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New obesity guidelines fall short, expert says

In over 25 years of practice, I have met countless overweight or obese patients who have lost weight – usually through diet and exercise. Almost all have put the weight back on.

This is not surprising, given that we now know body weight is regulated by a complex and highly redundant neurobiological system, which vigorously "defends" against weight loss and will eventually overcome (or sabotage) the resolve of even the most motivated "dieter."

This is why the World Health Organization, the American Medical Association and other leading health bodies have recognized obesity as a chronic disease in its own right.

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Now, a new clinical-practice guideline, published in the Canadian Medical Association Journal, shares the rather sobering view of "lifestyle" treatments for obesity and even goes so far as to recommend against the routine use of structured weight-loss programs for those at risk of weight gain.

As to how obesity is best treated in those who already have the problem, the new guideline has remarkably little to offer. Bariatric surgery, clearly the most effective treatment for severe obesity, is not discussed in this guideline, perhaps because it is still not available to most Canadians who would stand to benefit from it.

The guideline also makes short work of the only prescription medications sometimes used for the treatment of obesity in Canada (orlistat and metformin), as they are deemed only marginally effective.

Clearly, obesity management in Canada lags far behind the treatments we have for Canadians living with other conditions, such as diabetes, hypertension or heart disease.

While doctors (and patients) in Canada can choose from a wide range of medications, alone or in combination, to control their diabetes, blood pressure or heart problems, we have little to offer our patients for the treatment of their obesity.

Coincidentally, a clinical-practice guideline just released by the U.S. Endocrine Society provides evidence-based recommendations for the long-term use of prescription anti-obesity medications, of which there are now five available in the United States.

Unfortunately, Canadians living with obesity remain stuck between the rather modestly effective "diet and exercise" approach or the considerably more drastic surgery. No wonder many Canadians see no other option than to turn to the billion-dollar commercial "weight-loss" industry, which is only too happy to exploit this treatment gap.

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While we should certainly increase our efforts to prevent more Canadians from becoming obese in the first place, it is also high time we brought more effective treatments for obesity to Canadians living with this condition.

Health Advisor contributors share their knowledge in fields ranging from fitness to psychology, pediatrics to aging.

Arya Sharma, chair in obesity research and management at the University of Alberta, spearheaded the launch of the Canadian Obesity Network in 2005. He is also past president of the Canadian Association of Bariatric Physicians and Surgeons. Dr. Sharma has received speaking and consulting honoraria from pharmaceutical and medical-device companies working to find better treatments for obesity.

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