Recommendations for Obesity (continued)
Recommendations
ACC/AHA
COR
ACC/AHA
LOE
Lifestyle Intervention and Counseling (Comprehensive Lifestyle Intervention) (continued)
4e. Use a very-low-calorie diet (defined as <800 kcal/day)
only in limited circumstances and only when provided by
trained practitioners in a medical care setting where medical
monitoring and high intensity lifestyle intervention can be
provided. Medical supervision is required because of the rapid
rate of weight loss and potential for health complications.
IIa
c
A
4f. Advise overweight and obese individuals who have lost weight
to participate long term (≥1 year) in a comprehensive weight
loss maintenance program.
I A
4g. For weight loss maintenance, prescribe face-to-face or
telephone-delivered weight loss maintenance programs that
provide regular contact (monthly or more frequently) with
a trained interventionist
a
who helps participants engage
in high levels of physical activity (i.e., 200-300 minutes/
week), monitor body weight regularly (i.e., weekly or more
frequently), and consume a reduced-calorie diet (needed to
maintain lower body weight).
I A
Selecting Patients for Bariatric Surgical Treatment for Obesity
(Bariatric Surgical Treatment for Obesity)
5a. Advise adults with a BMI ≥40 kg/m
2
or BMI ≥35 kg/m
2
with
obesity-related comorbid conditions who are motivated to lose
weight and who have not responded to behavioral treatment
with or without pharmacotherapy with sufficient weight loss
to achieve targeted health outcome goals that bariatric surgery
may be an appropriate option to improve health and offer
referral to an experienced bariatric surgeon for consultation
and evaluation.
IIa
d
A
5b. For individuals with a BMI <35 kg/m
2
, there is insufficient
evidence to recommend for or against undergoing bariatric
surgical procedures.
N/A N/A
5c. Advise patients that choice of a specific bariatric surgical
procedure may be affected by patient factors, including age,
severity of obesity/BMI, obesity-related comorbid conditions,
other operative risk factors, risk of short- and long-term
complications, behavioral and psychosocial factors, and
patient tolerance for risk, as well as provider factors (surgeon
and facility).
IIb C
