Obesity in Adults (2015)

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    The CTFPHC released the “Recommendations for prevention of weight gain and use of behavioural and pharmacologic interventions to manage overweight and obesity in adults in primary care” in 2015.

    The task force recognizes that this guideline is currently out-of-date and has made a decision to place an update to this topic “on hold” as of December 2022. This pragmatic decision not to proceed on an update at this time was based on the following:

    • The evolving concept of obesity as a health issue (e.g., chronic disease or disorder versus risk factor)
    • A shift to patient-important health outcomes in obesity assessment rather than a primarily weight loss focus
    • Substantial changes in obesity management including psychological, pharmaceutical and surgical interventions
    • Availability of a comprehensive Canadian guidelines on obesity in adults

    The task force acknowledges the importance of this topic to the health and wellbeing of Canadians. We will continue to evaluate this topic for an update during our annual topic selection.

    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 at 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 interventions 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, we recommend that practitioners offer or refer to structured behavioural interventions 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 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.
      (Weak recommendation; moderate quality evidence)

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