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Approach to Obesity Treatment in Primary Care: A Review

Author/s: 
Susan Z Yanovski, Jack A Yanovski

Importance: More than 40% of US adults have obesity, which increases the risks for multiple chronic diseases and premature mortality. Historically, nonsurgical interventions often have not led to sufficient weight loss and maintenance to improve health, but highly effective antiobesity medications (AOMs) have recently become available, and additional effective therapeutics are under development. Given that most medical care for adults with obesity is delivered in primary care settings, guidance for integrating weight-management approaches is needed.

Observations: Lifestyle interventions can lead to a mean weight loss of 2% to 9% of initial weight at 1 year and increase the likelihood of weight loss of 5% or more, but weight regain over time is common even with continued treatment. Adjunctive treatments, including AOMs and surgical approaches, can lead to larger, more sustained weight loss and improvements in numerous obesity-associated medical conditions. Highly effective AOMs, including nutrient-stimulated hormone-based therapies, induce mean weight loss of 15% or more. Barriers to intervention, including access to care, have a disproportionate influence on populations most affected by obesity and its consequences.

Conclusions and relevance: Primary care clinicians play a vital role in the assessment, management, and support of patients with obesity. With careful clinical assessment and shared decision-making, a flexible treatment plan can be developed that reflects evidence of treatment efficacy, patient preference, and feasibility of implementation. Adjunctive therapies to lifestyle interventions, including more effective pharmacotherapeutics for obesity, offer hope to patients and the potential for considerable improvements in health and quality of life.

Keywords 
obesity lifestyle behaviors diet weight loss weight gain body weight

Association of Smoking Cessation and Cardiovascular, Cancer, and Respiratory Mortality

Author/s: 
Blake Thomson, Farhad Islami

There were an estimated 28 million current cigarette smokers in the US, and approximately twice as many former smokers, in 2021.1 Smoking cessation is associated with large reductions in excess mortality compared with continued smoking,2 but the timescale over which cause-specific mortality benefits of cessation may develop is unclear.3-6 Quantifying excess cause-specific mortality among former smokers by years since quitting may inform clinical decision-making and screening programs.

Keywords 
tobacco e-cigarettes smoking cessation lifestyle behaviors

New Physical Activity Guidelines A Call to Activity for Clinicians and Patients

Author/s: 
Thompson, Paul D., Eijsvogels, Thijs M. H.

These guidelines update those presented in 2008 and expand the medical conditions for which physical activity is likely beneficial. The final recommendations are based on a systematic literature review by a committee of exercise and health experts and include only those recommendations judged to have strong, or moderately strong, scientific support. Achieving the guideline-recommended levels of physical activity will be difficult for the entire nation, given that approximately 80% of US adults and adolescents do not presently accumulate sufficient physical activity for optimum health.1 Efforts to increase physical activity among people in the United States will require the cooperation of many sectors of society including clinicians, other health care professionals, and health care organizations. Achieving these recommendations will substantially improve individual and population health. So what are the key messages for clinicians, and what should clinicians tell patients?

Keywords 
physical activity lifestyle behaviors

The Physical Activity Guidelines for Americans

Author/s: 
Piercy, Katrina L., Trioano, Richard P., Ballard, Rachel M., Carlson, Susan A., Fulton, Janet E., Galuska, Deborah A., George, Stephanie M., Olson, Richard D.

Importance  Approximately 80% of US adults and adolescents are insufficiently active. Physical activity fosters normal growth and development and can make people feel, function, and sleep better and reduce risk of many chronic diseases.

Objective  To summarize key guidelines in the Physical Activity Guidelines for Americans, 2nd edition (PAG).

Process and Evidence Synthesis  The 2018 Physical Activity Guidelines Advisory Committee conducted a systematic review of the science supporting physical activity and health. The committee addressed 38 questions and 104 subquestions and graded the evidence based on consistency and quality of the research. Evidence graded as strong or moderate was the basis of the key guidelines. The Department of Health and Human Services (HHS) based the PAG on the 2018 Physical Activity Guidelines Advisory Committee Scientific Report.

Recommendations  The PAG provides information and guidance on the types and amounts of physical activity to improve a variety of health outcomes for multiple population groups. Preschool-aged children (3 through 5 years) should be physically active throughout the day to enhance growth and development. Children and adolescents aged 6 through 17 years should do 60 minutes or more of moderate-to-vigorous physical activity daily. Adults should do at least 150 minutes to 300 minutes a week of moderate-intensity, or 75 minutes to 150 minutes a week of vigorous-intensity aerobic physical activity, or an equivalent combination of moderate- and vigorous-intensity aerobic activity. They should also do muscle-strengthening activities on 2 or more days a week. Older adults should do multicomponent physical activity that includes balance training as well as aerobic and muscle-strengthening activities. Pregnant and postpartum women should do at least 150 minutes of moderate-intensity aerobic activity a week. Adults with chronic conditions or disabilities, who are able, should follow the key guidelines for adults and do both aerobic and muscle-strengthening activities. Recommendations emphasize that moving more and sitting less will benefit nearly everyone. Individuals performing the least physical activity benefit most by even modest increases in moderate-to-vigorous physical activity. Additional benefits occur with more physical activity. Both aerobic and muscle-strengthening physical activity are beneficial.

Conclusions and Relevance  The Physical Activity Guidelines for Americans, 2nd edition, provides information and guidance on the types and amounts of physical activity that provide substantial health benefits. Health professionals and policy makers should facilitate awareness of the guidelines and promote the health benefits of physical activity and support efforts to implement programs, practices, and policies to facilitate increased physical activity and to improve the health of the US population.

Keywords 
physical activity lifestyle behaviors
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