Managing obesity in adults: Tips for primary care physicians

Managing adult obesity is challenging for primary care physicians, but a new review published in CMAJ (Canadian Medical Association Journal) aims to provide an evidence-based approach to counselling patients to help them lose weight and maintain weight loss.

"Even though evidence suggests that patients are considerably more likely to lose weight when they are advised to do so by their physicians, most patients who are clinically obese do not receive weight-loss counselling in primary care," writes Dr. Gilles Plourde, Cliniques Médicales de Nutrition et d'Amaigrissement de Gatineau, Quebec, with coauthor. "Patients may be told to lose weight, but they may not be given advice on how to do so successfully. There is an urgent need to find simple, effective strategies for improving weight-loss counselling in clinical practice."

The Canadian Health Measures survey (2007-2009) estimates that 62% of Canadian adults are overweight, and 24% are obese. is most common in middle-aged adults and declines after age 65. The economic costs of obesity are high, estimated at $4.6 billion in 2008, and when the health costs of related diseases are included, cost estimates rise to almost $7.1 billion. Obesity is linked to increased risks of high blood pressure, diabetes, heart disease, osteoarthritis, various cancers and other diseases.

While there is no single approach that works with everyone, physicians can use the 5A model to successfully counsel patients to change their eating habits and levels of physical activity. The 5A model, adapted from smoking cessation therapies, consists of assess/ask, advise, agree, assist and arrange.

Dietary modification and caloric restriction have been shown to be effective. Increases in physical activity and/or intensity combined with caloric restriction increase weight loss. As well, behavioural therapy to change a patient's behaviour and habit has been shown to increase the success of dietary and exercise interventions, which also can help patients maintain weight loss.

Many physicians do not feel trained to treat obesity and issues. Research indicates that regularly measuring body mass index and waist circumference and using prompts to record can lead to better management of obesity.

"Adult obesity remains a public health concern in Canada," state the authors. " are in an influential position to provide counselling, which can be successfully done using the 5A model of behavioural change and stage-specific strategies for changing lifestyles… .A sixth "A" should be added to the mnemonic: advocate — that is, to advocate for environmental and policy changes that support healthy eating and physical activity."

More information: Study: www.cmaj.ca/lookup/doi/10.1503/cmaj.111640

add to favorites email to friend print save as pdf

Related Stories

Physician's weight may influence obesity diagnosis and care

Jan 26, 2012

A patient's body mass index (BMI) may not be the only factor at play when a physician diagnoses a patient as obese. According to a new study led by researchers at the Johns Hopkins Bloomberg School of Public Health, the diagnosis ...

Recommended for you

More aging boomers, but fewer doctors to care for them

2 hours ago

By 2030, the last of the Baby Boomer generation will have turned 65 years old, putting the population of "senior boomers" in the United States at approximately 71 million. Currently, only about 7,000 certified geriatricians – ...

UK study examines communication and end-of-life decisions

2 hours ago

For many people, talking about end-of-life decisions can be very difficult. Although making choices about health care at the end of life is an important outcome of these conversations, recent research suggests that talking ...

User comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.