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Every health check-up should include a measure of waist circumference in addition to a weigh-in, according to sweeping new guidelines on the prevention and management of obesity.

"Where the fat is sitting matters as much as how much fat there is," said David Lau, the president of Obesity Canada and chairman of the guidelines committee.

"Waist circumference should be considered a new vital sign that's just as important as taking blood pressure, and measuring lipid and blood sugar levels."

A waistline of more than 94 centimetres (37 inches) for a man and 80 centimetres (32 inches) for a woman should be considered a risk factor for serious conditions such as diabetes and cardiovascular disease, though healthy waist size varies a bit by ethnicity. (Waist circumference is measured at the biggest point of the belly; it is not the same as pants size.)

The guidelines, published in Tuesday's edition of the Canadian Medical Association Journal, also recommend:

Beginning at age 10, anyone who is overweight or obese should be routinely tested for levels of fasting glucose (an indication of diabetes), HDL and LDL cholesterol and triglycerides;

Programs to promote healthy active living, including daily physical activity, should be implemented in all schools;

Screen time — be it television, video or computer games — should be limited to a maximum of two hours daily;

The preferred treatment for people who are overweight or obese is lifestyle changes such as regular exercise and proper nutrition; only if unsuccessful should drug treatments and stomach-stapling surgery be considered;

Weight-management programs, including behaviour modification and education, should be an integral part of care;

Denis Drouin, a professor of family medicine at Laval University in Quebec City and a member of the expert panel, said the hope is that the 120 pages of guidelines will help health care practitioners better treat patients and help the understand that "their weight and body shape can have a serious impact on their long-term health, and they need to act now to lessen their risk of heart disease and diabetes."

He noted too that even modest improvements such as the loss of five to 10 per cent of body weight, or trimming a few inches from the waist can have significant health benefits.

Peter Nieman, a Calgary pediatrician who runs an obesity clinic, said while the new guidelines are thorough, they are too academic and not user-friendly enough for busy practitioners and for Canadians worried about their weight or that of their children.

"My mantra is: The best way to prevent adult obesity is to prevent childhood obesity," he said.

Dr. Nieman said the guidelines are a "bit thin" when it comes to practical advice on tackling soaring rates of childhood obesity.

A total of 59 per cent of adults and 26 per cent of children are either overweight or obese, according to Statistics Canada.

About half of adults are also considered obese based on their waists circumference.

Sarah McDonald, a professor of maternal-fetal medicine at McMaster University in Hamilton, Ont. who has done obesity research, said that, overall, the new guidelines should prove quite useful to health care practitioners.

But she too noted some shortcomings, notably a failure to mention smoking, despite a strong association between overweight and smoking.

Dr. McDonald said the impact of being overweight or obese on fertility and pregnancy is not stressed enough either. She noted that being heavy can interfere with getting pregnant and that obese woman have far more problems birthing, and a higher likelihood of babies with birth defects.

Dr. Lau said he is proud of the fact that the expert group has produced the "world's first comprehensive, evidence-based guidelines on the management and prevention of obesity."

He said that, in addition to providing practical information to physicians and nurses, the document should "serve as a call to action, an important reminder that obesity is more than a personal issue, it's a societal issue."