The Evidence Report - National Institutes of Health

1 CLINICALGUIDELINESONTHEIDENTIFICATION,EV ALUATION, ANDTREATMENTOFOVERWEIGHTANDOBESITYINADUL TSThe Evidence ReportNATIONAL Institutes OF HEALTHNATIONAL HEART, LUNG, AND BLOOD INSTITUTEO besity Education InitiativeCLINICALGUIDELINESON THEIDENTIFICATION,EVALUATION, ANDTREATMENT OFOVERWEIGHT ANDOBESITY INADULTSThe Evidence ReportNIH PUBLICATIONNO. 98-4083 SEPTEMBER1998 NATIONALINSTITUTESOFHEALTHN ational Heart, Lung, and Blood institute in cooperation with The National institute ofDiabetes and Digestive andKidney DiseasesiiNHLBI Obesity Education Initiative Expert Panel on the Identification,Evaluation, and Treatment of Overweight and Obesity in AdultsF.

2 Xavier Pi-Sunyer, , Chair of the PanelChief, Endocrinology, Diabetes, and Nutrition Director, Obesity Research CenterSt. Luke's/Roosevelt Hospital CenterProfessor of MedicineColumbia University College of Physicians and SurgeonsNew York, NY Diane M. Becker, , for Health PromotionAssociate ProfessorDepartment of MedicineThe Johns Hopkins UniversityBaltimore, MDClaude Bouchard, of Exercise PhysiologyPhysical Activity SciencesLaboratoryLaval UniversitySainte Foy, QuebecCANADAR ichard A. Carleton, of MedicineBrown University School of MedicinePawtucket, RI Graham A.

3 Colditz, , Professor of MedicineHarvard Medical School Channing LaboratoryBoston, MA William H. Dietz, , of Nutrition and Physical ActivityNational Center for Chronic Disease Prevention and Health PromotionCenters for Disease Control and PreventionAtlanta, GA John P. Foreyt, of Medicine and Director Nutrition Research ClinicBaylor College of MedicineHouston, TX Robert J. Garrison, ProfessorDepartment of Preventive MedicineUniversity of Tennessee, MemphisMemphis, TN Scott M. Grundy, , for Human NutritionUniversity of TexasSouthwestern Medical Center at DallasDallas, TX Barbara C.

4 Hansen, of PhysiologyDirector of Obesity and Diabetes Research CenterUniversity of Maryland School of MedicineBaltimore, MD Millicent Higgins, of EpidemiologySchool of Public HealthUniversity of MichiganAnn Arbor, MI iiiJames O. Hill, Director of ResearchCenter for Human NutritionUniversity of Colorado Health Sciences CenterDenver, CO Barbara V. Howard, Research InstituteWashington, DC Robert C. Klesges, of Memphis Prevention CenterUniversity of MemphisMemphis, TNRobert J. Kuczmarski, , AnalystNational Center for Health StatisticsCenters for Disease Control and PreventionHyattsville, MD Shiriki Kumanyika, , , and HeadDepartment of Human Nutrition and Dietetics The University of Illinois at ChicagoChicago, ILR.

5 Dee Legako, Care Canyon Park Family Physicians, , OK T. Elaine Prewitt, , ProfessorDepartment of Preventive Medicine and EpidemiologyLoyola University Medical CenterMaywood, IL Albert P. Rocchini, of CardiologyUniversity of Michigan Medical CenterAnn Arbor, MI Philip L. Smith, of MedicineDivision of Pulmonary and Critical Care MedicineThe Johns Hopkins Asthma and Allergy CenterBaltimore, MD Linda G. Snetselaar, , ProfessorHead of Preventive Nutrition EducationDepartment of Preventive MedicineUniversity of IowaIowa City, IA James R.

6 Sowers, of Medicine and PhysiologyDirectorDivision of Endocrinology, Metabolism, and HypertensionWayne State University School of MedicineUniversity Health CenterDetroit, MI Michael Weintraub, of Drug Evaluation VFood and Drug AdministrationRockville, MD David F. Williamson, , of Diabetes Translation Centers for Disease Control and PreventionChamblee, GA ivG. Terence Wilson, K. Buros Professor of PsychologyDirector, Rutgers Eating Disorders ClinicPiscataway, NJ Ex-Officio MembersClarice D. Brown, ManagerCODA Research, Spring, MD Karen A.

7 Donato, , *Executive Director of the PanelCoordinatorNHLBI Obesity Education InitiativeNational Heart, Lung, and Blood InstituteNational Institutes of HealthBethesda, MD Nancy Ernst, , *Nutrition CoordinatorOffice of the DirectorDivision of Epidemiology and Clinical ApplicationsNational Heart, Lung, and Blood InstituteNational Institutes of HealthBethesda, MD D. Robin Hill, *Social Science AnalystBehavioral Medicine BranchDivision of Epidemiology and Clinical ApplicationsNational Heart, Lung, and Blood InstituteNational Institutes of HealthBethesda, MD Michael J.

8 Horan, , *DirectorDivision of Heart and Vascular DiseasesNational Heart, Lung, and Blood InstituteNational Institutes of HealthBethesda, MD Van S. Hubbard, , , NIH Division of Nutrition Research CoordinationChief, Nutritional Sciences BranchNational institute of Diabetes and Digestive and Kidney DiseasesNational Institutes of HealthBethesda, MD James P. Kiley, *DirectorAirway Biology and Disease ProgramDivision of Lung DiseasesNational Heart, Lung, and Blood InstituteNational Institutes of HealthBethesda, MD Eva Obarzanek, , , *Research NutritionistPrevention Scientific Research GroupDivision of Epidemiology and Clinical ApplicationsNational Heart, Lung, and Blood InstituteNational Institutes of HealthBethesda, MD ConsultantDavid Schriger, , , ProfessorUCLA Emergency Medicine CenterUniversity of California at Los AngelesSchool of MedicineLos Angeles.

9 CA San Antonio Cochrane CenterElaine Chiquette, Cochrane Center at San AntonioAudie L. Murphy Memorial Veterans HospitalSan Antonio, TX * NHLBI Obesity Education Initiative Task Force MembersvCynthia Mulrow, , Cochrane Center at San AntonioAudie L. Murphy Memorial Veterans HospitalSan Antonio, TX StaffAdrienne Blount, Sciences, , MD Maureen Harris, , Sciences, , MD Anna Hodgson, Sciences, , MD Pat Moriarty, , Sciences, , MD The panel acknowledges the assistance of Chotani, Johns Hopkins University; Klesges, University of Memphis; Pories, East Carolina University; Dr.

10 IvanBaines, NHLBI; Dr. Christine Kelly, NHLBI;Glen Bennett, NHLBI; Dr. Fred Heydrick,BioReview; Debbie Lurie, Prospect Associates;Estelle Schwalb, Prospect Associates; LoriMcCray, Sciences, Inc.; and Niyati Pandya, Sciences, Summaryxi1. Introduction1A. Rationale for Guidelines Development1B. Objectives of the Guidelines2C. Guideline Development Methodology2D. Statement of Assumptions5E. Intended Users of These Guidelines52. Overweight and Obesity: Background6A. Health and Economic Costs61. Prevalence and Time Trends62. Demographic Variations in Overweight and Obesity Prevalence93.