It is traditionally a time for giving, and the American Heart Association (AHA) and the American College of Cardiology (ACC) have been very generous in the lead up to the holiday season, releasing four new sets of cardiovascular risk guidelines. Despite this time of year supposedly being one of good will, there has been some robust discussion among experts in the field, particularly with respect to the latest blood cholesterol guidelines (see here for an overview by DRG's Joseph Dwyer and Stefanie Matlok). The AHA/ACC guidelines on the management of overweight and obesity in adults, developed in association with the Obesity Society (TOS), have also received a mixed reception. Including from me (see here) bah, humbug.

The American Association of Clinical Endocrinologists (AACE) has also decided not to endorse the new guidelines, and expressed its concerns in a statement, which included the following:

These new guidelines fail to classify obesity as a disease and continue the paradigm of BMI-centric risk stratification, both of which are contrary to recently stated AACE positions. Moreover, the guidelines do not include any of the new FDA-approved pharmacologic agents to assist with weight loss. As a result, the focus of these new guidelines is primarily on lifestyle intervention and bariatric surgery. This is insufficient to meet the needs of the entire population of patients with overweight or obesity-related complications and is therefore inadequate.

I agree. The new AHA/ACC/TOS obesity guidelines give a thorough summary of recent data, but that is all. The new version has been trimmed down from 262 pages to a much more manageable 70 pages, which should make them more accessible to primary care practitioners, but there is nothing new in them: diet and excise remain the cornerstone of overweight and obesity management; behavioral interventions can work, but patients need good support; and bariatric surgery is the most efficacious treatment but it has risks.

A significant proportion of overweight and obese patients do not qualify for surgery and are not able to achieve weight loss targets with lifestyle interventions alone. The premise of the new guidelines, to provide clearer guidance for primary care providers, is to be lauded. But, with two new antiobesity agents recently launched and two more expected to launch in 2014, recommendations regarding these interventions would be more welcome to primary care practitioners than reconfirmation of what they already know. Delaying publication of the obesity management guidelines to include such information would have been preferable.

As the ACC, AHA and collaborating societies are planning to begin updating the guidelines in 2014, presumably to include assessment of the pharmacotherapeutic options, it begs the question: were all the time and resources used to develop the 2013 guidelines worth it? Like many patients who are overweight or obese, these guidelines have benefited from being slimmed down, but they need some pharmacotherapeutic input to really make a difference.

Tim Blackstock, M.B., Ch.B., is a business insights analyst in the Cardiovascular, Metabolic and Renal Disorders team at Decision Resources Group.

In-depth analysis of the obesity area, with accompanying epidemiology driven sales forecast models, is presented in Decision Resources Obesity Pharmacor. The 2013 edition was published on October 31.

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