New 'Real-World' Obesity Clinical Practice Guidelines

It is an unfortunate fact that despite the high prevalence of overweight and obesity in our society, most health care professionals receive little training in obesity medicine.  I am asked by colleagues just about every day: ‘How do I treat my patient who struggles with excess weight?’  Health care providers often feel lost in this arena.  

There are a number of obesity management guidelines that try to guide the care of people with obesity, but they often do not provide a consensus on a clear and concise approach to management or treatment goals.

Good news! The American Association of Clinical Endocrinologists and American College of Endocrinology have produced a new set of Clinical PracticeGuidelines for obesity that they describe as an evidence based, real-world approach, that gives health care providers practical, straightforward, and tangible algorithms for diagnosis, assessment, and management of people with excess weight.

The theme of these guidelines (which I fully agree with) is that management of obesity is not about the numbers on the scale, but about improving overall health and well being.

The approach to diagnosis and management in these guidelines are nicely packaged into a handful of algorithms and tables that you can access here.  Some of the highlights:

1.  The diagnosis of obesity is not just about the numbers on the scale.  They break down the obesity diagnosis into two components: the anthropometric component (numbers: BMI, waist circumference), and the critically important clinical component (complications of the excess weight, of which they have included a convenient checklist of things to look for and how to screen for them).

2.  There is a beautiful table that lists how much weight loss is recommended to improve any particular complication of obesity (eg 5-15% for type 2 diabetes, 5-15% or more for polycystic ovary syndrome, 7-11% or more for obstructive sleep apnea).

3.  They break down lifestyle treatment into three components: meal plan, physical activity, and behavior modification.  They review pros and cons to different types of diets and where evidence exists for improvement of parameters of health (while emphasizing that the dietary approach needs to be individualized to each patient).

4.  They review pros and cons of medications to treat obesity (note that only two of the medications reviewed are available in Canada – namely, liraglutide and orlistat), along with clinical features that may favor the use of one antiobesity medication over another.

In the spirit of focusing on treating to improve weight-associated health complications rather than focus on numbers on the scale, they suggest more intensive treatment approaches (eg medication or bariatric surgery) in situations where complications of obesity already exist.  Personally, I am inclined to favor a more proactive approach, not only looking at these treatment options to improve upon existing complications of obesity, but also to prevent these complications from developing in the first place.

Overall, these guidelines and nicely packaged tables and algorithms provide a great framework to help health care professionals with a real-world approach to obesity management.  Check it out!

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