Periodic health examination, 1999 update:
1. Detection, prevention and treatment of obesity

Table 6: Summary of manoeuvres, effectiveness, levels of evidence and recommendations for the prevention and treatment of obesity in adults
Manoeuvre	Effectiveness	Levels of evidence*	Recommendation*
Detection
BMI measurement	In general adult population, BMI measurement is a reliable and valid method of determining body fat content and diagnosing obesity	Cohort studies (II-2)35–39	Because of lack of evidence supporting long-term effectiveness of weight-reduction interventions, there is insufficient evidence to recommend for or against BMI measurement in the periodic health examination of the general population (C)
	For obese adults with obesity-related disease,† weight reduction should be considered if BMI is > 27	RCTs (I);80–82,86,94cohort studies (II-2)89–93,96–102	There is fair evidence to recommend BMI measurement in the periodic health examination of obese adults with obesity-related disease (B)
Prevention
Community-based obesity prevention programs	These programs have not been proven effective in promoting weight reduction. Methodologic limitations in studies preclude definitive conclusions relating to the prevention of obesity	Nonrandomized trials (II-1)48–50	There is insufficient evidence to recommend for or against community-based obesity prevention programs (C)‡
Treatment
Weight-reduction therapy (dietary, pharmacologic, surgical or behavioural)	For obese adults without obesity-related disease,† weight reduction is not effective in long term; methodologic limitations in studies preclude definitive conclusions relating to treatment of obesity	RCTs (I);51–56,65–76,78–82nonrandomized trial (II-1);65cohort studies (II-2)60–64,77,83–86	There is insufficient evidence to recommend for or against weight-reduction therapy in obese adults without obesity-related disease (C)
	For obese adults with obesity-related disease,† weight reduction, at least in short term, can alleviate symptoms and reduce need for drug therapy for related diseases	RCTs (I);80–82,94,95,103,104, 109nonrandomized trials (II-1)89–93,96–102	There is fair evidence to recommend weight-reduction therapy in obese adults with obesity-related disease (B)
Note: RCTs = randomized controlled trials. *See Appendix 1 for definitions of the levels of evidence and grades of recommendations. †Diabetes mellitus, hypertension, coronary artery disease, hyperlipidemia, obstructive sleep apnea. ‡Because of considerable health risks associated with obesity and the limited long-term effectiveness of weight reduction methods, the prevention of obesity should be a high priority for health care providers.

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