Obesity in Adults (2015)

Summary of recommendations for clinicians and policy-makers

The CTFPHC will continue to carefully monitor the scientific developments in the prevention and management of obesity and report back to Canadians within 5 years with an update of the 2015 guidelines.

Recommendations

Measurement of BMI

These recommendations apply to apparently healthy adults ≥ 18 years of age who present to primary care. These recommendations do not apply to people with eating disorders, or who are pregnant.

• We recommend measuring height, weight and calculating BMI1BMI [weight (kg) ÷ height (m²)] categories are underweight = BMI < 18.5; normal weight = BMI 18.5–24.9; overweight = BMI 25.0–29.9; obese = BMI ≥ 30. at appropriate2Appropriate visits include: wellness visits, visits for medication renewal and other visits where the primary care practitioner deems it appropriate. primary care visits.
  (Strong recommendation; very low quality evidence)

Prevention of weight gain

These recommendations do not apply to people with eating disorders, or who are underweight, pregnant, overweight or obese (Body Mass Index [BMI] ≥ 25).

• We recommend that practitioners not offer formal, structured interventions3Formal structured interventions are behavioural modification programs that involve several sessions or interactions that take place over weeks to months. Interventions examined for prevention of weight gain included behaviourally-based prevention interventions focused on diet, increasing exercise, making lifestyle changes, or any combination of these. These could be offered in primary care settings or settings where primary care practitioners may refer patients, such as credible commercial or community programs. Recommended interventions for management of overweight and obesity include intensive behaviourally-based interventions focused on diet, increasing exercise, making lifestyle changes, or any combination of these. Lifestyle interventions generally included counselling, education or support, and/or environmental changes in addition to changes in exercise and/or diet. aimed at preventing weight gain in normal weight adults.
  (Weak recommendation; very low quality evidence)

Management of overweight and obesity

These recommendations apply to adults ≥ 18 years of age who are overweight or obese (25 ≤ BMI < 40). Pregnant women and people with health conditions where weight loss is inappropriate are excluded. These guidelines do not apply to people with BMI ≥ 40, who may benefit from specialized bariatric programs.

• For adults who are obese (30 ≤ BMI < 40) and are at high risk of diabetes4High risk status is defined by 10 year risk of diabetes of ≥ 33%, which can be assessed using the CANRISK or FINDRISC risk assessment tool., we recommend that practitioners offer or refer to structured behavioural interventionsiii aimed at weight loss.
  (Strong recommendation; moderate quality evidence)
• For adults who are overweight or obese, we recommend that practitioners offer or refer to structured behavioural interventions5Formal structured interventions are behavioural modification programs that involve several sessions or interactions that take place over weeks to months. Interventions examined for prevention of weight gain included behaviourally-based prevention interventions focused on diet, increasing exercise, making lifestyle changes, or any combination of these. These could be offered in primary care settings or settings where primary care practitioners may refer patients, such as credible commercial or community programs. Recommended interventions for management of overweight and obesity include intensive behaviourally-based interventions focused on diet, increasing exercise, making lifestyle changes, or any combination of these. Lifestyle interventions generally included counselling, education or support, and/or environmental changes in addition to changes in exercise and/or diet. aimed at weight loss.
  (Weak recommendation; moderate quality evidence)
• For adults who are overweight or obese, we recommend that practitioners not routinely offer pharmacologic interventions (orlistat or metformin) aimed at weight loss6The CTFPHC examined the use of metformin and orlistat for weight loss only and not for the treatment of other conditions, such as diabetes..
  (Weak recommendation; moderate quality evidence)