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Updated Canadian guidelines address obesity treatment, prevention
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The Canadian Task Force on Preventative Health Care has released updated guidelines for the treatment and prevention of obesity in adults, according to data recently published in the Canadian Medical Association Journal.
The guidelines build on previous recommendations for the treatment of obesity published in 1999 and the prevention of obesity published in 2006.
According to the authors, obesity in Canada has increased from 14% to 26% in the past 40 years. Sixty-seven percent of men and 54% of women in Canada are overweight or obese. Of those, roughly two-thirds were at a normal weight in adolescent years and gained approximately 0.5 kg to 1 kg every 2 years in adulthood.
"The creeping pounds add up quickly but often go unnoticed until it's too late," Paula Brauer, PhD, RD, FDC, chair of the task force adult obesity working group, said in a press release.
The studies referenced in the guidelines are randomized controlled trials conducted in primary care settings or settings patients have been referred to by their primary care provider from Jan. 1, 1980, to June 27, 2013. Prevention and treatment issues the studies examine include BMI, behavioral interventions and medication.
According to the updated guidelines, BMI should be measured by patients’ primary health care provider as an easy, inexpensive and effective way to track obesity.
Providers should not offer interventions to normal-weight adults (BMI, 18.5-24.9 kg/m) because of the programs’ minimal effects in this population and the lack of evidence that any effects are maintained in the long term. However, providers are advised to use their judgment when considering adults without obesity who may still have a high risk for obesity, type 2 diabetes or cardiovascular disease, or who are interested in maintaining their normal weight, and may benefit from the interventions.
The guidelines strongly recommend offering long-term structured weight-loss programs to adults with obesity (BMI, 25-39.9 kg/m) and those who are at a higher risk for type 2 diabetes. These behavioral interventions include diet and exercise and other lifestyle changes, such as counseling, education, support and environment modifications.
The guidelines also recommend against routinely offering pharmacologic weight-loss interventions. Although participants in drug studies assigned to pharmacologic interventions often experienced similar effects as those assigned to behavioral interventions, the medications (metformin or orlistat) were more likely to cause adverse events (number needed to harm=10) and gastrointestinal events (number needed to harm=5). The task force also questioned the generalizability of these study results to the broader population.
"Behavioral interventions for overweight and obesity require long-term commitment to change diet and physical activity habits," task force member Brett Thombs, PhD, said in the release. "Values and preferences, previous experiences with weight loss, personal motivators and barriers, social support and practical resources will all affect decisions to undertake intervention. Discussion with the patient is needed to determine the best course of action."
Members of the task force said these guidelines are not intended for patients who are pregnant or who have an eating disorder. Tools are available at canadiantaskforce.ca to help physicians translate these new guidelines to their patients.
Disclosure: The Canadian Task Force on Prevention Health Care is funded by the Public Health Agency of Canada and the Canadian Institutes of Health Research. Brauer reports being a volunteer member of the Canadian Obesity Network, the Canadian Diabetes Association and Dieticians of Canada.
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