Dr. Shafiq Qaadri
It will take more than guidelines to address Canada's obesity epidemic.
About four out of 10 of us are either overweight or obese, and this will lead to a tsunami of diabetes, kidney failure, heart attacks and stroke. In fact, obesity is perhaps the prime mover for all these conditions.
Since the Canadian Task Force on Preventive Health Care guidelines, published Monday in the Canadian Medical Association Journal, are directed at health practitioners, as opposed to the public, it does seem a bit late in the day to be recommending BMI (body mass index) measurements; surely that is not new. This measurement is or should be part of every patient's chart. Measuring waist circumference (WC) – which is a new vital sign – is much easier done by patients at home. While waist circumference was briefly mentioned in the guidelines, no optimal numbers were offered.
Since these are updated 2015 guidelines that family doctors are expected to adopt and follow, it's also surprising that slight mention was made of ethnic differences: Various ethnicities have tighter weight thresholds. (Certain races tend to get overweight more quickly.) We know this for waist circumferences.
For example, a Caucasian male is allowed to have a WC of up to 40 inches before being considered at high risk for developing health problems; for a South Asian, Chinese or South American male, the cut-off is 35 inches. That's a huge difference, with many implications. This racial difference completely skews the general BMI recommendations, which say you are overweight if your BMI is over 25. This doesn't hold for huge segments of the Canadian population.
One encouraging highlighted fact is that even modest weight loss – losing just 5 per cent of body weight – does have positive health benefits.
This will help reduce high blood pressure, sugar levels and cholesterol levels. So that's important for family doctors to emphasize, as we cheer our patients on to make healthy choices.
Here's another singularly unhelpful conclusion: "For adults who are overweight or obese, we recommend that practitioners not routinely offer pharmacologic interventions." Perhaps that's best medical practice, because no medications work too well for too long, and many have serious side effects. But we are pushed by patients, who have tried everything else, to prescribe medication for quitting smoking, insomnia, alcohol addiction and many other conditions. So with due respect to my colleagues who authored the guidelines, the blanket dismissal of drug therapy is a bit of a disconnect with the realities of family practice. (There are also new weight-loss medications on the horizon.)
As with most conditions, surgery is the final option. But bariatric surgery – "stomach stapling" – is only meant for very high-end obesity.
Over all, perhaps the tentative, half-hearted, cautious tone of these guidelines reflects the challenges of obesity management. So far, nothing seems to work reliably and reproducibly for the vast majority of patients. So more research must be done, because the need for effective obesity treatment(s) is urgent.
Health Advisor contributors share their knowledge in fields ranging from fitness to psychology, pediatrics to aging.
Shafiq Qaadri, MPP, is a Toronto family physician.