With 61% of the U.S. adult population considered overweight or obese, the National Heart, Lung, and Blood Institute has released a new practical guide to help doctors treat their overweight patients. It consists of a 10-step plan to help the nation's 97 million obese or overweight adults to lose weight and thereby reduce their risk of illness or death from hypertension, diabetes, heart disease and other conditions that have been associated with overweight.

Of particular interest to those with high blood pressure is this specific recommendation:

Weight loss is recommended to lower elevated blood pressure in overweight and obese persons with high blood pressure.

In making this recommendation, the experts evaluated dozens of controlled clinical trials to determine the effect of weight loss on blood pressure and hypertension. They found:

• Strong, consistent evidence that weight loss produced by lifestyle modifications reduces blood pressure both in people with normal blood pressure and those with hypertension.
• Limited evidence that decreases in abdominal fat will reduce blood pressure in overweight nonhypertensive individuals, although not independent of weight loss.
• Considerable evidence that increased aerobic activity to increase cardiorespiratory fitness reduces blood pressure independent of weight loss.
• Suggestive evidence that weight loss induced by most weight loss medications in combination with lifestyle modifications will be accompanied by reductions in blood pressure. The exception is the drug sibutramine.

In preparing a new practical guide to help doctors treat their obese and overweight patients, the NIH panel reviewed relevant treatment strategies designed for weight loss. Their recommendations emphasize the potential effectiveness of weight control using multiple interventions and strategies, including:

• Dietary therapy - A low calorie diet - with a deficit of 500 to 1000 calories/day -- is recommended for weight loss.
• Physical activity - Individuals should start moderate activity for 30-45 minutes, 3 - 5 days/week, and aim for at least 30 minutes or more of moderate physical activity on most, and preferably all, days.
• Behavior therapy - This is a useful adjunct when incorporated into treatment for weight loss and weight maintenance.
• Pharmacotherapy - Using FDA-approved weight loss medications, in combination with diet and physical activity, results in weight loss when used for 6 months to a year.
• Weight loss surgery is an option for carefully selected patients with clinically severe obesity when less invasive methods of weight loss have failed and the patient is at high risk for obesity-associated illness or death.

Further, the panel recommended that dietary therapy, physical activity, and behavior therapy be used in combination for the greatest success. The panel recommends these methods to foster long-term weight control and prevention of weight gain as well.

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