Briefly describe a specific question, or set of related questions, about a health care test or treatment that this program should consider.

Treating Adult Obesity - Which specific dietary strategies (with and without medication), behavioral treatment approaches, and physical activity approaches work?

In a direct comparison, which is most effective in helping overweight and obese adults lose weight and maintain weight loss.

Does your question include a comparison of different health care approaches? (If no, your topic will still be considered.)

yes

If yes, explain the specific technologies, devices, drugs, or interventions you would like to see compared:

Comparisons may include, but are not limited to:

One or more strategies for weight loss in adults - for example, Atkins Diet vs. Zone Diet vs. Weight Watchers vs. Ornish Diet; Diet advice/600 calorie deficit/low-fat diet vs very low fat diet; Diet and behavior therapy (BT) vs diet only; physical activity (PA) vs diet; PA + diet + BT vs diet alone, etc.

Methods of delivery - for example, individual treatment vs family treatment; individual treatment vs. group treatment

Intensity of services - for example, higher intensity physical activity vs lower intensity physical activity

Type of practitioner

What patients or group(s) of patients does your question apply to? (Please include specific details such as age range, gender, coexisting diagnoses, and indications for therapy.)

Adults in the U.S. who are overweight or obese

Are there subgroups of patients that your question might apply to? (For example, an ethnic group, stage or severity of a disease.)

All of AHRQ's priority populations except children would apply (low income, minority/ethnic groups, women, elderly, etc.)

Describe the health-related benefits you are interested in. (For example, improvements in patient symptoms or problems from treatment or diagnosis.)

Health outcomes of interest include but are not limited to: weight loss, maintenance of weight loss, improvements in blood pressure, glucose level, and cholesterol level, improved physical fitness; improved quality of life and emotional functioning; decreased morbidity from selected conditions; Reduced disability; reduced mortality.

Describe any health-related risks, side effects, or harms that you are concerned about.

Harms include but are not limited to: side effects of medication; harms associated with counseling; injuries due to physical activity; hypoglycemia; nutritional deficits, cardiovascular disease, bone mass loss, death

Appropriateness for EHC Program

Does your question include a health care drug, intervention, device, or technology available (or likely to be available) in the U.S.?

yes

Which priority area(s) and population(s) does this topic apply to? (check all that apply)

EHC Priority Conditions (updated in 2008)

• Obesity

AHRQ Priority Populations

• Low income groups
• Minority groups
• Women
• Elderly

Federal Health Care Program

• Medicaid
• Medicare

Importance

Describe why this topic is important.

According to an analysis by the CDC, overweight and obesity due to poor diet and physical inactivity ranked second only to tobacco as an actual cause of death in the United States in 2000, accounting for around 365,000 (15.2%) of all deaths. Obesity and overweight are most commonly defined and classified by body mass index (BMI), calculated as weight in kilograms divided by height in meters squared. Results from the 1999-2002 National Health and Nutrition Examination Survey (NHANES) indicate that 30% of U.S. adults age 20 years and over are obese (BMI ? 30.0), with another 35% falling into the category of overweight (BMI 25.0 - 29.9). These prevalences have increased since 1988-1994 NHANES from 23% and 34%, respectively.

Overweight and obesity ultimately results from an energy imbalance involving excessive energy consumption and/or inadequate physical activity. This imbalance causes both increased fat mass and enlarged fat cells, which are associated with multiple chronic diseases, including diabetes mellitus, hypertension, heart disease, certain types of cancer (e.g., colorectal, breast, endometrial, prostate), gallbladder disease, non-alcoholic fatty liver disease, osteoarthritis, and sleep apnea. Recently, BMI and waist circumference have been shown to be inversely associated with cardiorespiratory fitness in adolescents and adults. Obesity has been linked to premature mortality. In an analysis of data from the Framingham Study, 40-year-old obese nonsmoking women lost 7.1 years of life and obese nonsmoking men lost 5.8 years.3 Although some effects of obesity may be mediated through other risk factors, a recent study showed that obesity at middle age predicts hospitalization and mortality from coronary heart disease, independent of its associations with other coronary risk factors. There is also evidence that obese people are at increased risk of psychological dysfunction and experience decreased health-related quality of life. The optimum healthy B

What specifically motivated you to ask this question? (For example, you are developing a clinical guideline, working with a policy with large uncertainty about the appropriate approach, costly intervention, new research you have read, items in the media you may have seen, a clinical practice dilemma you know of, etc.)

The U.S. Preventive Services Task Force is currently updating its recommendation on screening for obesity in adults. This information would be used to enhance its recommendation statement.

Further, in the area of prevention, the Department of Health and Human Services is focusing on weight management.

Does your question represent uncertainty for clinicians and/or policy-makers? (For example, variations in clinical care, controversy in what constitutes appropriate clinical care, or a policy decision.)

yes

If yes, please explain:

Clinicians are uncertain what are the most effective treatment strategies to recommend for their overweight and obese adult patients.

Potential Impact

How will an answer to your research question be used or help inform decisions for you or your group?

The U.S. Preventive Services Task Force will use information from this report to enhance its updated recommendation statement on screening for obesity in adults.

Describe the timeframe in which an answer to your question is needed.

The end of 2010/spring 2011

Describe any health disparities, inequities, or impact on vulnerable populations your question applies to.

This questions applies to many of AHRQ's priority populations.

Nominator Information

Other Information About You: (optional)

Please choose a description that best describes your role or perspective: (you may select more than one category if appropriate)

The U.S. Preventive Services Task Force will use information from this report to enhance its updated recommendation statement on screening for obesity in adults.

Are you making a suggestion as an individual or on behalf of an organization?

Organization

Please tell us how you heard about the Effective Health Care Program

AHRQ Supports the U.S. Preventive Services Task Force