Treating Heart Disease: Part 3 Obesity

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.

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