Obesity in Adults (2015)

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    College of Family Physicians of Canada

    This Clinical Practice Guideline has been endorsed by the College of Family Physicians of Canada.

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    Summary of recommendations for clinicians and policy-makers

    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 BMI[footnote]BMI [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.[/footnote] at appropriate[footnote]Appropriate visits include: wellness visits, visits for medication renewal and other visits where the primary care practitioner deems it appropriate.[/footnote] 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 interventions[footnote]Formal 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.[/footnote] 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 diabetes[footnote]High risk status is defined by 10 year risk of diabetes of ≥ 33%, which can be assessed using the CANRISK or FINDRISC risk assessment tool.[/footnote], 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 interventions[footnote]Formal 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.[/footnote] 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 loss[footnote]The CTFPHC examined the use of metformin and orlistat for weight loss only and not for the treatment of other conditions, such as diabetes.[/footnote].
      (Weak recommendation; moderate quality evidence)

     

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