New clinical guidelines don't provide much guidance for physicians dealing with obese patients, says one obesity expert.
Recently published in the Canadian Medical Association Journal, the Canadian Task Force on Preventative Health Care made recommendations to family doctors about prevention and interventions for overweight and obese patients.
The last guidelines on preventing adult obesity were published in 2006, while recommendations for the treatment of obesity have not been updated since 1999.
The new guidelines are rather thin on accurate treatment recommendations, says Dr. Arya Sharma, professor of medicine and chair in obesity research and management at the University of Alberta.
"What the guidelines don't do is talk about what the treatment options are and how to deliver those treatment options. There's not a lot of specifics there," he says.
The task force's first recommendation is for family doctors to measure and track a patient's height, weight and body mass index (BMI). These measurements are not currently taken at routine visits.
BMI is inexpensive and easy to apply, requires no special equipment and can be used to monitor weight changes over time, says the independent panel of clinicians and methodologists.
Although there is no direct evidence to show that calculating BMIs for all patients will help with weight loss, it is an objective measure that is more accurate than self-estimation or a visual estimation by a health care provider.
The task forced graded the recommendation as "strong" but based on "very low-quality evidence."
"It's not enough to simply measure BMI," says Sharma, who is also the founder and scientific director of the Canadian Obesity Network.
BMI alone does not indicate whether the patient is at risk for other chronic diseases such as diabetes or heart disease, he says.
Waist circumference and waist-to-hip ratio are other accepted measures of obesity classification and indicate risk of obesity-related illnesses.
Not just a lifestyle problem
Current research lacks evidence that structured programs aimed at preventing weight gain in normal weight adults are effective over the long term, states the paper.
Thus, the task force advises family doctors to use their own judgment before referring their normal weight patients to such programs.
Routinely prescribing medications for overweight and obese adults is also not recommended by the task force since available research shows patients are more likely to experience complications with drug treatment.
Medication and bariatric surgery are effective treatment options for cases of severe obesity, says Sharma.
Compared to the U.S. where there are five drugs approved for obesity treatment, Canada has one.
"If we compare the treatment options for obesity to the treatment options for diabetes where we have 20 to 30 different drugs for hypertension, obesity has nothing. That's a huge treatment gap that is not filled," he says.
One of the reasons for this gap is that most people do not consider obesity a chronic disease.
The vast majority of patients with high blood pressure need medication to keep the disease under control, explains Sharma. Behaviour and lifestyle changes – the "eat less and move more" approach – does not work for everyone.
"There is tons of data showing that is only marginally effective for most people."
As clinical practice guidelines, the recommendations provide little guidance for doctors in dealing with their patients, says Sharma.
But the guidelines themselves are not necessarily to blame, instead addressing a key problem in the obesity field.
"The guidelines look at what's available in Canada and there's not much here."
It is the family doctor's job to have a non-judgmental discussion about weight with their patients, address risks of obesity and the different treatment options that would be suitable for them, says Sharma.
