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
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).
"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:
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
About Structured Behavioural Intervention
BMI calculation is inexpensive, easy to apply, and requires no special
training or equipment.
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
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.