New national guidelines for doctors say family physicians have a much more active front-line role to play in the battle against obesity.
The guidelines, issued by the Canadian Task Force on Preventive Health Care and published on Monday in the Canadian Medical Association Journal, urge physicians to track the body mass index (BMI) of all adult patients and prescribe physical activity, dietary changes or counselling to those who are overweight or obese. The number of Canadians who are considered obese has increased dramatically in recent years – from 14 per cent of the adult population in 1978-1979 to 26 per cent in 2009-2011. Being overweight or obese puts individuals at risk for serious health problems, including high blood pressure, heart disease, stroke, Type 2 diabetes, cancer and arthritis.
The federal task force, an independent panel of experts, last issued obesity-prevention guidelines in 2006.
There is no quick fix to the obesity epidemic, but using family doctors as a backstop could help some patients get their weight under control, said Paula Brauer, chair of the working group that drafted the guidelines and associate professor in family relations and applied nutrition at the University of Guelph in Guelph, Ont.
Family physicians are "the backbone of the system," she says, arguing that this gives them a unique opportunity to intervene and prevent patients from becoming obese or developing health-related problems as a result. And even though most people hear messages about weight loss in the media every day, family doctors can give patients a personal assessment of how their weight, blood pressure, glucose levels and other factors may be putting their health at risk, which is much more likely to hit home, Dr. Brauer said.
Some key recommendations in the guidelines:
- Family physicians should calculate BMI during primary health-care appointments to monitor weight changes over time.
- For healthy adults of normal weight, primary-care doctors should not offer formal structured programs to prevent weight gain, which have minimal effect.
- For overweight and obese adults, health-care practitioners should offer structured programs to change behaviour to help with weight loss, especially for patients at high risk of developing type 2 diabetes.
- Physicians should not routinely offer medications to help people lose weight, with behavioural intervention being the preferred option.
Currently, many family doctors don't even weigh their patients or keep track of fluctuations over time, Dr. Brauer says, which can be a huge missed opportunity.
"They see patients getting more overweight, struggling with weight," she said.
The body mass index, which uses a person's height and weight to determine whether they are "normal" weight, overweight or obese, has been criticized increasingly in recent years. In particular, critics point out that BMI does not take muscle into account, and as a result, may wrongly categorize certain people as overweight. Conversely, people who are slim and have little muscle but some fat may be classified as having a normal, healthy weight.
Dr. Brauer said those criticisms are valid and that is why BMI must be used in conjunction with other measurements, such as blood pressure, to get the full picture of a patient's health.
It is widely understood that the rising prevalence of obesity will have dire consequences for thousands of Canadians as well as the health-care system, which must find the resources to treat more and more preventable illnesses. But many questions are unanswered about the exact causes and how to tackle the problem.
The next challenge will be figuring out how to give busy doctors the support and resources to monitor BMI and make recommendations to patients who are overweight or obese. The guidelines say that more work needs to be done to address these gaps and help primary-care physicians make obesity prevention a priority.
Dr. Brauer acknowledges that the new guidelines are not a magic solution, but that they represent an important step.
Although the guidelines are not binding, many of the Canadian Task Force on Preventive Health Care's previous recommendations, such as guidance on breast and prostate cancer screening, have become standard practice. The College of Family Physicians of Canada has endorsed the guidelines.