Obesity registers

Given the health risks associated with obesity, especially the increased potential for cardiovascular disease and type 2 diabetes, we should consider obesity to be a chronic disease and should treat it as such. Many Canadian family physicians have already set up chronic disease registers; an obesity register could be set up without too much difficulty in every practice that has an electronic medical record system.

In the United Kingdom, general practitioners are being taught how to set up obesity registers in their own practices (for patients over 16 years of age who have had a body mass index greater than 30 kg/m2 for 15 months) and receive remuneration for doing so.1^,2 Canada could learn from this initiative.

However, it is debatable whether an obesity register should be based upon the body mass index or upon the ratio of waist and hip circumference. The former is simple to calculate from height and weight measurements, which can quickly be taken by an office assistant or nurse. The waist and hip circumferences require accurate measurements at precise locations. Most people know their height and weight but not their waist and hip circumferences. However, the ratio of waist and hip circumference is the strongest predictor of future cardiovascular disease.3

There has been little primary care research focusing on identifying and managing the care of obese Canadian.4 Encouraging family physicians to keep obesity registers would initiate a process whereby patients could be identified for practical assistance and future studies. The primary care community needs to start formalizing a process for setting up obesity registers in family practices, before the problem starts to outweigh the solution.