Canadian Task Force on Preventive Health Care

Selected References



Periodic health examination, 1999 update: 1. Detection, prevention and treatment of obesity

Prepared by James D. Douketis, MD and John Attia, MD, PhD, Department of Medicine, McMaster University, Hamilton, Ont.; John W. Feightner, MD, Department of Family and Community Medicine, University of Western Ontario, London, Ont.; William F. Feldman, MD, Department of Pediatrics, University of Toronto, Toronto, Ont.; with the Canadian Task Force on Preventive Health Care

These recommendations were finalized by the Task Force in January 1998 and published in the Canadian Medical Association Journal February 23, 1999 (CMAJ 1999; 160(4) ).


 

  1. Reeder BA, Angel A, Ledoux M, Rabkin SW, Young TK, Sweet LE, and the Canadian Heart Health Surveys Research Group. Obesity and its relation to cardiovascular disease risk factors in Canadian adults. CMAJ 1992;146:2009-19.
  2. Macdonald SM, Reeder BA, Chen Y, Després JP, and the Canadian Heart Health Surveys Research Group. Obesity in Canada: a descriptive analysis. CMAJ 1997;157(1 Suppl):S3-S9.
  3. Van Italie TB. Health implications of overweight and obesity in the United States. Ann Intern Med 1985;103:983-8.
  4. Bjorntorp P. Obesity. Lancet 1997;350:423-6.
  5. Rabkin SW, Chen Y, Leiter L, Liu L, Reeder BA, and the Canadian Heart Health Surveys Research Group. Risk factor correlates of body mass index. CMAJ 1997;157(1 Suppl):S26-S31.
  6. Bray GA. Obesity: basic considerations and clinical approaches. Dis Mon 1989;15:461-537.
  7. Stamler R, Stamler J, Riedlinger WF, Algera G, Roberts RH. Weight and blood pressure. Findings in hypertension screening of 1 million Americans. JAMA 1978;240:1607-10.
  8. Reeder BA, Senthilselvan A, Després JP, Angel A, Liu L, Wang H, et al. The association of cardiovascular disease risk factors with abdominal obesity in Canada. CMAJ 1997;157(1 Suppl):S39-S45.
  9. Colditz GA, Willet WC, Rotnitzky A, Manson J. Weight gain as a risk factor for clinical diabetes mellitus in women. Ann Intern Med 1995;122:481-6.
  10. Manson JE, Nathan DM, Krolewski AS, Stampfer MJ, Willett WC, Hennekens CH. A prospective study of exercise and incidence of diabetes among US male physicians. JAMA 1992;268:63-7.
  11. Wilcosky T, Hyde J, Anderson JJB, Bangdiwala S, Duncan B. Obesity and mortality in the Lipid Research Clinics Program Follow-up Study. J Clin Epidemiol 1990;43:743-52.
  12. Freedman DS, Jacobsen SJ, Barboriak JJ, et al. Body fat distribution and male/female differences in lipids and lipoproteins. Circulation 1990;81:1498-1506.
  13. Willet WC, Manson JE, Stampfer MD, et al. Weight, weight change, and coronary heart disease in women. Risk within the "normal" weight range. JAMA 1995;273:461-5.
  14. Hubert HB, Fienleib M, McNamara PM, et al. Obesity as an independent risk factor for cardiovascular disease: a 26-year follow-up of participants in the Framingham Heart Study. Circulation 1983;67:968-77.
  15. Rabkin SW, Mathewson FAL, Hsu PH. Relation of body weight to development of ischemic heart disease in a cohort of young North America men after a 26 year observation period: the Manitoba Study. Am J Cardiol 1977;39:452-8.
  16. Harris TB, Launer LJ, Madans J, Feldman JJ. Cohort study of effect of being overweight and change in weight on risk of coronary heart disease in old age. BMJ 1997;314:1791-4.
  17. Smith PL, Gold AR, Myers DA, et al. Weight loss in mildly to moderately obese patients with obstructive sleep apnea. Ann Intern Med 1985;103:850-5.
  18. Wittels EH, Thompson S. Obstructive sleep apnea and obesity. Otolaryngol Clin North Am 1990;23:751-60.
  19. Paffenberger RS Jr, Kampert JB, Chang HG. Characteristics that predict risk of breast cancer before and after the menopause. Am J Epidemiol 1980;112:258-68.
  20. Lubin F, Ruder AM, Wax Y, et al. Overweight and changes in weight throughout life in breast cancer etiology. A case–control study. Am J Epidemiol 1985;122:579-88.
  21. Kelsey JL, LiVolsi VA, Holford TR, Fischer DB, Mostow ED, Schwartz PE, et al. A case–control study of cancer of the endometrium. Am J Epidemiol 1982;116:333-42.
  22. Snowdon DA, Phillips RL, Choi W. Diet, obesity and risk of fatal prostate cancer. Am J Epidemiol 1982;120:244-50.
  23. Nomura A, Heilbrun LK, Stemmermann GN. Body mass index is a predictor of cancer in men. J Natl Cancer Inst 1985;74:319-27.
  24. Phillips RL, Snowdon DA. Dietary relationships with fatal colorectal cancer among Seventh Day Adventists. J Natl Cancer Inst 1985;74:307-17.
  25. Wadden TA, Stunkard AJ. Social and psychological consequences of obesity. Ann Intern Med 1985;103:1062-7.
  26. Wardle J. Obesity and behaviour change: matching problems to practice. Int J Obes 1996;20(Suppl 1):S1-S8.
  27. Sarlio-Lahteenkorva S, Stunkard A, Rissanen A. Psychosocial factors and quality of life in obesity. Int J Obes 1995;19(Suppl 6):S1-S5.
  28. Jarrett JR, Shipley MJ, Rose G. Weight and mortality in the Whitehall Study. BMJ 1982;285:535-7.
  29. Waaler HT: Height, weight and mortality: the Norwegian experience. Acta Med Scand 1984;679:1-56.
  30. Manson JE, Willet WC, Stampfer MJ, et al. Body weight and mortality among women. N Engl J Med 1995;333:677-85.
  31. Canadian guidelines for healthy weights: report of an expert group convened by Health Promotion Directorate, Health Services and Promotion Branch. Ottawa: Health Promotion Directorate, Department of National Health and Welfare; 1988.
  32. Report of the Task Force on the Treatment of Obesity. Ottawa: Health Services and Promotion Branch, Department of National Health and Welfare; 1991.
  33. Fleiss JL. Statistical methods for rates and proportions. New York: John Wiley & Sons; 1973. p. 43-7.
  34. Goldbloom R, Battista RN. The periodic health examination: 1. Introduction. CMAJ 1986;134:721-3.
  35. Canadian Task Force on the Periodic Health Examination. Periodic health examination, 1992 update: 1. Screening for gestational diabetes mellitus. CMAJ 1992;147:435-43.
  36. Revicki DA, Israel RG. Relationship between body mass indices and measures of body adiposity. Am J Public Health 1986;76:992-4.
  37. Bray GA, Frank FL, Molitch ME, et al. Use of anthropometric measures to assess weight loss. Am J Clin Nutr 1978;31:769-73.
  38. Garrow JS, Webster J. Quetelet's index (W/H2) as a measure of fatness. Int J Obes 1985;9:147-53.
  39. Florey C du V. The use and interpretation of ponderal index and other weight–height ratios in epidemiological studies. J Chronic Dis 1970;23:93-103.
  40. Keys A, Fidanza F, Karvonen MJ, Kimura N, Taylor HL. Indices of relative weight and obesity. J Chronic Dis 1972;25:329-43.
  41. Heymsfield SB, Casper K. Anthropometric assessment of the adult hospitalized patient. J Parent Ent Nutr 1987;11(Suppl):36S-41S.
  42. Kannel WB, Cupples LA, Ramaswami R, et al. Regional obesity and risk of cardiovascular disease: the Framingham Study. J Clin Epidemiol 1991;44:183-90.
  43. Ducimetiere P, Richard J, Cambien F. The pattern of subcutaneous fat distribution in middle-aged men and the risk of coronary heart disease: the Paris Prospective Study. Int J Obes 1986;10:229-40.
  44. Lapidus L, Bengtsson C, Larsson B, et al. Distribution of adipose tissue and risk of cardiovascular disease and death: a 12 year follow up of participants in the population study of women in Gothenburg, Sweden. BMJ 1984;289:1257-61.
  45. Chan JM, Rimm EB, Colditz GA, Stampfer MJ, Willett WC. Obesity, fat distribution, and weight gain as risk factors for clinical diabetes in men. Diabetes Care 1994;17:961-9.
  46. Ledoux M, Lambert J, Reeder BA, Després JP, and the Canadian Heart Health Surveys Research Group. A comparative analysis of weight to height and waist to hip circumference indices as indicators of the presence of cardiovascular disease risk factors. CMAJ 1997;157(1 Suppl):S32-S38.
  47. Ashwell M, LeJeune S, McPherson K. Ratio of waist circumference to height may be a better predictor of need for weight management [letter]. BMJ 1996;312:377.
  48. Fortmann SP, Williams PT, Hulley SB, et al. Effect of health education on dietary behavior: the Stanford Three Community Study. Am J Clin Nutr 1981;34:2030-8.
  49. Barr Taylor C, Fortmann SP, Flora J, et al. Effect of long-term community education on body mass indices. The Stanford Five City Project. Am J Epidemiol 1991;134:235-49.
  50. Jeffery RW. Minnesota studies in community-based approaches to weight loss and control. Ann Intern Med 1993;119(Suppl):719-21.
  51. Hakala P, Karvetti RL, Ronnemaa T. Group vs. individual weight reduction programmes in the treatment of severe obesity — a five year follow-up study. Int J Obes Relat Metab Disord 1993;17:97-102.
  52. Miura J, Arai K, Tsukahara S, Ohno M, Ikeda Y. The long term effectiveness of combined therapy by behavior modification and very low calorie diet: 2 years follow-up. Int J Obes 1989;13(Suppl 2):73-7.
  53. Wadden TA, Sternberg JA, Letezia KA, Stunkard AJ, Foster GD: Treatment of obesity by very low calorie diet, behavior therapy, and their combination: a five-year perspective. Int J Obes 1989;13(Suppl 2):S39-S46.
  54. Karvetti RL, Hakala P: A seven-year follow up of a weight reduction programme in Finnish primary health care. Eur J Clin Nutr 1992;46:743-52.
  55. Skender ML, Goodrick GK, Del Junco D, et al. Comparison of 2-year weight loss trends in behavioral treatments of obesity: diet, exercise, and combination interventions. J Am Diet Assoc 1996;96:342-6.
  56. Torgerson JS, Lissner L, Lindroos AK, Kruijer H, Sjöstrom L. VLCD plus dietary and behavioural support versus support alone in the treatment of severe obesity. A randomised two-year clinical trial. Int J Obes Relat Metab Disord 1997;21:987-94.
  57. Ryttig KR, Flaten H, Rossner S. Long-term effects of a very low calorie diet (Nutrilett®) in obesity treatment. A prospective, randomized, comparison between VLCD and a hypocaloric diet + behavior modification and their combination. Int J Obes 1997;21:574-9.
  58. King LC, Frey-Hewitt B, Dreon DM, Wood PD. Diet vs exercise in weight maintenance. The effects of minimal intervention strategies on long-term outcomes in men. Arch Intern Med 1989;149:2741-6.
  59. Pekkarinen T, Mustajoki P. Comparison of behavior therapy with and without very-low-energy diet in the treatment of morbid obesity. Arch Intern Med 1997;157:1581-5.
  60. Pekkarinen T, Takala I, Mustajoki P. Two year maintenance of weight loss after a VLCD and behavioural therapy for obesity: correlation to the scores of questionnaires measuring eating behaviour. Int J Obes 1996;20:332-7.
  61. Nunn RG, Newton KS, Faucher P. 2.5 years follow-up of weight and body mass index values in the Weight Control for Life! program: a descriptive analysis. Addict Behav 1992;17:579-85.
  62. Anderson JW, Hamilton CC, Crown-Weber E, et al. Safety and effectiveness of a multidisciplinary very-low calorie diet program for selected obese individuals. J Am Diet Assoc 1991;91:1582-4.
  63. Anderson JW, Brinkman VL, Hamilton CC. Weight loss and 2-year follow-up for 80 morbidly obese patients treated with intensive very-low calorie diet and an education program. Am J Clin Nutr 1992;56(Suppl):244S-246S.
  64. Bjorvell H, Rossner S. A ten-year follow-up of weight change in severely obese subjects treated in a combined behavioural modification program Int J Obes 1992;16:623-5.
  65. Goldstein DJ, Rampey AH Jr, Enas GG, et al: Fluoxetine: a randomized clinical trial in the treatment of obesity. Int J Obes 1994;18:129-35.
  66. Guy-Grand B, Apfelbaum M, Crepaldi G, Gries A, Lefebvre P, Turner P. International trial of long-term dexfenfluramine in obesity. Lancet 1989;2:1142-5.
  67. Mathus-Vliegen EMH, van de Voorde K, Kok AME, et al.Dexfenfluramine in the treatment of severe obesity: a placebo-controlled investigation of the effects on weight loss, cardiovascular risk factors, food intake and eating behaviour. J Intern Med 1992;232:119-27.
  68. Enzi G, Baritussio A, Marchiori E, et al. Short-term and long-term clinical evaluation of a non-amphetaminic anorexiant (mazindol) in the treatment. J Intern Med Res 1976;4:305-18.
  69. Weintraub M. Long term weight control: the National Heart, Lung, and Blood Institute funded multimodal study. Clin Pharmacol Ther 1992;51(Suppl):581-646.
  70. O’Connor HT, Richman RM, Steinbeck KS, Caterson ID. Dexfenfluramine treatment of obesity: a double blind trial with post trial follow up. Int J Obes 1995;19:181-9.
  71. Stunkard AJ, Wilcoxon Craighead L, O’Brien R. Controlled trial of behaviour therapy, pharmacotherapy, and their combination in the treatment of obesity. Lancet 1980;2:1045-7.
  72. Manning RM, Jung RT, Leese GP, Newton RW. The comparison of four weight reduction strategies aimed at overweight diabetic patients. Diabet Med 1995;12:409-15.
  73. Andersen T, Stokholm KH, Backer OG, Quaade F. Long-term (5-year) results after either horizontal gastroplasty or very-low-calorie diet for morbid obesity. Int J Obes 1988;12:277-84.
  74. Hall JC, Watts JM, O’Brien PE, et al: Gastric surgery for morbid obesity. The Adelaide Study. Ann Surg 1990;4:419-27.
  75. Naslund I, Wickbom G, Agren G. A prospective randomized comparison of gastric bypass and gastroplasty. Acta Chir Scand 1986;152:681-9.
  76. Lechner GW, Elliot DW. Comparison of weight loss after gastric exclusion and partitioning. Arch Surg 1983;118:685-92.
  77. Ashley S, Bird DL, Sugden G, et al. Vertical banded gastroplasty for the treatment of morbid obesity. Br J Surg 1993;80:1421-3.
  78. Trials of Hypertension Prevention Collaborative Research Group. Effects of weight loss and sodium reduction intervention on blood pressure and hypertension incidence in overweight people with high-normal blood pressure. The Trials of Hypertension Prevention, phase II. Arch Intern Med 1997;157:657-67.
  79. Hakala P. Weight reduction programmes at a rehabilitation centre and a health centre based on group counselling and individual support: short- and long-term follow-up study. Int J Obes Relat Metab Disord 1994;18:483-9.
  80. Stamler R, Stamler J, Grimm R, Gosch FC, Elmer P, Dyer A, et al. Nutritional therapy for high blood pressure. Final report of a four-year randomized controlled trial — the Hypertension Control Program. JAMA 1987;257:1484-91.
  81. Hypertension Prevention Trial Research Group. The Hypertension Prevention Trial: three-year effects of dietary changes on blood pressure. Arch Intern Med 1990;150:153-62.
  82. Elmer PJ, Grimm R, Laing B, et al. Lifestyle intervention: results of the Treatment of Mild Hypertension Study (TOMHS). Prev Med 1995;24:378-88.
  83. Eriksson KF, Lindgarde F. Prevention of type 2 (non-insulin-dependent) diabetes mellitus by diet and physical exercise. Diabetologia 1991;34:891-8.
  84. Jeffery RW, Bjornson-Benson WM, Rosenthal BS, Lindquist RA, Kurth CL, Johnson SL. Correlates of weight loss and its maintenance over two years of follow-up among middle-aged men. Prev Med 1984;13:155-68.
  85. Kramer FM, Jeffery RW, Forster JL, Snell MK. Long-term follow-up of behavioral treatment for obesity: patterns of weight regain among men and women [review]. Int J Obes 1989;13:123-6.
  86. Adams SO, Grady KE, Lund AK, Mukaida C, Wolk CH. Weight loss: long-term results in an ambulatory setting. J Am Diet Assoc 1983;83:306-10.
  87. Sackett DL, Haynes RB, Guyatt GH, Tugwell P. Clinical epidemiology: a basic science for clinical medicine. Boston: Little Brown & Co; 1991. p. 283-304.
  88. Methods for voluntary weight loss and control. NIH Technology Assessment Conference Panel. Ann Intern Med 1992;116:942-9.
  89. Ohlson LO, Larsson B, Svardsudd K, et al. The influence of body fat distribution on the incidence of diabetes mellitus. 13.5 years of follow-up of the participants in the study of men born in 1913. Diabetes 1985;34:1055-8.
  90. Wing RR, Marcus MD, Salata R, et al. Effects of a very-low calorie diet on long-term glycemic control in obese type 2 diabetic subjects. Arch Intern Med 1991;151:1334-40.
  91. Fitz JD, Sperling EM, Fein HG. A hypocaloric high-protein diet as primary therapy for adults with obesity-related diabetes: effective long-term use in a community hospital. Diabet Care 1983;6:328-33.
  92. Tuck ML, Sowers J, Dornfeld L, et al. The effect of weight reduction on blood pressure, plasma renin activity, and plasma aldosterone levels in obese patients. N Engl J Med 1981;304:930-3.
  93. Wiensier RI, James LD, Darnell BE, et al. Obesity-related hypertension: evaluation of the separate effects of energy restriction and weight reduction on hemodynamic and neuroendocrine status. Am J Med 1991;90:460-8.
  94. Davis BR, Blaufox MD, Oberman A, et al. Reduction in longterm antihypertensive medication requirements. Effects of weight reduction by dietary intervention in overweight persons with mild hypertension. Arch Intern Med 1993;153:1773-82.
  95. Stevens VJ, Corrigan SA, Obarzanek E, et al. Weight loss intervention in phase I of the Trials of Hypertension Prevention. Arch Intern Med 1993;153:849-58.
  96. Kirschner MA, Schnieder G, Ertel NH, et al. An 8-year experience with very low calorie formula diet for control of major obesity. Int J Obes 1988;12:69-80.
  97. Jalkanen L. The effect of a weight reduction program on cardiovascular risk factors among overweight hypertensives in primary health care. Scand J Soc Med 1991;19:66-71.
  98. Dattilo AM, Kris-Etherton PM. Effects of weight reduction on blood lipids and lipoproteins: a meta-analysis. Am J Clin Nutr 1992;56:320-8.
  99. Wing R, Jeffery RW. Effect of modest weight loss on changes in cardiovascular risk factors: Are there differences between men and women or between weight loss and maintenance? Int J Obes 1995;19:67-73.
  100. Langford HG, Blaufox MD, Oberman A, et al. Dietary therapy slows the return of hypertension after stopping prolonged medication. JAMA 1985;253:657-64.
  101. Suratt PM, McTier RF, Findlay LJ, et al. Changes in breathing and the pharynx after weight loss in obstructive sleep apnea. Chest 1987;92:631-7.
  102. Loube DI, Loube AA, Mitler MM. Weight loss for obstructive sleep apnea: the optimal therapy for obese patients [review]. J Am Diet Assoc 1994;94:1291-5.
  103. Niebauer J, Hambrecht R, Velich T, et al. Attenuated progression of coronary artery disease after 6 years of multifactorial risk intervention. Role of physical exercise. Circulation 1997;96:2534-41.
  104. Haskell WL, Alderman EL, Fair JM, et al. Effects of intensive multiple risk factor reduction on coronary atherosclerosis and clinical cardiac events in men and women with coronary artery disease: the Stanford Coronary Risk Intervention Project (SCRIPT). Circulation 1994;89:975-90.
  105. Ornish D, Brown SE, Scherwitz LW, et al. Can lifestyle changes reverse coronary heart disease? The Lifestyle Heart Trial. Lancet 1990;336:129-33.
  106. Schuler G, Hambrecht R, Schlierf G, et al. Regular exercise and low-fat diet. Effects on progression of coronary artery disease. Circulation 1992;86:1-11.
  107. Williamson DF, Pamuk E, Thun M, et al. Prospective study of intentional weight loss and mortality in never-smoking overweight US white women aged 40–64 years. Am J Epidemiol 1995;141:1128-41.
  108. Lean MEJ, Powrie JK, Anderson AS, et al. Obesity, weight loss and prognosis in type 2 diabetes. Diabet Med 1990;7:228-33.
  109. National Task Force on the Prevention and Treatment of Obesity, National Institutes of Health. Very low-calorie diets [review]. JAMA 1993;270:967-74.
  110. Everhart JE. Contribution of obesity and weight loss to gallstone disease. Ann Intern Med 1993;119:1029-35.
  111. National Task Force on the Prevention and Treatment of Obesity. Long-term pharmacotherapy in the management of obesity. JAMA 1996;276:1907-15.
  112. Abenhaim L, Moride Y, Brenot F, Rich S, Benichou J, Kurz X, et al. Appetite-suppressant drugs and the risk of primary pulmonary hypertension. International Primary Pulmonary Hypertension Study Group. N Engl J Med 1996;335:609-16.
  113. Connolly HM, Crary JL, McGoon MD, et al. Valvular heart disease associated with fenfluramine–phenteramine. N Engl J Med 1996;337:581-8.
  114. MacLean LD, Rhode BM, Forse RA. Late results of vertical banded gastroplasty for morbid and super obesity. Surgery 1990;107:20-7.
  115. Kolonowski J. Gastroplasty for morbid obesity: the internist's view. Int J Obes 1995;19(Suppl 3):S61-S65.
  116. Wadden TA, Stunkard AJ, Smoller JW. Dieting and depression: a critical review. J Psychosom Res 1987;31:429-40.
  117. Wilson GT. Relation of dieting and voluntary weight loss to psychological functioning and binge eating. Ann Intern Med 1993;119(Suppl):727-30.
  118. Lissner L, Odell PM, D'Agostino RB, et al. Variability of body weight and health outcomes in the Framingham population. N Engl J Med 1991;324:1839-44.
  119. Hamm P, Shekelle RB, Stamler J. Large fluctuation in body weight during young adulthood and twenty-five-year risk of coronary death in men. Am J Epidemiol 1989;129:312-8.
  120. National Task Force on the Prevention and Treatment of Obesity, National Institutes of Health. Weight cycling. JAMA 1994;272:1196-202.
  121. Muls E, Kempen K, Vansant G, et al. Is weight cycling detrimental to health? A review of the literature in humans. Int J Obes 1995;19(Suppl 3):S46-S50.
  122. Jeffery R. Does weight cycling present a health risk? Am J Clin Nutr 1996;63(Suppl):452S-455S.
  123. Benjamin SB, Maher KA, Cattau EL Jr, et al. Double-blind controlled trial of the Garren-Edwards gastric bubble: an adjunctive treatment for exogenous obesity. Gastroenterology 1988;95:581-8.
  124. Lindor KD, Hughes RW, Ilstrup DM, et al. Intragastric balloons in comparison with standard therapy for obesity: a randomized, double-blind trial. Mayo Clin Proc 1987;62:992-6.
  125. Sweeney ME. Severe versus moderate energy restriction with and without exercise in the treatment of obesity. Am J Clin Nutr 1993;57:127-34.
  126. Saris WHM. The role of exercise in the dietary treatment of obesity. Int J Obes 1993;17(Suppl 1):S17-S21.
  127. King AC, Tribble DL. The role of exercise in weight reduction in non-athletes. Sports Med 1991;11:331-49.
  128. Drent ML, Larsson I, William-Olsson T, et al. Orlistat (RO 18-0647), a lipase inhibitor, in the treatment of human obesity: a multiple dose study. Int J Obes 1995;19:221-6.


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Link to Summary Table of Recommendations of this review

Link to 1994 chapter: Prevention of obesity in adults

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