In 1995, the National Obesity Education Initiative of the National Heart, Lung, and Blood Institute (NHLBI), in cooperation with the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), convened the first Expert Panel on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults to develop clinical practice guidelines for primary care practitioners.

The impetus for these guidelines was the recognition that the prevalence of overweight and obesity in the United States is increasing, and that practitioners need to be alerted to the accompanying health risks. According to the latest statistics from the third National Health and Nutrition Examination Survey, 97 million Americans are overweight or obese. Excess weight is often accompanied by high blood pressure, high blood cholesterol, type 2 diabetes, coronary heart disease, and other health problems. The total costs attributable to obesity-related disease approach $100 billion annually in the United States.

The panel used the principles of evidence-based medicine, including an evidence model and evidence categories. It was the first time a panel thoroughly examined the scientific evidence for risks associated with overweight and obesity, and their treatments, and developed clinical practice recommendations based on their conclusions.

The panel was headed by Dr. F. Xavier Pi-Sunyer, of St. Luke's/Roosevelt Hospital Center in New York City. He and the other 23 panel members methodically and critically examined a vast amount of published scientific evidence. The panel also obtained scientific input from approximately 115 outside reviewers. The result was The Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults: The Evidence Report. Dr. David Schriger of the University of California at Los Angeles, who is a methodologist consultant in the area of evidence-based practice guidelines, and Dr. Elaine Chiquette of the San Antonio Cochrane Center in Texas, who developed the evidence tables, served as key advisors to the panel.

Evidence examined by the panel included: research on the relationship of overweight and obesity to high blood pressure, high blood cholesterol, type 2 diabetes, stroke, congestive heart failure, coronary heart disease, various cancers, osteoarthritis, and sleep apnea; risks associated with the distribution and amount of body fat; and various treatment strategies, including diet, physical activity, behavior therapy, pharmacotherapy, and surgery. The resulting guidelines document how different treatment strategies affect weight loss and how weight control affects the major risk factors for heart disease and stroke.

The guidelines have been reviewed and endorsed by many professional organizations. In fact, because of the associated risks between high blood pressure and high blood cholesterol and overweight and obesity, the document represents the first clinical practice guidelines to be reviewed and endorsed by members of the coordinating committees of both the National Cholesterol Education Program and the National High Blood Pressure Education Program which comprise approximately 52 professional societies, government agencies, and consumer organizations. Two additional groups endorsing the guidelines are the North American Association for the Study of Obesity and the NIDDK National Task force on the Prevention and Treatment of Obesity.

The report, the evidence model and its accompanying evidence tables, and a body mass index calculator are available on the NHLBI website at the following location: http://www.nhlbi.nih. gov./nhlbi/cardio/obes/prof/guidelns/ob_home. htm

An abbreviated version of the evidence report is being prepared and will be distributed to primary care physicians, nurses, registered dietitians and nutritionists, and other health care practitioners.

It is our hope that these clinical guidelines will not only help the health care practitioner understand the importance of weight management but also provide them with the tools to assess and treat their patients more effectively. Equally important, we hope that the guidelines lead to a greater public understanding of obesity and a greater appreciation for the persistent efforts of millions of people to lose weight.

Claude Lenfant, M.D.

Director

National Heart, Lung, and Blood Institute

Evidence Report Endorsements

NATIONAL CHOLESTEROL EDUCATION PROGRAM (NCEP)

Coordinating Committee Member Organizations

Theodore G. Ganiats, M.D., American Academy of Family Physicians, Gary Graham, M.D., American Academy of Insurance Medicine, Ronald Kleinman, M.D., American Academy of Pediatrics, Ann Smith, R.N., C.O.H.N.-S., American Association of Occupational Health Nurses, Richard C. Pasternak, M.D., F.A.C.C., American College of Cardiology, Gerald T. Gau, M.D., American College of Chest Physicians, Ruth Ann Jordan, M.D., American College of Occupational and Environmental Medicine, Thomas E. Nolan, M.D., American College of Obstetricians and Gynecologists, Alan J. Garber, M.D., Ph.D., American Diabetes Association, Inc., Linda Van Horn, Ph.D., R.D., American Dietetic Association, Scott Grundy, M.D., Ph.D., American Heart Association, Sandra Cornett, R.N., Ph.D., American Hospital Association, Yank D. Coble, Jr., M.D., American Medical Association, Joan Watson, R.N., Ph.D., F.A.A.N., American Nurses' Association, Michael Clearfield, D.O., American Osteopathic Association, Joanne Mitten, M.H.E., Association of State and Territorial Health Officials, Gerald J. Wilson, M.B.A., Citizens for Public Action on Blood Pressure and Cholesterol, Inc., Linda Burnes-Bolton, Dr.P.H., R.N., National Black Nurses' Association, Inc., Luther T. Clark, M.D., National Medical Association, Darlene Lansing, M.P.H., R.D., Society for Nutrition Education

Associate Member Coordinating Committee Organizations

Stanley Wallach, M.D., American College of Nutrition, Donald O. Fedder, Dr.P.H., M.P.H., Society for Public Health Education

Federal Agency Liaison Coordinating Committee Representatives

Yvonne L. Bronner, Sc.D., R.D., L.D., NHLBI Ad Hoc Committee on Minority Populations, Francis D. Chesley, M.D., Agency for Health Care Policy and Research, William H. Dietz, M.D., Ph.D., Centers for Disease Control and Prevention, Thomas M. Lasater, Ph.D., Coordinating Committee for the Community Demonstration Studies, Alanna Moshfegh, M.S., R.D., Department of Agriculture, Col. Michael Parkinson, M.D., M.P.H., Department of Defense, Pamela Steele, M.D., Department of Veterans Affairs, Celia Hayes, M.P.H., R.D., Health Resources and Services Administration, Clifford Johnson, M.P.H., National Center for Health Statistics, Linda Meyers, Ph.D., Office of Disease Prevention and Health Promotion

NATIONAL HIGH BLOOD PRESSURE EDUCATION PROGRAM (NHBPEP)

Coordinating Committee Member Organizations

Lee A. Green, M.D., M.P.H., American Academy of Family Physicians, Jack P. Whisnant, M.D., American Academy of Neurology, Barry N. Hyman, M.D., F.A.C.P., American Academy of Ophthalmology, Lisa Mustone-Alexander, M.P.H., P.A., American Academy of Physician Assistants, Henry Guevara, B.S.N., R.N., C.O.H.N.-S., American Association of Occupational Health Nurses, Edward D. Frohlich, M.D., American College of Cardiology, Sheldon G. Sheps, M.D., American College of Chest Physicians, Ron Stout, M.D., American College of Occupational and Environmental Medicine, Jerome D. Cohen, M.D., American College of Physicians, Carlos Vallbona, M.D., American College of Preventive Medicine, James R. Sowers, M.D., American Diabetes Association, Inc., Mary C. Winston, Ed.D., R.D., American Dietetic Association, Daniel W. Jones, M.D., American Heart Association, Roxane Spitzer, Ph.D., F.A.A.N., American Hospital Association, Nancy Houston Miller, B.S.N., American Nurses' Association, Linda Casser, O.D., American Optometric Association, William A. Nickey, D.O., American Osteopathic Association, Raymond W. Roberts, Pharm.D., American Pharmaceutical Association, Pamela J. Colman, D.P.M., American Podiatric Medical Association, Nancy McKelvey, M.S.N., R.N., American Red Cross, Barry L. Carter, Pharm.D., F.C.C.P., American Society of Health-System Pharmacists, Norman M. Kaplan, M.D., American Society of Hypertension, Jackson T. Wright, M.D., Ph.D., Association of Black Cardiologists, Gerald J. Wilson, M.B.A., Citizens for Public Action on Blood Pressure and Cholesterol, Inc., Joseph L. Izzo, Jr., M.D., Council on Geriatric Cardiology, James W. Reed, M.D., F.A.C.P., F.A.C.E., International Society on Hypertension in Blacks, Rita Strickland, Ed.D., R.N., National Black Nurses' Association, Inc., William Manger, M.D., Ph.D., National Hypertension Association, Inc., Murray Epstein, M.D., National Kidney Foundation, Inc., Otelio S. Randall, M.D., F.A.C.C., National Medical Association, Edwin Marshall, O.D., M.P.H., National Optometric Association, Harold W. “Pete” Todd, National Stroke Association, Kathryn M. Kolasa, Ph.D., R.D., L.D.N., Society for Nutrition Education

Federal Agency Liaison Coordinating Committee Representatives

Keith Ferdinand, M.D., F.A.C.C., NHLBI Ad Hoc Committee on Minority Populations, Francis D. Chesley, M.D., Agency for Health Care Policy and Research, H. Mitchell Perry, Jr., M.D., Department of Veterans Affairs, Jay Merchant, M.H.A., Health Care Financing Administration, Vicki Burt, R.N., Sc.M., National Center for Health Statistics, Elizabeth H. Singer, M.S., National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)

NIDDK NATIONAL TASK FORCE ON THE PREVENTION AND TREATMENT OF OBESITY

NORTH AMERICAN ASSOCIATION FOR THE STUDY OF OBESITY (NAASO)