Obesity health strategy in Canada shifts to prevention

Prevention of even a slight weight gain is key to avert heart disease, cancer and other chronic health problems from setting in at middle age, according to new Canadian guidelines.

Expanding waistlines are well recognized. Obesity measurements among adult Canadians has almost doubled from 14 per cent in 1978-1979 to 26 per cent in 2009-2011.  

The excess weight is a public health concern since research suggests it increases the risk of cardiovascular disease, cancer, Type 2 diabetes, osteoarthritis and back pain. 

To counter the health problems, the Canadian Task Force on Preventive Health Care released recommendations for family physicians Monday on prevention of weight gain and treatment of overweight and obesity.

"Weight really creeps up on people," task force member Dr. Brett Thombs of Jewish General Hospital in Montreal said in an interview.

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That's why Thombs and his colleagues encourage doctors to track their patients. "People don't realize they're putting on a pound a year until it's too late."

The recommendations include:

• Measure height, weight and calculate body mass index (BMI) at primary care visits to monitor weight changes over time.
• Don’t offer formal programs to prevent weight gain in healthy adults because there’s such scant evidence of success in terms of lower BMI, reduced waist circumference or loss of body fat. 
• Do offer structured programs with such those with diet and exercise to coach behaviour changes in those who are overweight and obese, especially if they are at high risk of developing Type 2 diabetes.
• Don’t routinely offer medications for weight loss since trials suggest participants were more likely to experience gastrointestinal side-effects compared with those in a control group. Behavioural options are preferred.

Previously in 2006, the panel supported interventions for adults with Type 2 diabetes and hypertension related to obesity. Panellists pointed to updates in knowledge to explain the change, which they called consistent with other national international guidelines.  

They also suggested practitioners should be aware of barriers to participation in structured weight-loss programs, such as unrealistic expectations, hunger, sociocultural factors and past stigmitizing experiences.

Dr. Raj Padwal of the University of Alberta in Edmonton was an expert reviewer for the report.

"Given the trade off between spending time, between modest weight loss results and getting a person's blood pressure controlled and preventing their stroke, I think the health care provider can only do the latter and that's what I think they should be spending their time doing," Padwal said.

Successful weight loss will mean looking beyond the health-care system, to other aspects such as  buildings conducive to encourage exercise, countering sedentary lifestyles, and curbing calorie-dense foods, Padwal said.

Karen Ward blogs as the Curvy Canadian and has a plus-sized clothing store in Toronto. Ward says nearly all of her clients have dieted and felt badly about themselves at some point.

"I would like to see the conversation framed in such a way that the focus is shifted away from preventing or treating obesity, which I look to be a side-effect or a symptom of maybe something else going on," Ward said.

Ward recalls she started gaining weight around age nine. 

"The best way to manage my health personally was not to necessarily worry about the number on the scale or about the size of my dress, but to make sure I am getting the proper nutrition and proper exercise …but not necessarily to worry about the all the rest of the stuff because it was damaging to my mental health."

The recommendations made by the task force do not apply to pregnant women or individuals with eating disorders.