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New American College of Physicians' guidelines for obesity management recommend diet and exercise for everyone and drugs and surgery only for obese patients who are not able to achieve weight-loss goals with diet and exercise alone (Clinical Guidelines, p. 525). ACP guidelines apply to patients with body mass indices (BMIs) over 30. Patients with BMIs over 30 might consider drug therapy. Surgery is reserved for those with BMIs over 40 who also have obesity-related health problems such as high blood pressure, diabetes, or sleep apnea. ACP identifies six drugs that, according to valid clinical studies, aid weight loss, but says that the drugs have potential side effects and do not have long-term studies of effectiveness and safety. Moreover, the average weight loss at one year is small to moderate. ACP discusses several types of obesity (bariatric) surgical procedures and cautions that none have randomized, controlled trials comparing surgery with non-surgical control groups. Furthermore, all have possible side effects, ranging from surgical complications to gall bladder disease and digestive difficulties. The ACP guidelines estimate that the death rate from bariatric surgery, including in-hospital deaths and deaths within 30 days of discharge, range from 0.3 per 100 surgeries to as high as 1.9 per 100 surgeries. ACP recommends that doctors and patients considering obesity surgery seek highly experienced surgeons and surgical centers.
(These guidelines are the subject of a video news release. Call for coordinates. BMI calculators can be accessed at www.DoctorsForAdults.com, the public-patient Web site of the American College of Physicians.)
In a study of 11 healthy adult volunteers given a one-week course of ibuprofen, the volunteers' platelet functions returned to normal by 24 hours after stopping ibuprofen (Brief Communication, p. 506). Patients are often asked to discontinue nonsteroidal anti-inflammatory drugs, such as ibuprofen, for at least one week before surgery. This study suggests that it may not be necessary to discontinue ibuprofen until 24 hours before surgery. However, the authors say that more studies involving patients with many common underlying medical conditions are needed.
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