Health Care Guideline Prevention and Management of …

1 Health care GuidelinePrevention and Management of Obesity for AdultsHow to cite this document:Fitch A, Everling L, Fox C, Goldberg J, Heim C, Johnson K, Kaufman T, Kennedy E, Kestenbaun C, Lano M, Leslie D, Newell T, O Connor P, Slusarek B, Spaniol A, Stovitz S, Webb B. Institute for Clinical Systems Improvement. Prevention and Management of Obesity for Adults. Updated May of this ICSI Health care Guideline may be distributed by any organization to the organization s employees but, except as provided below, may not be distributed outside of the organization without the prior written consent of the Institute for Clinical Systems Improvement, Inc.

2 If the organization is a legally constituted medical group, the ICSI Health care Guideline may be used by the medical group in any of the following ways: copies may be provided to anyone involved in the medical group s process for developing and implementing clinical guidelines ; the ICSI Health care Guideline may be adopted or adapted for use within the medical group only, provided that ICSI receives appropriate attribution on all written or electronic documents and copies may be provided to patients and the clinicians who manage their care , if the ICSI Health care Guideline is incorporated into the medical group s clinical Guideline other copyright rights in this ICSI Health care Guideline are reserved by the Institute for Clinical Systems Improvement.

3 The Institute for Clinical Systems Improvement assumes no liability for any adap-tations or revisions or modifications made to this ICSI Health care Guideline . Copyright 2013 by Institute for Clinical Systems Improvement and Diagnosis Algorithm Copyright 2013 by Institute for Clinical Systems Improvement 1

4 Text in blue in this algorithm indicates a linked corresponding = Evidence-based recommendation includedNote: Not all numbered boxes have annotated care Guideline : Prevention and Management of Obesity for AdultsSixth EditionMay 2013 Negotiate goals and Management strategy to achieve weight to risk-appropriate resources as Risk Nutrition Physical Behavioral Medications Surgery Activity Management Overweight Low x x x *x+ Obese Class I Moderate x

5 X x x Obese Class II High x x x x *x> 40 Obese Class III Severe x x x x x*May be considered if concomitant obesity-related risk factors or diabetes are present + May be initiated starting at a BMI of 27 or greater with comorbid disease Lap band FDA-approved (not all insurances cover) for obesity with related comorbidities 10 Measure height and weight,and calculate body mass indexUnderweightBMI < Normal weightBMI for major and minor comorbid conditions7 BMI > 25?

6 24 Out of guideline5noAdvise weight maintenanceand manage other risk factors6 Reassess goals and risk factors, and counsel regarding weight maintenance13 Goals achieved?yesnoyes31 Reassess atregular intervals1112 Assess goals and risk factors, and counsel regarding weight maintenanceno9Is patient ready to lose weight?8yesMajor comorbid conditions Waist circumference (males > 35 inches) Established coronary artery disease - History of myocardial infarction - History of angioplasty - History of CABG - History of acute coronary syndrome Peripheral vascular disease Abdominal aortic aneurysm Symptomatic carotid artery disease Type 2 diabetes mellitus Obstructive sleep apneaMajor comorbid conditions Cigarette smoking Hypertension (BP greater than or equal to 140/90)

7 Or current use of antihypertensives LDL cholesterol > 130 mg/dL HDH cholesterol < 40 mg/dL for men, less than 50 mg/dL for women Prediabetes Family history of premature coronary artery disease Age 65 years for males Age 55 years for females or menopausal femalesReturn to Table of ContentsInstitute for Clinical Systems Improvement

8 Of Contents Prevention and Management of Obesity for Adults Sixth Edition/May 2013 Work Group LeaderAngela Fitch, MDBaritrician, Park Nicollet Medical GroupWork Group MembersEssentia HealthKathy Johnson, PharmDPharmacyFairview Health ServicesBridget Slusarek, RN, BSNN ursingHealthPartners Medical Group and Regions HospitalJennifer Goldberg, MS, RD, LDDietitianTracy Newell, RD, LD, CNSDD ietitianPatrick O'Connor, MD, MA, MPHF amily Medicine and GeriatricsMayo ClinicTara Kaufman, MDFamily MedicinePark Nicollet Health ServicesClaire Kestenbaun, RPhPharmacyRidgeview Medical CenterMike Lano, MDFamily MedicineRobbinsdale School District #281 Amber Spaniol, RN, LSN, PHNS chool NurseUniversity of MinnesotaClaudia Fox, MD.

9 MPHD irector of Pediatric Weight Management ProgramUniversity of Minnesota PhysiciansDan Leslie, MDSurgerySteven Stovitz, MDSports MedicineICSI Patient Advisory CouncilLynn EverlingPatient RepresentativeErika KennedyPatient RepresentativeICSIC arla HeimClinical Systems Improvement CoordinatorBeth Webb, RN, BAProject ManagerAlgorithms and Annotations ..1-43 Algorithm ..1 Evidence Grading ..3-4 Recommendations Table ..5 ForewordIntroduction ..6-7 Scope and Target Population ..7 Aims ..7 Clinical Highlights ..7-8 Implementation Recommendation Highlights.

10 8-9 Related ICSI Scientific Documents ..9 Definition ..9 Annotations ..10-43 Quality Improvement Support ..44-57 Aims and Measures ..45 Measurement Specifications ..46-52 Implementation Recommendations ..53 Implementation Tools and Resources ..54 Implementation Tools and Resources Table ..55-57 Supporting ..59-67 Appendices ..68-91 Appendix A Medications Associated with Weight Gain and Weight Loss ..68 Appendix B Physical Activity Prescription ..69-70 Appendix C FDA-Approved Medications for the Treatment of Obesity ..71 Appendix D Overview of Bariatric Procedures.