As you all know by now, the American Heart Association and the American College of Cardiology published new guidelines on the prevention & treatment of heart disease earlier this week, focusing on cholesterol, lifestyle and obesity. However, I must admit to some disappointment as I read over the obesity guideline.
For instance, we're directed to measure & weight at each visit, at least annually. Really? Then the definition of overweight & obesity (class I, II & III) are reviewed. We are then advised to assess the need to lose weight. But wait! No pun intended, this is a guideline on obesity. Of course we're talking about people who are obese and need to lose weight! To add fuel to the fire, we are then told to advise our patients to avoid weight gain. No sh-t, Sherlock, pardon my French. Here I was hoping for new guidance on what diet to recommend. Or perhaps what medication to recommend. Or even a mention of body composition vs body mass index and what to do with those who are skinny fat.
Ironically, a systematic review was published yesterday early online in JAMA in which the authors concluded that weight loss medication used in conjunction w/lifestyle modifications did lead to greater weight loss than placebo. Orlistat & lorcaserin were noted to be least beneficial while the highest dose of phentermine plus topiramate had 3 times the relative weight loss.
So here it is w/2014 fast approaching and we still don't have a magic bullet to ward off obesity. As far as this guideline is concerned, it still comes down to eating less & moving more. That and maybe pop a pill.
What I found intriguing is that the recommendations to lower blood pressure are very similar to those to lower cholesterol. In other words, the authors found strong evidence to support consuming mostly vegetables, fruits & whole grains while limiting sweets, sugar-sweetened beverages, and red meat. Low-fat dairy products, poultry, fish, legumes & non-tropical vegetable oils & nuts help serve as an alternative.
While strong, the evidence regarding physical activity was not nearly as impressive as that of diet, whether attempting to improve cholesterol or blood pressure. Still the authors concluded that adults should be encouraged to reduce LDL cholesterol & blood pressure via 3-4 40 minute sessions a week of moderate-to-high intensity physical activity.
So there you have it. But before arranging for more meds, see if you can improve your risk factors via lifestyle modification.