Document: Recommendations for prevention of weight gain and use of behavioural and pharmacologic interventions to manage overweight and obesity in adults in primary care
The new obesity guidelines for doctors: How might they affect our work as dietitians?
Summary and review provided by Diana Dibblee, RD
- According to the Heart and Stroke's 2015 Report on the Health of Canadians, 60% of Canadian adults are overweight or obese. This Report notes some of the biggest risk factors for obesity including 'poor diet and a lack of physical activity'.
-The new obesity guidelines issued by the Canadian Task Force on Preventive Health Care and published recently in the Canadian Medical Association Journal (2015) include:
Taking the weight and height of all adults over the age of 18 to calculate body mass index
For adults of normal weight, recommendations against offering formal structured interventions aimed at preventing weight gain
For adults who are obese and are at high risk of diabetes, practitioners offer or refer to structured behavioural interventions aimed at weight loss (including dietary changes, counselling and physical activity) *Key role for dietitians.
Medication shouldn’t be offered as a weight loss intervention
-The guidelines are intended to support health professionals when working with overweight and obese patients. The Task Force that completed the research into obesity "recommend screening for body mass index at each annual visit, and using the screening results to engage patients in a discussion about their weight and its impact on their overall health" (Zamosky, 2015 Modern Medical Network). This is contrary to the research stating that BMI is only one factor that supports the understanding of a patient's weight. Alone, it is not a strong or reliable measure of health.
-The guidelines note the important role health professionals play in supporting a behavioral plan for weight loss and in preventing and managing obesity through services offered to patients.
Note- Do health professionals have a weight bias with obese patients, as noted in Dr Sharma's recent blog posts? How best do we address the overweight or obese patient's weight loss? http://www.obesitynetwork.ca/obesity-blogs
-Beyond the guidelines, obesity expert Dr Sharma recognizes the complexity of obesity treatment. He states "the assessment of obesity requires a systematic assessment of factors potentially affecting energy intake, metabolism, and expenditure. Rather than just identifying and describing a behaviour (“this patient eats too much”), we should seek to identify the determinants of this behaviour (“why does this patient eat too much?”) (Dietitians of Canada Obesity Learning Retreat, 2012).
-The new guidelines recommend that doctors and an interdisciplinary team work to address weight issues. Dr Sharma has stated (Obesity Notes, 2015) that health care practitioners can support the patient however, bariatric surgery is the best and most effective method to support weight loss for obesity patients with a BMI over 40. Check out Obesity Notes (http://www.drsharma.ca/).
- The guidelines also state that a small weight loss such as a "sustained loss of just 3% to 5% of one’s body weight can produce clinically meaningful health benefits,” (Zamosky, 2015).
- The task force makes a strong recommendation for obese patients, by offering behavioural interventions aimed at weight loss, or referring them to a weight loss program. These "behavioral interventions should be greater than 12 months duration, including diet and/or exercise and/or lifestyle components, and include group and individual sessions" (CMAJ, February 17, 2015).
- The obesity guidelines recommend obese patients work to make these changes with trained healthcare professionals, however, there was no specific mention of doctor referrals to dietitians.
-As noted, The American Endocrine Society's clinical practice guidelines do suggest the use of obesity drugs, as supported by Dr Sharma (there are new obesity drugs) however, the use of obesity drugs is not regarded as an effective intervention according to the new Canadian Obesity guidelines.
-In short, there is not a lot of good news for overweight or obese patients. The guidelines do not clearly recognize the important role of dietitians. No dietitians were part of the Task Force Committee. The obesity epidemic is complex, however dietitians can and do play an important role as part of an interdisciplinary team to treat and support obese and overweight patients.
For more information and reading:
Find the obesity guidelines and recommendations at http://www.cmaj.ca/content/187/3/184.
The Canadian Obesity Network http://www.obesitynetwork.ca/
Suggested further Reading: Rollnick S, Miller WR, Butler CC. (2008) Motivational Interviewing in Health Care: Helping Patients Change Behavior. New York: The Guilford Press.