All adults should have their height and weight measured during checkups and anyone who is obese should be referred for intensive diet and exercise programs if needed, according to new U.S. guidelines for physicians.
The government-backed U.S. Preventive Services Task Force said Tuesday that its latest recommendations on screening for obesity reflect evidence on how adults can successfully shed pounds and keep them off to gain health benefits.
Earlier this month, doctors writing in the Canadian Medical Association Journal also concluded that measuring waist circumference can identify adults with abdominal obesity who may have a normal body mass index.
"Even though evidence suggests that patients are considerably more likely to lose weight when they are advised to do so by their primary care physicians, most patients who are clinically obese do not receive weight-loss counselling in primary care," wrote Health Canada's Dr. Gilles Plourde of Gatineau, Que.
Plourde and his co-author Dr. Denis Prud’homme of the University of Ottawa advised family doctors to use the 5As when counseling patients to change their eating habits and increase physical activity levels: assess/ask, advise, agree, assist and arrange.
Patients "should be asking what their BMI is, and tracking that over time," said task force member Dr. David Grossman, medical director for preventive care at the Group Health Co-operative in Seattle.
The U.S. task force said patients with a body mass index of 30 or higher should be offered intensive behavioural interventions like group or individual weight-loss counseling sessions.
A normal BMI is less than 25, obesity begins at 30, and anything in-between is considered overweight. The Canadian review noted the body-weight classification is intended for all ethnic and racial groups but there are limitations in applying it to people who aren't white.
According to the most recent Canadian Health Measures Survey from 2007 to 2009, about 62 per cent of the adult population is overweight and 24.3 per cent is obese.
A 2010 survey of members of the American Academy of Family Physicians found up to 40 per cent of those primary care doctors calculated their patients' BMIs.
No quick fix
Surveys show only about a third of obese patients recalled their doctor counseling them about weight loss, even though people whose doctors discuss the problem are more likely to do something about it.
Doctors may be reluctant to advise patients about weight loss since few doctors are trained in obesity and they're discouraged by yo-yo dieting, said Dr. Glen Stream, president of the physicians' group.
"Our American culture is always looking for an easy fix, a pill for every problem," Stream said. "The updated recommendation is important because it makes clear exactly what doctors should do to help."
This week's issue of the Annals of Internal Medicine summarizes the panel’s advice, which includes:
- Offer 12 to 26 face-to-face meetings over a year, most in the first few months.
- Make patients set realistic weight-loss goals. Losing just five per cent of your initial weight — 10 pounds for a 200-pound person — can significantly improve health.
- Analyze what blocks each patient from reaching those goals. Do they eat high-calorie comfort foods to deal with depression? Spend too much time at a desk job?
- Tailor ways to help people integrate physical activity into their daily routine.
- Require self-monitoring, such as a food diary or a pedometer to track activity.
The task force also acknowledged that more research is needed to find the best ways to help people who are overweight.