Primary care clinician involvement ranged from limited interactions with participants in interventions conducted by other practitioners or individuals ie, group-based interventions conducted by lifestyle coaches or registered dietitians to reinforcing intervention messages through brief counseling sessions.

In the trials not involving a primary care clinician, the interventionists were highly diverse and included behavioral therapists, psychologists, registered dietitians, exercise physiologists, lifestyle coaches, and other staff. The majority of the trials focused on individual participants, but a few interventions invited family members to participate.

Trials used various delivery methods group, individual, mixed, and technology- or print-based. Group-based interventions ranged from 8 group sessions over 2. These interventions consisted of classroom-style sessions lasting 1 to 2 hours.

Most of the individual-based interventions provided individual counseling sessions, with or without ongoing telephone support. The median number of sessions in the first year for individual-based interventions was Mixed interventions included comparatively equal numbers of group- and individual-based counseling sessions, with or without other forms of support eg, telephone-, print-, or web-based.

Most of these interventions took place for more than 1 year and involved more than 12 sessions median, 23 total sessions in the first year. Among technology-based interventions, intervention components included computer- or web-based intervention modules, 1 web-based self-monitoring, mobile phone—based text messages, smartphone applications, social networking platforms, or DVD learning.

Only 1 trial delivered its intervention through print-based tailored materials. Rates of participant adherence were generally high. In addition, all study participants completed more than two-thirds of the intervention. Participation rates did decline over time.

Behavior-based weight loss maintenance trials were designed to maintain weight loss by continuing dietary changes and physical activity.

Most weight loss maintenance interventions lasted for 12 to 18 months; the majority of interventions had more than 12 sessions in the first year.

Interventions that combined pharmacotherapy with behavioral interventions reported greater weight loss and weight loss maintenance over 12 to 18 months compared with behavioral interventions alone.

These trials also had high attrition. In addition, data were lacking about the maintenance of improvement after discontinuation of pharmacotherapy. The USPSTF has made recommendations on screening for abnormal blood glucose levels and type 2 diabetes, 13 screening for high blood pressure, 14 statin use in persons at risk for cardiovascular disease, 15 counseling for tobacco smoking cessation, 16 aspirin use in certain persons for prevention of cardiovascular disease, 17 and behavioral counseling interventions to promote a healthful diet and physical activity for cardiovascular disease prevention in adults with and without common risk factors 18 , 19 Table.

The USPSTF recommends that clinicians screen for obesity in children 6 years or older and offer or refer them to a comprehensive, intensive behavioral intervention B recommendation.

The Community Preventive Services Task Force recommends multicomponent interventions that use technology-supported coaching or counseling to help adults lose weight and maintain weight loss. Psychosocial, quality of life, and patient-centered outcomes should continue to be evaluated in future studies.

Well-designed pragmatic trials and improved reporting of intervention characteristics to enable evaluation and dissemination of interventions in primary care settings are needed.

Future research is needed on factors eg, genetics or untreated medical or psychological conditions that may be barriers to weight loss during behavioral interventions.

Trials are needed that examine whether interventions that focus on both weight loss and support of persons living with obesity improve patient-centered outcomes. Comparative effectiveness trials would provide more evidence about the components of effective interventions.

The age-adjusted prevalence of obesity is higher among non-Hispanic black Among men, obesity prevalence is The USPSTF commissioned a systematic evidence review to update its recommendation on screening for obesity in adults.

The USPSTF reviewed evidence on interventions behavioral counseling and pharmacotherapy for weight loss or weight loss maintenance that can be provided in or referred from a primary care setting.

Waist circumference may be an acceptable alternative to BMI measurement in some patient subpopulations. Surgical weight loss interventions and nonsurgical weight loss devices eg, gastric balloons are considered to be outside the scope of the primary care setting. The USPSTF reviewed the evidence on 4 types of interventions: behavior-based weight loss 80 trials , behavior-based weight loss maintenance 9 trials , pharmacotherapy-based weight loss 32 trials , and pharmacotherapy-based weight loss maintenance 3 trials.

In the weight loss maintenance trials, patient randomization occurred after prior weight loss. The USPSTF identified 89 behavior-based weight loss and weight loss maintenance trials, 26 of which were good quality and 63 of which were fair quality.

Eighty trials focused on behavior-based weight loss interventions. In more than half of the trials 40 trials , participants came from an unselected population of adults who were overweight or had obesity.

In the remaining trials, enrolled participants had elevated clinical or subclinical risk of cardiovascular disease or cancer.

The mean baseline BMI ranged from 25 to Fourteen trials were limited to women, and 4 trials were restricted to men. Socioeconomic status was not well reported in trials; however, when described, most participants were of medium to high socioeconomic status.

Nine trials focused on behavior-based weight loss maintenance. In most trials 8 trials , participants came from an unselected population of adults who were overweight or had obesity. One trial enrolled participants with cardiovascular risk factors.

Participants were required to meet weight loss goals before enrollment. The mean BMI at enrollment ranged from When this information was reported, participants were mostly white and of medium to high socioeconomic status. Intermediate outcomes eg, prevalence of high blood pressure or the metabolic syndrome, use of cardiovascular disease medications, or estimated year risk of cardiovascular disease were seldom reported.

Effects of interventions on cardiovascular disease risk, the metabolic syndrome, hypertension or hyperlipidemia diagnoses, and medication use were mixed. Twelve of the 13 trials enrolled participants with impaired fasting glucose or increased risk for type 2 diabetes ie, persons with a family history of diabetes or personal history of gestational diabetes or the metabolic syndrome.

In the remaining trials, the differences between the intervention and control groups were not statistically significant. However, these trials were smaller and shorter than the larger trials. Participants in behavior-based weight loss intervention groups demonstrated greater weight loss and decreased waist circumference compared with those in control groups at 24 months of follow-up.

Pharmacotherapy trials evaluated liraglutide 4 trials , lorcaserin 4 trials , naltrexone and bupropion 3 trials , orlistat 21 trials , and phentermine-topiramate 3 trials in combination with behavioral counseling. All trials were fair quality. Across all trials, both study groups ie, placebo and pharmacotherapy groups received the same behavioral interventions.

The trials were conducted in the United States, Europe, Australia, New Zealand, and other regions. Participant characteristics were similar to those in the behavioral intervention trials. Many trials required participants to demonstrate medication adherence, meet weight loss goals before enrollment, or both.

The more narrowly defined inclusion criteria of these trials resulted in more selective populations enrolled as study participants. Pharmacotherapy-based weight loss maintenance trials did not report any health outcomes.

However, these trials were limited by high dropout rates. The USPSTF looked for evidence on potential harms of behavioral weight-loss interventions, including increased risk for fractures, serious injuries resulting from increased physical activity, and an increased risk for eating disorders, weight stigma, and weight fluctuation.

Fifteen trials were good quality and 15 trials were fair quality. Intervention harms were sparsely reported. Overall, the trials showed no serious harms, and most trials observed no difference in the rate of adverse events between intervention and control groups.

Three trials demonstrated mixed results for musculoskeletal problems. Pharmacological agents for weight loss have multiple potential harms, including anxiety, pancreatitis, and gastrointestinal symptoms with liraglutide; dizziness and cognitive impairment with lorcaserin; nausea, constipation, headache, and dry mouth with naltrexone and bupropion; cramps, flatus, fecal incontinence, and oily spotting with orlistat; and mood disorders, elevated heart rate, and metabolic acidosis with phentermine-topiramate.

These harms have not been well studied. Serious adverse events were uncommon and similar between groups. The higher rate of adverse events in the medication groups resulted in higher dropout rates than in the placebo groups.

The USPSTF found adequate evidence that intensive, multicomponent behavioral interventions in adults with obesity can lead to clinically significant improvements in weight status and reduce the incidence of type 2 diabetes among adults with obesity and elevated plasma glucose levels; these interventions are of moderate benefit.

The USPSTF found adequate evidence that behavior-based weight loss maintenance interventions are of moderate benefit. The USPSTF found adequate evidence that the harms of intensive, multicomponent behavioral interventions including weight loss maintenance interventions in adults with obesity are small to none.

Therefore, the USPSTF concludes with moderate certainty that offering or referring adults with obesity to intensive behavioral interventions or behavior-based weight loss maintenance interventions has a moderate net benefit.

Various environmental and genetic factors play an important role in the development of obesity. As a result, weight loss can be challenging. Weight declines after the sixth decade of life. Losing weight may reduce the risk for illness and mortality and improve overall health.

A draft version of this recommendation statement was posted for public comment on the USPSTF website from February 20 to March 19, In response to comments, the USPSTF expanded the description of behavioral counseling interventions in the Clinical Considerations section.

In the Discussion section, the USPSTF clarified why persons who are overweight were not included in the recommendation statement, expanded the description on harms of behavioral counseling interventions and pharmacotherapy, and added the limitations of pharmacotherapy trials.

This recommendation updates the USPSTF recommendation statement on screening for obesity in adults B recommendation. The Canadian Task Force on Preventive Health Care recommends screening for obesity in adults with BMI at primary care visits.

The US Preventive Services Task Force USPSTF members include the following individuals: Susan J. Curry, PhD University of Iowa, Iowa City ; Alex H. Krist, MD, MPH Fairfax Family Practice Residency, Fairfax, Virginia, and Virginia Commonwealth University, Richmond ; Douglas K.

Owens, MD, MS Veterans Affairs Palo Alto Health Care System, Palo Alto, California, and Stanford University, Stanford, California ; Michael J.

Barry, MD Harvard Medical School, Boston, Massachusetts ; Aaron B. Davidson, PhD, MASc Columbia University, New York, New York ; Chyke A. Doubeni, MD, MPH University of Pennsylvania, Philadelphia ; John W. Epling Jr, MD, MSEd Virginia Tech Carilion School of Medicine, Roanoke ; David C.

Grossman, MD, MPH Kaiser Permanente Washington Health Research Institute, Seattle ; Alex R. Seth Landefeld, MD University of Alabama at Birmingham ; Carol M. Mangione, MD, MSPH University of California, Los Angeles ; Maureen G. Phipps, MD, MPH Brown University, Providence, Rhode Island ; Michael Silverstein, MD, MPH Boston University, Boston, Massachusetts ; Melissa A.

Simon, MD, MPH Northwestern University, Evanston, Illinois ; Chien-Wen Tseng, MD, MPH, MSEE University of Hawaii, Honolulu, and Pacific Health Research and Education Institute, Honolulu, Hawaii ; John B. Wong, MD Tufts University School of Medicine, Boston, Massachusetts.

Conflict of Interest Disclosures: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. All members of the USPSTF receive travel reimbursement and an honorarium for participating in USPSTF meetings.

No other disclosures were reported. The US Congress mandates that the Agency for Healthcare Research and Quality AHRQ support the operations of the USPSTF. Disclaimer: Recommendations made by the USPSTF are independent of the US government.

They should not be construed as an official position of AHRQ or the US Department of Health and Human Services. Copyright Notice: USPSTF recommendations are based on a rigorous review of existing peer-reviewed evidence and are intended to help primary care clinicians and patients decide together whether a preventive service is right for a patient's needs.

To encourage widespread discussion, consideration, adoption, and implementation of USPSTF recommendations, AHRQ permits members of the public to reproduce, redistribute, publicly display, and incorporate USPSTF work into other materials provided that it is reproduced without any changes to the work of portions thereof, except as permitted as fair use under the US Copyright Act.

AHRQ and the US Department of Health and Human Services cannot endorse, or appear to endorse, derivative or excerpted materials, and they cannot be held liable for the content or use of adapted products that are incorporated on other Web sites. Any adaptations of these electronic documents and resources must include a disclaimer to this effect.

Advertising or implied endorsement for any commercial products or services is strictly prohibited. This work may not be reproduced, reprinted, or redistributed for a fee, nor may the work be sold for profit or incorporated into a profit-making venture without the express written permission of AHRQ.

This work is subject to the restrictions of Section of the Social Security Act, 42 U. When parts of a recommendation statement are used or quoted, the USPSTF Web page should be cited as the source.

Behavioral and Pharmacotherapy Weight Loss Interventions to Prevent Obesity-Related Morbidity and Mortality in Adults: An Updated Systematic Review for the US Preventive Services Task Force: Evidence Synthesis No.

Rockville, MD: Agency for Healthcare Research and Quality; AHRQ publication EF Ogden CL, Carroll MD, Fryar CD, Flegal KM.

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