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Family Docs Urged To Do More to Manage Obesity

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New national guidelines from the Canadian Task Force for Preventative Health Care were published in the Canadian Medical Association Journal last week. The guidelines urge physicians to track patient’s body mass index (BMI) and strongly recommend prescribing “behavioural interventions” to help obese patients lose weight. The College of Family Physicians of Canada has endorsed the new guidelines.

Overweight individuals are at risk for a range of health problems including heart disease, hypertension, Type 2 diabetes, and cancer and arthritis.  Over one quarter of us are already considered ‘obese’ and 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.”

Critics of the guidelines suggest they don’t go far enough; that most patients who undertake diet and exercise programs put weight back on; that obesity should be treated on par with other chronic conditions; that the guidelines discouraging the use of medications for obesity demonstrates a limited appreciation for the pressure on family physicians to prescribe medications for people who have tried everything else.

Regardless of the specifics of these new guidelines, if we consider obesity to be in the same category as other chronic diseases, family physicians will face the same limitations in addressing it: most of chronic disease health outcomes are due to lifestyle factors and medication adherence, but medication adherence rates are surprisingly low, and behavioural changes are notoriously difficult to sustain.

Ultimately, obesity patients and their families, as with any other chronic condition, need to be empowered with the skills, knowledge and confidence to manage their lifestyle and medication regime beyond the point of care and in their daily lives.