The Canadian Task Force on Preventive Health Care (Task Force) has issued its latest guidelines on adult obesity prevention and management. Adult obesity in Canada has nearly tripled in the past 40 years.
Today 67% of men and 54% of women are considered overweight or obese making adult obesity one of Canada's most pressing public health challenges. The Task Force's guidelines provide evidence-based recommendations designed to help primary care doctors play a more integral role in the prevention and management of this growing problem. Guidelines are published in the Canadian Medical Association Journal (CMAJ).
Advertisement"As part of a broader effort to stabilize the current obesity trend in Canada, we must encourage primary care doctors to play a more prominent role," said Dr. Paula Brauer, chair of the Task Force adult obesity working group. "On average, adults gain one pound a year. The creeping pounds add up quickly and can result in significant weight gain. With excess weight comes the increased risk of several chronic conditions. This is why it is essential for doctors to regularly track patients' weight, and when necessary, discuss a suitable strategy to manage the extra pounds. By doing this doctors can help their patients mitigate, or ideally, avoid the risks associated with obesity by either preventing or treating the problem."
The mandate of the Task Force is to make recommendations based on the best evidence available. In order to provide the most accurate recommendations, the Task Force systematically reviewed the prevention and treatment literature separately. Recommendations of the guideline include:
1.A strong recommendation for the calculation of BMI for both prevention and management of obesity at appropriate primary care visits.
2.Placing a relatively high value on the low cost of BMI and that it is an easy to calculate clinical measure with widely accepted cut-points
3.For adults of normal weight, the Task Force recommends against offering formal structured interventions aimed at preventing weight gain.
4.For adults who are obese and are at high risk of diabetes, the Task Force strongly recommends that practitioners offer or refer to structured behavioral interventions aimed at weight loss.
5.For adults who are overweight or obese the Task Force recommends that practitioners offer or refer to structured behavioral interventions aimed at weight loss.
6.For adults who are overweight or obese the Task Force recommends that practitioners not routinely offer pharmacologic interventions (orlistat or metformin) aimed at weight loss. "From available research, we see that 1 in 9 people who engage in behavioural programs for weight loss will lose a considerable amount of weight," said Dr. Brett Thombs, a member of the Task Force. "Furthermore, we see that even a small reduction of 5% in weight can have a big impact on the health of those in high-risk groups, showing the importance of interventions. To make these treatment options more accessible we encourage health care systems in Canada to provide resources to support physicians in their efforts."
About Adult Obesity
Adult obesity is a complex and often misunderstood condition. While excess weight is ultimately the result of energy consumed versus energy expended, there are many contributing outside factors including: biology, genetics, behavior, society and environment.
Excess weight increases the risk of several chronic conditions including cardiovascular disease (CVD), some cancers, type 2 diabetes (T2D), osteoarthritis and back pain. While weight loss interventions are only modestly effective, research shows that small reductions of just 5% will have a big impact on the health of those in high-risk groups.
Overweight and/or obese status is commonly assessed using BMI calculation. Despite its limitations, the Task Force selected BMI as the preferred measure for both prevention and management of obesity for the following reasons:
- Accessibility: BMI calculation is inexpensive, easy to apply, and requires no special training or equipment.
- Objectivity: There is strong evidence that adults tend to overestimate height and underestimate weight and there is increasing evidence that health care providers' visual estimation is relatively inaccurate.
- Accuracy: Of the clinically feasible measures, BMI is the body composition measure most strongly associated with mortality.
Structured behavioural interventions are intensive behavioural modification programs that involve numerous sessions spanning several weeks to months. Recommended interventions are those that focus on diet, exercise, or lifestyle changes with the inclusion of counselling, education and environmental changes for long-term health. Successful interventions should include a combination of approaches.
While the success rate of behavioral interventions is highly reliant on the motivation of the patient, the Task Force chose to recommend it as the preferred treatment option based on the benefits to harms ratio. Unlike pharmacological treatments that can have adverse effects such as gastrointestinal problems, behavioural interventions do not have these adverse effects and do benefit many patients.
About the Canadian Task Force on Preventive Health Care
The Canadian Task Force on Preventive Health Care has been established to develop clinical practice guidelines that support primary care providers in delivering preventive health care. The mandate of the Task Force is to develop and disseminate clinical practice guidelines for primary and preventive care, based on systematic analysis of the scientific evidence.