bodies. Let's put the responsibility where it belongs - on the patient. If you're going to ignore sound medical advice, why go to the doctor in the first place?

[jsf14]

I see no signs that such programs have led people to lose weight and become healthier. The receptionists, nursing assistants, and other less educated employees of my HMO are almost all very overweight or obese to morbidly obese. They have access to the HMOs weight loss programs. Many have participated in these programs. They are still fat.

[55minus5]

Yeah right, they'll just use a measure tape and a calculator, and here ya go, with a bill for $1000 to pay and a nasty record.

[fiddlestickawshucks]

Sounds like another idiotic part of Obamacare to me.

There aren't enough doctors in the world to go around to handle this.

I still think all this BS about everything you put in your mouth is to get people to the point where they are going to demand Soylent Green.

I weigh about 115 and am considered very healthy, but even if I weighed 215; it's nobody's business but mine.

Solve all the other crises we have here in the US, and maybe I will actually have the time to be frantic about eing overweight,

Right now, I am too busy trying to figure out how I'm going to pay all of these bills, keep a roof over our heads and feed my children.!!!

[jtdev1]

Don't you mean Romney Care?

After all, Obama care is modeled off of Romney Care complete with the same Individual Mandate...

[radfatty]

Studies show that dieting, even that considered "naturalistic", among young people lead to weight cycling [Naturalistic weight reduction efforts predicted weight gain and onset of obesity in adolescent girls; http://ebn.bmj.com/content/3/3/88.full]

There is an evidence-based compassionate alternative to conventional dieting: Health At Every Size®. Please consider this alternative prior to making a decision that may result in weight cycling.

NAAFA, the oldest non-profit civil rights organization dedicated to ending size discrimination in all of its forms, advocates the use of HAES® tenets and has developed a brochure directed to healthcare providers that deal with fat patients. You can find NAAFA's guidelines at: http://*******.com/7gbevd6

For more information on Health At Every Size, you can find a general explanation on Wikipedia (http://en.wikipedia.org/wiki/Health_at_Every_Size) or find in-depth research-based information in the book Health At Every Size - The Surprising Truth About Your Weight by Dr. Linda Bacon (http://www.lindabacon.org/HAESbook/).

[FormerUSMCSergeant]

U.S. panel: Doctors should screen for obesity
---

Tough screen that is - loads of sub-cutaneous fat?

Obese.

[zarnon61]

Here's the problem. I refer all the time to nutritional counseling but I get the referral kicked back as most insurance (including medicare) will only pay for nutritional counseling in selected circumstances -- most notably diabetes or renal failure.

Great that the USPTF recommends this. Who's going to pay for it?

[JoeSocrates]

One of the great problems in modern healthcare is doctors are taught to look for acute heart, lung and circulation problems every visit.

In fact the BMI, Waist Hip ratio, percent body fat, and hormone levels should be checked often. Few people need the check for acute disabling illness at every visit especially if the doctor knows the patient.

We need more focus on the problems of obesity, cholesterol. hypertension, and all lung diseases.

It is the entrenched curriculum for doctors to look for and treat acute problems when a massive majority of patients need chronic care which is much more effective than they get now.

I am a doctor myself and I am in direct disagreement with the approach to medicine for chronic and long term care. I have no conflict with treatment of injury, acute illness, surgery. Those take an acute remedy and we can do that, but then they get kicked back into an acute system instead of a maintenance system.