Summary of recommendations on prevention of weight gain in normal-weight adults and treatment of overweight and obesity in Canada and elsewhere
| Organization | Recommendation |
|---|---|
| Prevention of weight gain | |
| CTFPHC (2015) | We recommend that practitioners not offer formal, structured interventions* aimed at preventing weight gain in normal-weight adults. |
| CTFPHC (2006)15 | Insufficient evidence to recommend for or against community-wide cardiovascular disease preventive programs to prevent obesity. Fair evidence to recommend intensive individual and small-group counselling for a reduced-calorie or low-fat diet to prevent obesity. Fair evidence to recommend an intensive individual or structured group program of endurance exercise to prevent obesity. Insufficient evidence to recommend a program of strength-training exercise to prevent obesity. Fair evidence to recommend an intensive individual or small-group program of a combined low-fat/reduced-calorie diet and endurance exercise intervention to prevent obesity. Fair evidence to recommend against low-intensity interventions employing telephone or mail support, or financial incentives to promote a low-fat/reduced-calorie diet and endurance exercise as a means to prevent obesity. |
| USPSTF (2012)46 | No prevention recommendation; screen all adults for obesity. |
| NICE (2010)47 | Everyone should aim to maintain or achieve a healthy weight, to improve their health and reduce the risk of diseases associated with overweight and obesity; people should follow the strategies which may make it easier to maintain a healthy weight by balancing “calories in” and “calories out.” |
| SIGN (2010)48 | Individuals consulting about weight management should be advised to reduce intake of energy-dense foods by selecting foods with low energy density instead, reduce consumption of fast foods and reduce alcohol intake. Individuals consulting about weight management should be encouraged to be physically active and reduce sedentary behaviour, including television-watching. |
| Obesity Canada (2007)49 | Recommend programs that combine a low-fat or energy-reduced diet and endurance exercise; individual and small-group counselling for dietary interventions; insufficient evidence for community interventions aimed at cardiovascular disease risk reduction. |
| Treatment of overweight and obesity | |
| CTFPHC (2015) | Offer or refer to formal, structured behavioural interventions aimed at decreasing weight in overweight or obese adults. Do not recommend pharmacologic interventions. |
| CTFPHC (1999)14 | Insufficient evidence to recommend weight-reduction therapy for obese adults without obesity-related diseases; for obese adults with obesity-related diseases weight reduction is recommended. |
| National Health and Medical Research Council (Australia) (2013)50 | For adults who are overweight or obese, strongly recommend lifestyle change — including reduced-energy intake, increased physical activity and measures to support behavioural change. For adults with a BMI ≥ 30, or adults with a BMI ≥ 27 and comorbidities, orlistat may be considered as an adjunct to lifestyle interventions, taking into account the individual situation. |
| USPSTF (2012; 2014)46,51 | Screen all adults for obesity; offer or refer patients with a BMI ≥ 30 to intensive, multicomponent behavioural interventions. Offer or refer adults who are overweight or obese and have additional cardiovascular disease risk factors to intensive behavioural counselling interventions to promote a healthful diet and physical activity for cardiovascular disease prevention. |
| NICE (2010)47 | Multicomponent interventions are the treatment of choice. Weight-management programs should include behaviour change strategies to increase physical activity or decrease inactivity, improve eating and diet quality and reduce energy intake. Pharmacologic treatment should be considered only after dietary, exercise and behavioural approaches have been started and evaluated. |
| SIGN (2010)48 | Weight-management programs should include physical activity, dietary change and behavioural components. Orlistat should be considered as an adjunct to lifestyle interventions in the management of weight loss following assessment of risk and benefits. |
| Obesity Canada (2007)49 | Recommend an energy-reduced diet, regular physical and comprehensive lifestyle intervention. Pharmacotherapy for adults not attaining or unable to attain weight loss with diet and exercise therapy. |
Note: BMI = body mass index, CTFPHC = Canadian Task Force on Preventive Health Care, NICE = National Institute for Health and Clinical Excellence (UK), SIGN = Scottish Intercollegiate Guideline Network, USPSTF = U.S. Preventive Services Task Force.
↵* Formal, structured interventions are behavioural modification programs that involve several sessions or interactions that take place over weeks to months. Interventions examined include behaviourally based prevention interventions focused on diet, exercise, lifestyle changes or any combination of these.