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News Article | May 15, 2017
Site: www.eurekalert.org

BIRMINGHAM, Ala. - The body mass index calculations that physicians have been relying on for decades may not be accurate for assessing body fat in adolescents between the ages of 8 and 17. A new study published today in the Journal of the American Medical Association Pediatrics shows that tri-ponderal mass index estimates body fat more accurately than the traditional BMI in adolescents. These new findings are timely as diagnosing, treating and tracking the prevalence of children and adolescents with obesity is a high public health priority. Moreover, many school districts are sending home report cards labeling adolescents as overweight -- a practice that has been controversial because children and adolescents tend to be more vulnerable to weight bias and fat shaming than adults. "Treating obesity in adolescents requires an accurate diagnosis first," said lead scientist Courtney Peterson, Ph.D., an assistant professor in the School of Health Professions at the University of Alabama at Birmingham. "We found that TMI is both more accurate and easier to use than BMI percentiles. These new findings have the power to potentially change the way we diagnose obesity in children and adolescents ages 8 to 17." BMI is the standard used worldwide to screen for obesity in both children and adults, despite prior evidence that it does not work as well in adolescents. To test BMI accuracy in adolescents, researchers compared body composition data from 2,285 Caucasian individuals ages 8 to 29 who participated in the 1999-2004 U.S. National Health and Nutrition Examination Survey (NHANES). Their findings challenge the accuracy of BMI (weight in kilograms divided by height in meters squared) in adolescents and show that TMI (weight divided by height cubed) estimates body fat more accurately than BMI in those 8 to 17 years old. "BMI is a pretty good tool for determining whether adults are overweight or obese," Peterson said. "But we've always kind of known that it doesn't work as well in children." Using three different calculations -- stability with age, accuracy in estimating percent body fat and accuracy in classifying adolescents as overweight versus normal weight -- researchers compared BMI to several different obesity indices. They found that TMI is the best overall body fat index to use in Caucasian adolescents between the ages of 8 and 17. The researchers found that TMI better estimates body fat percentage, especially in male adolescents for whom the investigators found BMI to be particularly inaccurate. Their analysis also showed TMI to be a better index for diagnosing overweight adolescents than the current BMI percentiles. Using BMI percentiles, researchers noted that adolescents are incorrectly diagnosed as overweight 19.4 percent of the time, versus an only 8.4 percent incorrect overweight diagnosis rate for TMI. The data showed this is especially true for lean adolescents, a significant fraction of whom are incorrectly being diagnosed as overweight. The researchers also used mathematical strategies to show how the relationship between body weight and height is much more complex in children and adolescents than it is in adults, particularly when adolescents are rapidly growing. The authors explained that for decades this complexity made it challenging to figure out the optimal body fat index for adolescents. Steven Heymsfield, M.D., one of the team's physician scientists at LSU's Pennington Biomedical Research Center, added that, to make BMI work in children, complicated BMI percentiles called "Z scores" were developed to diagnose overweight status and obesity based on BMI levels specific to a child's age and gender. But the researchers found that using percentiles does not solve BMI's accuracy problems. Peterson mentioned that percentiles are problematic because they change over time and can become outdated. However, she emphasizes that, even if BMI percentiles were updated to be as accurate as TMI for diagnosing adolescents as lean versus overweight, TMI still inherently estimates levels of body fat in adolescents more accurately than BMI does, while also eliminating the need for complicated percentiles. "These findings are important," Peterson said. "Many school districts send home report cards labeling adolescents as overweight, and children and adolescents tend to be more vulnerable to weight bias and fat shaming than adults." Obesity increases the risk of several chronic diseases in adults, including diabetes, cardiovascular disease and cancer. Children who are overweight are at an even higher risk than adults, and nearly one in six children in the United States is overweight. Several national and global initiatives are underway to screen and diagnose children who are overweight as a first step in curbing the obesity epidemic and the chronic diseases that follow. Investigators agree that further research is needed to assess the effectiveness of TMI in broader audiences, including wider age ranges and ethnicities. "We look forward to collaborating with other existing national and global health organizations to analyze additional data for diagnosing weight status among children and adolescents," Peterson said. "Ultimately, we hope this research lays the foundation for improving the health of adolescents, and we think that down the road TMI will likely replace BMI for children and adolescents." Researchers from the University of Alabama at Birmingham, LSU's Pennington Biomedical Research Center, Montclair State University, the United States Military Academy, The Albert Einstein College of Medicine and Verona University Medical School collaborated on this research and publication.


News Article | May 15, 2017
Site: www.sciencedaily.com

The body mass index calculations that physicians have been relying on for decades may not be accurate for assessing body fat in adolescents between the ages of 8 and 17. A new study published today in the Journal of the American Medical Association Pediatrics shows that tri-ponderal mass index estimates body fat more accurately than the traditional BMI in adolescents. These new findings are timely as diagnosing, treating and tracking the prevalence of children and adolescents with obesity is a high public health priority. Moreover, many school districts are sending home report cards labeling adolescents as overweight -- a practice that has been controversial because children and adolescents tend to be more vulnerable to weight bias and fat shaming than adults. "Treating obesity in adolescents requires an accurate diagnosis first," said lead scientist Courtney Peterson, Ph.D., an assistant professor in the School of Health Professions at the University of Alabama at Birmingham. "We found that TMI is both more accurate and easier to use than BMI percentiles. These new findings have the power to potentially change the way we diagnose obesity in children and adolescents ages 8 to 17." BMI is the standard used worldwide to screen for obesity in both children and adults, despite prior evidence that it does not work as well in adolescents. To test BMI accuracy in adolescents, researchers compared body composition data from 2,285 Caucasian individuals ages 8 to 29 who participated in the 1999-2004 U.S. National Health and Nutrition Examination Survey (NHANES). Their findings challenge the accuracy of BMI (weight in kilograms divided by height in meters squared) in adolescents and show that TMI (weight divided by height cubed) estimates body fat more accurately than BMI in those 8 to 17 years old. "BMI is a pretty good tool for determining whether adults are overweight or obese," Peterson said. "But we've always kind of known that it doesn't work as well in children." Using three different calculations -- stability with age, accuracy in estimating percent body fat and accuracy in classifying adolescents as overweight versus normal weight -- researchers compared BMI to several different obesity indices. They found that TMI is the best overall body fat index to use in Caucasian adolescents between the ages of 8 and 17. The researchers found that TMI better estimates body fat percentage, especially in male adolescents for whom the investigators found BMI to be particularly inaccurate. Their analysis also showed TMI to be a better index for diagnosing overweight adolescents than the current BMI percentiles. Using BMI percentiles, researchers noted that adolescents are incorrectly diagnosed as overweight 19.4 percent of the time, versus an only 8.4 percent incorrect overweight diagnosis rate for TMI. The data showed this is especially true for lean adolescents, a significant fraction of whom are incorrectly being diagnosed as overweight. The researchers also used mathematical strategies to show how the relationship between body weight and height is much more complex in children and adolescents than it is in adults, particularly when adolescents are rapidly growing. The authors explained that for decades this complexity made it challenging to figure out the optimal body fat index for adolescents. Steven Heymsfield, M.D., one of the team's physician scientists at LSU's Pennington Biomedical Research Center, added that, to make BMI work in children, complicated BMI percentiles called "Z scores" were developed to diagnose overweight status and obesity based on BMI levels specific to a child's age and gender. But the researchers found that using percentiles does not solve BMI's accuracy problems. Peterson mentioned that percentiles are problematic because they change over time and can become outdated. However, she emphasizes that, even if BMI percentiles were updated to be as accurate as TMI for diagnosing adolescents as lean versus overweight, TMI still inherently estimates levels of body fat in adolescents more accurately than BMI does, while also eliminating the need for complicated percentiles. "These findings are important," Peterson said. "Many school districts send home report cards labeling adolescents as overweight, and children and adolescents tend to be more vulnerable to weight bias and fat shaming than adults." Obesity increases the risk of several chronic diseases in adults, including diabetes, cardiovascular disease and cancer. Children who are overweight are at an even higher risk than adults, and nearly one in six children in the United States is overweight. Several national and global initiatives are underway to screen and diagnose children who are overweight as a first step in curbing the obesity epidemic and the chronic diseases that follow. Investigators agree that further research is needed to assess the effectiveness of TMI in broader audiences, including wider age ranges and ethnicities. "We look forward to collaborating with other existing national and global health organizations to analyze additional data for diagnosing weight status among children and adolescents," Peterson said. "Ultimately, we hope this research lays the foundation for improving the health of adolescents, and we think that down the road TMI will likely replace BMI for children and adolescents."


New research presented at this year's European Congress on Obesity (ECO) in Porto, Portugal (17-20) May shows that achieving the guideline amounts of moderate-to-vigorous physical activity is associated with significantly lower BMI and body fat in children. The study was conducted by Dr Peter Katzmarzyk and Dr Amanda Staiano at the Pennington Biomedical Research Center, Baton Rouge, LA, USA. Excess weight and body fat are known to be risk factors for a range of serious health problems including diabetes, cancers, cardiovascular diseases, and even dementia. There is also increasing evidence that the harmful effects of high levels of adiposity begin to manifest themselves in childhood. The Canadian 24-hour Movement Guidelines are an internationally recognised set of recommendations for healthy amounts of moderate-to-vigorous physical activity (MVPA), sedentary behaviour (television viewing), and sleep for children and young people. They recommend a minimum of 60 minutes MVPA on at least 5 days per week, less than 2 hours per day of TV viewing, and sleeping 9 - 11 h/night for 5 - 13 year olds, reducing to 8 - 10 h/night for 14 - 18 year olds. This study aimed to evaluate the relationship between adherence to those guidelines and rates of adiposity in a sample group of 357 white (170) and African American (187) children aged 5 - 18 years. The children were recruited from the Baton Rouge, Louisiana community using media outlets and recruitment through paediatricians' offices. Activity, sedentary behaviour, and amount of sleep was measured using questionnaires while the height and weight of participating children were measured to obtain BMI which was compared with Centers for Disease Control (CDC) reference data. Obesity was defined as having a BMI greater than the 95th percentile (i.e. in the top 5% of BMI) of the reference data for a child of that age; total fat mass was measured using Dual Energy X-ray Absorption (DXA), and Magnetic Resonance Imaging (MRI) was used to find the total amounts of visceral (VAT) and subcutaneous (SAT) fat within the abdomen. Within the sample group, 35% of children performed the guideline amount of MVPA, 31% achieved the desired level of sedentary behaviour, and 52% met the target for sleep duration. A total of 27% of the sample group achieved none of the guidelines, whereas 36%, 28%, and 8% hit 1, 2, or all 3 of the targets respectively. A higher proportion of white children met the guidelines than African American children. The odds of being obese was 89% lower (odds ratio = 0.11, a statistically significant result) in children meeting all three guidelines compared to children meeting none of the guidelines. In children meeting 2 of 3 guidelines, there was a 40% reduced risk of obesity versus those meeting none of the guidelines; and for meeting 1 out of 3 guidelines, the risk of obesity was 24% lower versus those who met none of the guidelines. Meeting the MVPA guideline was associated with having significantly lower total fat mass, and SAT mass. Staying within the guideline amount of TV viewing was associated with having significantly lower BMI, total fat mass, and SAT mass, while meeting the sleep guideline was associated with having significantly lower BMI, total fat mass, SAT, and VAT masses. The authors noted that: "A small proportion of this sample met all 3 of the 24 h movement guidelines" and that "Meeting more components of the guidelines was associated with lower amounts of adiposity and lower odds of obesity." They conclude: "This work suggests that interventions that target multiple lifestyle behaviours may have a potent effect on levels obesity and overweight in children."


News Article | May 15, 2017
Site: www.chromatographytechniques.com

The body mass index calculations that physicians have been relying on for decades may not be accurate for assessing body fat in adolescents between the ages of 8 and 17. A new study published today in the Journal of the American Medical Association Pediatrics shows that tri-ponderal mass index estimates body fat more accurately than the traditional BMI in adolescents. These new findings are timely as diagnosing, treating and tracking the prevalence of children and adolescents with obesity is a high public health priority. Moreover, many school districts are sending home report cards labeling adolescents as overweight — a practice that has been controversial because children and adolescents tend to be more vulnerable to weight bias and fat shaming than adults. “Treating obesity in adolescents requires an accurate diagnosis first,” said lead scientist Courtney Peterson, an assistant professor in the School of Health Professions at the University of Alabama at Birmingham. “We found that TMI is both more accurate and easier to use than BMI percentiles. These new findings have the power to potentially change the way we diagnose obesity in children and adolescents ages 8 to 17.” BMI is the standard used worldwide to screen for obesity in both children and adults, despite prior evidence that it does not work as well in adolescents. To test BMI accuracy in adolescents, researchers compared body composition data from 2,285 Caucasian individuals ages 8 to 29 who participated in the 1999-2004 U.S. National Health and Nutrition Examination Survey (NHANES). Their findings challenge the accuracy of BMI (weight in kilograms divided by height in meters squared) in adolescents and show that TMI (weight divided by height cubed) estimates body fat more accurately than BMI in those 8- to 17-years-old. “BMI is a pretty good tool for determining whether adults are overweight or obese,” Peterson said. “But we’ve always kind of known that it doesn’t work as well in children.” Using three different calculations — stability with age, accuracy in estimating percent body fat and accuracy in classifying adolescents as overweight versus normal weight — researchers compared BMI to several different obesity indices. They found that TMI is the best overall body fat index to use in Caucasian adolescents between the ages of 8 and 17. The researchers found that TMI better estimates body fat percentage, especially in male adolescents for whom the investigators found BMI to be particularly inaccurate. Their analysis also showed TMI to be a better index for diagnosing overweight adolescents than the current BMI percentiles. Using BMI percentiles, researchers noted that adolescents are incorrectly diagnosed as overweight 19.4 percent of the time, versus an only 8.4 percent incorrect overweight diagnosis rate for TMI. The data showed this is especially true for lean adolescents, a significant fraction of whom are incorrectly being diagnosed as overweight. The researchers also used mathematical strategies to show how the relationship between body weight and height is much more complex in children and adolescents than it is in adults, particularly when adolescents are rapidly growing. The authors explained that for decades this complexity made it challenging to figure out the optimal body fat index for adolescents. Steven Heymsfield, M.D., one of the team’s physician scientists at LSU’s Pennington Biomedical Research Center, added that, to make BMI work in children, complicated BMI percentiles called “Z scores” were developed to diagnose overweight status and obesity based on BMI levels specific to a child’s age and gender. But the researchers found that using percentiles does not solve BMI’s accuracy problems. Peterson mentioned that percentiles are problematic because they change over time and can become outdated. However, she emphasizes that, even if BMI percentiles were updated to be as accurate as TMI for diagnosing adolescents as lean versus overweight, TMI still inherently estimates levels of body fat in adolescents more accurately than BMI does, while also eliminating the need for complicated percentiles. “These findings are important,” Peterson said. “Many school districts send home report cards labeling adolescents as overweight, and children and adolescents tend to be more vulnerable to weight bias and fat shaming than adults.” Obesity increases the risk of several chronic diseases in adults, including diabetes, cardiovascular disease and cancer. Children who are overweight are at an even higher risk than adults, and nearly one in six children in the United States is overweight. Several national and global initiatives are underway to screen and diagnose children who are overweight as a first step in curbing the obesity epidemic and the chronic diseases that follow. Investigators agree that further research is needed to assess the effectiveness of TMI in broader audiences, including wider age ranges and ethnicities. “We look forward to collaborating with other existing national and global health organizations to analyze additional data for diagnosing weight status among children and adolescents,” Peterson said. “Ultimately, we hope this research lays the foundation for improving the health of adolescents, and we think that down the road TMI will likely replace BMI for children and adolescents.”


Is alternate-day fasting more effective for losing and maintaining weight compared with a daily diet that simply limits calorie intake? Findings of a new study have revealed that while fasting diets are on trend these days, they are no better than traditional calorie-restricted diet when it comes to weight loss. In a new study published in JAMA Internal Medicine on May 1, Eric Ravussin, from Louisiana State University's Pennington Biomedical Research Center, and colleagues took a closer look at the relative effectiveness of the alternate-day fasting weight loss method in which a person drastically reduces his or her calorie intake every other day but eat more than usual on so-called non-fasting days. Beyoncé and Benedict Cumberbatch are just among the celebrities whose diets are known to be based on intermittent fasting. Ravussin and colleagues found that intermittent fasting is not significantly better compared with diet that restricts intake of calories per day for people who want to lose weight or maintain weight. Participants in the traditional diet group and the fasting group lost an average of about 7 percent more of their body weight than those who did not go on a diet after six months. After a year, participants in the first two group lost 5 to 6 percent of their initial body weight. The results show that there is no significant difference between traditional method of losing weight and alternate-day fasting. "Alternate-day fasting has been promoted as a potentially superior alternative to daily calorie restriction under the assumption that it is easier to restrict calories every other day. However, our data from food records, doubly labeled water, and regular weigh-ins indicate that this assumption is not the case," the researchers wrote in their study. In the study, those in the alternate-day fasting group consumed 25 percent of their normal calories intake on fasting days but 125 percent of their normal calorie intake on non-fasting days. Those in the traditional diet group, on the other hand, consumed 75 percent of their normal calorie intake daily. Researchers also found that it is not easy to change people's eating habits. A large percentage of the participants who were asked to fast for the study did not follow the requirements and even dropped out of the study. In comparison, 38 percent of those in the fasting group dropped out prior to the one-year mark of the study because they were not satisfied with their diet, while only 29 percent of those in the traditional diet group did. "We know daily calorie restriction — if you have to count your calories every day and all that — it's a tough one. I think that there's some hope that this alternate-day fast, or modified fast, would be a better or easier strategy, but ... the dropout rate is kind of alarming," Ravussin said. Researchers also found that participants in the fasting group tend to cheat on their fasting days by eating more than they should. © 2017 Tech Times, All rights reserved. Do not reproduce without permission.


Bouchard C.,Pennington Biomedical Research Center
Experimental Physiology | Year: 2012

The concept of individual differences in the response to exercise training or trainability was defined three decades ago. In a series of experimental studies with pairs of monozygotic twins, evidence was found in support of a strong genotype dependency of the ability to respond to regular exercise. In the HERITAGE Family Study, it was observed that the heritability of the maximal oxygen uptake response to 20 weeks of standardized exercise training reached 47% after adjustment for age, sex, baseline maximal oxygen uptake and baseline body mass and composition. Candidate gene studies have not yielded as many validated gene targets and variants as originally anticipated. Genome-wide explorations have generated more convincing predictors of maximal oxygen uptake trainability. A genomic predictor score based on the number of favourable alleles carried at 21 single nucleotide polymorphisms appears to be able to identify low and high training response classes that differ by at least threefold. Combining transcriptomic and genomic technologies has also yielded highly promising results concerning the ability to predict trainability among sedentary people. © 2012 The Author. Journal compilation © 2012 The Physiological Society.


Katzmarzyk P.T.,Pennington Biomedical Research Center
Medicine and Science in Sports and Exercise | Year: 2014

PURPOSE: Several studies have documented significant associations between sedentary behaviors such as sitting or television viewing and premature mortality. However, the associations between mortality and other low-energy-expenditure activities such as standing have not been explored. The purpose of this study was to examine the association between daily standing time and mortality among 16,586 Canadian adults 18-90 yr of age. METHODS: Information on self-reported time spent standing as well as several covariates including smoking, alcohol consumption, physical activity readiness, and moderate-to-vigorous physical activity was collected at baseline in the 1981 Canada Fitness Survey. Participants were followed for an average of 12.0 yr for the ascertainment of mortality status. RESULTS: There were 1785 deaths (743 from cardiovascular disease [CVD], 530 from cancer, and 512 from other causes) in the cohort. After adjusting for age, sex, and additional covariates, time spent standing was negatively related to mortality rates from all causes, CVD, and other causes. Across successively higher categories of daily standing, the multivariable-adjusted hazard ratios were 1.00, 0.79, 0.79, 0.73, and 0.67 for all-cause mortality (P for trend <0.0001); 1.00, 0.82, 0.84, 0.68, and 0.75 for CVD mortality (P for trend 0.02); and 1.00, 0.76, 0.63, 0.67, and 0.65 for other mortality (P for trend <0.001). There was no association between standing and cancer mortality. There was a significant interaction between physical activity and standing (P < 0.05), and the association between standing and mortality was significant only among the physically inactive (<7.5 MET·h·wk). CONCLUSIONS: The results suggest that standing may not be a hazardous form of behavior. Given that mortality rates declined at higher levels of standing, standing may be a healthier alternative to excessive periods of sitting. © 2014 by the American college of Sports Medicine.


Staiano A.E.,Pennington Biomedical Research Center
International journal of obesity (2005) | Year: 2012

Body fat and the specific depot where adipose tissue (AT) is stored can contribute to cardiometabolic health risks in children and adolescents. Imaging procedures including magnetic resonance imaging and computed tomography allow for the exploration of individual and group differences in pediatric adiposity. This review examines the variation in pediatric total body fat (TBF), visceral AT (VAT) and subcutaneous AT (SAT) due to age, sex, maturational status and ethnicity. TBF, VAT and SAT typically increase as a child ages, though different trends emerge. Girls tend to accumulate more TBF and SAT during and after puberty, depositing fat preferentially in the gynoid and extremity regions. In contrast, pubertal and postpubertal boys tend to deposit more fat in the abdominal region, particularly in the VAT depot. Sexual maturation significantly influences TBF, VAT and SAT. Ethnic differences in TBF are mixed. VAT tends to be higher in white and Hispanic youth, whereas SAT is typically higher in African American youth. Asian youth typically have less gynoid fat but more VAT than whites. Obesity per se may attenuate sex and ethnic differences. Particular health risks are associated with high amounts of TBF, VAT and SAT, including insulin resistance, hepatic steatosis, metabolic syndrome and hypertension. These risks are affected by genetic, biological and lifestyle factors including physical activity, nutrition and stress. Synthesizing evidence is difficult as there is no consistent methodology or definition to estimate and define depot-specific adiposity, and many analyses compare SAT and VAT without controlling for TBF. Future research should include longitudinal examinations of adiposity changes over time in representative samples of youth to make generalizations to the entire pediatric population and examine variation in organ-specific body fat.


Bray G.A.,Pennington Biomedical Research Center
Obesity | Year: 2013

Objective: Obesity is a public health problem, which increases the risk of chronic diseases and mortality. Weight loss can reduce mortality and improve most of the detrimental health consequences of obesity. Design and Methods: This paper was developed from two presentations to the US Food and Drug Administration (FDA), which has responsibility for reviewing and approving drugs to treat obesity. Results: A weight loss of 5% or more is sufficient to significantly reduce health risks in individuals with impaired glucose tolerance, hypertension, or nonalcoholic fatty liver disease. Slightly more weight loss (16% on average, achieved by surgery) reduces mortality. The goal of medicating for obesity is to help more patients achieve more weight loss. A barrier to drug approval has been the concern that weight loss medications might be used by individuals with little or no health risks, thus mandating a low side effect profile for approval of any drug. This limits the options for patients who have obesity-related health problems that could improve with weight loss. Recently the FDA signaled interest in identifying health benefits in higher risk patients that might justify medications with higher risk; however, the potential impact on a large segment of the population has led the FDA to consider requiring a cardiovascular outcome trial for all obesity medications, either prior to or after approval. Conclusion: This review argues that drugs are needed for obesity because they enhance behaviorally induced weight loss and that new medications for obesity are needed in the approval process. Copyright © 2013 The Obesity Society.


Kushner R.F.,Northwestern University | Ryan D.H.,Pennington Biomedical Research Center
JAMA - Journal of the American Medical Association | Year: 2014

IMPORTANCE: Even though one-third of US adults are obese, identification and treatment rates for obesity remain low. Clinician engagement is vital to provide guidance and assistance to patients who are overweight or obese to address the underlying cause of many chronic diseases. OBJECTIVES: To describe current best practices for assessment and lifestyle management of obesity and to demonstrate how the updated Guidelines (2013) for Managing Overweight and Obesity in Adults based on a systematic evidence review sponsored by the National Heart, Lung, and Blood Institute (NHLBI) can be applied to an individual patient. EVIDENCE REVIEW: Systematic evidence review conducted for the Guidelines (2013) for Managing Overweight and Obesity in Adults supports treatment recommendations in 5 areas (risk assessment, weight loss benefits, diets forweight loss, comprehensive lifestyle intervention approaches, and bariatric surgery); for areas outside this scope, recommendations are supported by other guidelines (for obesity, 1998 NHLBI-sponsored obesity guidelines and those from the National Center for Health and Clinical Excellence and Canadian and US professional societies such as the American Association of Clinical Endocrinologists and American Society of Bariatric Physicians; for physical activity recommendations, the 2008 Physical Activity Guidelines for Americans); a PubMed search identified recent systematic reviews covering depression and obesity, motivational interviewing forweight management, metabolic adaptation toweight loss, and obesity pharmacotherapy. FINDINGS: The first step in obesity management is to screen all adults for overweight and obesity. A medical history should be obtained assessing for the multiple determinants of obesity, including dietary and physical activity patterns, psychosocial factors, weight-gaining medications, and familial traits. Emphasis on the complications of obesity to identify patients who will benefit the most from treatment is more useful than using body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) alone for treatment decisions. The Guidelines (2013) recommend that clinicians offer patients who would benefit from weight loss (either BMI of ≥30 with or without comorbidities or ≥25 along with 1 comorbidity or risk factor) intensive, multicomponent behavioral intervention. Some clinicians do this within their primary care practices; others refer patients for these services. Weight loss is achieved by creating a negative energy balance through modification of food and physical activity behaviors. The Guidelines (2013) endorse comprehensive lifestyle treatment by intensive intervention. Treatment can be implemented either in a clinician's office or by referral to a registered dietitian or commercial weight loss program. Weight loss of 5%to 10% is the usual goal. It is not necessary for patients to attain a BMI of less than 25 to achieve a health benefit. CONCLUSIONS AND RELEVANCE Screening and assessment of patients for obesity followed by initiation or referral of treatment should be incorporated into primary care practice settings. If clinicians can identify appropriate patients for weight loss efforts and provide informed advice and assistance on how to achieve and sustain modest weight loss, they will be addressing the underlying driver of many comorbidities and can have a major influence on patients' health status. Copyright 2014 American Medical Association. All rights reserved.

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