Managing obesity in adults in primary care

Plourde, Gilles; Prud’homme, Denis

doi:10.1503/cmaj.111640

Cited by 43 publications

(48 citation statements)

References 41 publications

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“…27 More research and consultation is needed to establish appropriate BMI cut-off points for the major racial and ethnic groups in Canada, including Aboriginal populations. 28 Other acceptable measures of obesity have been reviewed elsewhere and include waist circumference and waist-to-hip ratio. [28][29][30] Waist circumference has been shown to independently classify individuals as higher risk for obesity-related illness, especially type 2 diabetes and cardiovascular diseases.…”

Section: Recommendationsmentioning

confidence: 99%

“…28 Other acceptable measures of obesity have been reviewed elsewhere and include waist circumference and waist-to-hip ratio. [28][29][30] Waist circumference has been shown to independently classify individuals as higher risk for obesity-related illness, especially type 2 diabetes and cardiovascular diseases. 31 Cut-off points for waist circumference vary across populations.…”

Section: Recommendationsmentioning

confidence: 99%

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Recommendations for prevention of weight gain and use of behavioural and pharmacologic interventions to manage overweight and obesity in adults in primary care

Brauer

Shaw

et al. 2015

CMAJ

135

125

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CMET he prevalence of obesity in adults has increased worldwide and has almost doubled in Canada, from 14% in 1978/79 1 to 26% in [2009][2010][2011]2 with 2% of men and 5% of women having a body mass index (BMI) score greater than 40 (Appendix 1, available at www .cmaj.ca/lookup/suppl/doi :10.1503/cmaj .140887 /-/DC1).3 Over two-thirds of Canadian men (67%) and more than half of Canadian women (54%) are overweight or obese, based on measured weight.2-4 Excess weight is a well-recognized risk factor for several common chronic conditions, such as cardiovascular disease, cancer, type 2 diabetes, osteoarthritis and back pain. 5About two-thirds of adults who are overweight or obese were in the healthy weight range as adolescents, but gained weight in adulthood (about 0.5-1.0 kg every two years on average). 6,7 Slow weight gain may go unnoticed until health problems develop in middle age. However, this overall mean increase masks substantial variation in the population, and some people remain weight stable over long periods, whereas others experience substantial gains and losses. Currently, we cannot predict future health effects of weight gain over the life course.The causes of obesity are complex. Although excess adiposity is ultimately the result of an imbalance in the amount of energy consumed and the amount of energy expended by an individual, there are many biological, behavioural, social and environmental factors that interact to affect this balance. The dramatic increase in obesity since the 1970s, however, suggests environmental causes are prominent and potentially amenable to interventions and prevention. 8,9 Possible approaches include a wide range of legislative and policy options, in addition to health-promotion advice to maintain a healthy weight, increase physical activity and eat a healthy diet.10 Primary care providers have an important role in preventing and managing obesity through services offered to patients.Overweight or obese status is commonly assessed using the BMI. The internationally recognized cut-off BMI values for adults are as follows: underweight (< 18.5), normal weight (18.5-24.9), overweight (25-29.9) and obese (≥ 30). The obese category is further broken down by BMI into class I (30.0-34.9), class II (35.0-39.9) and class III (≥ 40).11 Distribution of body fat is also an independent indicator of health risk, and high waist circumference is associated with an increased risk for cardiovascular disease and type 2 diabetes. 12Lifestyle interventions (e.g., behavioural therapies, and dietary and physical activity programming and support) are the first line of treatment for most patients with overweight or obesity. Pharmacotherapy and surgery are options for more severe cases of obesity. A weight loss of 5% is considered clinically important, 13 as many cardiovascular risk factors (e.g., elevated blood pres-

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Section: Recommendationsmentioning

confidence: 99%

Section: Recommendationsmentioning

confidence: 99%

Recommendations for prevention of weight gain and use of behavioural and pharmacologic interventions to manage overweight and obesity in adults in primary care

Brauer

Shaw

et al. 2015

CMAJ

135

125

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“…To further assist the patient in his long-term maintenance of weight loss, we have used the strategies from the National Weight Control Registry (NWCR) discussed in our recent CME [4] . The NWCR includes information from more than 5000 obese people who have lost, 31.8 kg on average, and kept it off for ≥ 6 years.…”

Section: Discussionmentioning

confidence: 99%

“…At the beginning the patient was doing 20 to 30 minutes of aerobic exercise at an intensity level of 50%-70% of maximum heart rate (220 minus age of patient) combined with a 20 to 30 minutes of resistance training 3 times/week that progressively increased to 45 minutes of aerobic exercise combined with 45 minutes of resistance training 5 times/week. During that period, the patient received counseling on dietary and physical interventions as described in a recent evidence-based Continuous Medical Education (CME) article by Plourde and Prud'homme [4] .…”

Section: Case Reportmentioning

confidence: 99%

“…The diet was monitored on a regular basis by a nutritionist. The patient also received counseling on strategies for maintaining long-term weight loss and preventing weight regain [4] . Three years after his first visit with us, his BMI is 32.9 kg/m 2 , he has normal blood pressure and physical exam, and his laboratory tests remain below the target level including an HbA1c that stays ≤ 6.5%.…”

Section: Case Reportmentioning

confidence: 99%

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Reversal of type 2 diabetes mellitus in an obese man: Role of dietary modification and physical activity

Plourde¹

2013

Clinical Nursing Studies

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Reversal of Type 2 diabetes mellitus (Type 2 DM) in obese patients with short-term history of diabetes has been seen. However, achieving such reversal in patients with long-term history of diabetes and maintaining long-term metabolic control with dietary modification and physical activity (PA) has not been documented. The aim of this paper is to report a novel case of an obese man (BMI = 43.6 kg/m 2 ) in his fifties with a 20-year history of Type 2 DM, dyslipidemia and hypertension treated with medication who was able to reverse these disorders and stop all medications after being exposed to a very low-calorie diet (VLCD) for 16 weeks. With this treatment he was able to reduce his weight by 15.3% (BMI = 37.0 kg/m 2 ) and his laboratory values were normal including a glycated hemoglobin (HbA1c) of 6.0%. Continuing with the combination of low-calorie diets (LCDs) and a supervised moderate-intensity exercise program for a period of 10 months, he reduced his weight by another 12.7% (BMI = 31.4 kg/m 2 ) and his laboratory values remained normal. At > 3 years of follow-up with the combination of weight-maintenance diet, supervised moderate-intensity exercise program and counselling his BMI is 32.9 kg/m 2 and he maintains adequate metabolic control including an HbA1c that stays ≤ 6.5%.Although future clinical research is needed to confirm these findings, this case-report demonstrates that dietary modification and PA can reverse Type 2 DM and provide long-term protective effects against obesity-associated disorders in patients with a long-history of Type 2 DM.

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Setting Appropriate Expectations After Bariatric Surgery

Ghaferi

Varban

2018

JAMA

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Bariatric surgery is the most effective intervention available for treating obesity and its numerous associated comorbid conditions, 1,2 and for improving the quality and length of life for patients with severe obesity. 3 Given the initial cost and risk of bariatric operations, defining the long-term benefits of bariatric surgery is critical for justifying its utility as an obesity treatment. Inadequate follow-up and lack of standardization of how to define failure of bariatric operations have limited the ability to fully assess their clinical utility. In this issue of JAMA, King et al 4 provide recommendations for how to best measure clinically important weight regain after bariatric surgery based on Longitudinal Assessment of Bariatric Surgery (LABS) study outcomes.Body weight does not reflect the degree of adiposity or extent of metabolic disease. 5 Weight regain alone after bariatric surgery may have few adverse health consequences, whereas clinically important weight regain will be associated with the return of comorbid disease. For that reason, when defining failure of a bariatric operation, weight regain needs to be assessed along with the return of comorbidities. Using data from the LABS study, King and colleagues 4 described patients who underwent Roux-en-Y gastric bypass (RYGB) surgery and achieved nadir weight and assessed the rate of weight regain after reaching nadir weight. The performance of commonly used weight regain measures (ie, weight in kilograms, body mass index [BMI], percentage of presurgery weight, percentage of nadir weight, and the percentage of maximum weight loss) was compared with the recurrence of 6 important clinical outcomes (progression of diabetes, hyperlipidemia, and hypertension, physical and mental health, health-related quality of life, and patient satisfaction with surgery). Data were analyzed from 83% of eligible patients (1406 of 1703) who had RYGB surgery at least 5 years previously and had complete weight and follow-up information. The characteristics of the study population were similar to the general bariatric surgery population-predominantly female (80.3%), white (85.6%), had a median age of 47 years prior to surgery, and a median BMI of 46.3.Overall, the median time to the maximal weight loss was 2.0 years after RYGB surgery and the maximum weight loss was 37.4% of presurgery weight. The rate of weight regain was the greatest during the first year after reaching nadir weight with a median regain of 9.5% of the maximum weight lost. At 5 years, the median regain of the maximum weight loss was 26.8%. The rate of weight regain slowed with time. This means, for example, that a patient with the median baseline weight of the study population of 130 kg (285 lbs; BMI, 46.3) would weigh

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Managing obesity in adults in primary care

Cited by 43 publications

References 41 publications

Recommendations for prevention of weight gain and use of behavioural and pharmacologic interventions to manage overweight and obesity in adults in primary care

Recommendations for prevention of weight gain and use of behavioural and pharmacologic interventions to manage overweight and obesity in adults in primary care

Reversal of type 2 diabetes mellitus in an obese man: Role of dietary modification and physical activity

Setting Appropriate Expectations After Bariatric Surgery

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