Summary Table: Prevention of Obesity in Adults

Canadian Task Force on Preventive Health Care

Summary Table of Recommendations

Please note: In 2003, the CTF updated its Grades of Recommendations to include an "I Recommendation" for situations where insufficient evidence exists to allow a recommendation to be made. (Formerly, these situations were captured under a "C Recommendation".) This change is not retroactive, and all "C Recommendations" made prior to 2003 have not been reevaluated in light of the new "I" recommendation grade. For a discussion of these recommendation grades, please link to the 2003 article in the Canadian Medical Association Journal here.

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) ).

MANEUVER EFFECTIVENESS LEVEL OF EVIDENCE <REF>* RECOMMENDATION*

Detection

BMI measurement In general adult population, BMI measurement is a reliable and valid method of determining body fat content and diagnosing obesity Cohort studies (II-2)<35–39> Because of lack of evidence supporting long-term effectiveness of weight-reduction interventions, there is insufficient evidence to recommend for or against BMI measurement in the periodic health examination of the general population (C)

For obese adults with obesity-related disease,† weight reduction should be considered if BMI is > 27 RCTs (I);<80–82,86,94> cohort studies (II-2)<89–93,96–102> There is fair evidence to recommend BMI measurement in the periodic health examination of obese adults with obesity-related disease (B)

Prevention

Community-based obesity prevention programs These programs have not been proven effective in promoting weight reduction. Methodologic limitations in studies preclude definitive conclusions relating to the prevention of obesity Nonrandomized trials (II-1)<48–50> There is insufficient evidence to recommend for or against community-based obesity prevention programs (C)‡

Treatment

Weight-reduction therapy (dietary, pharmacologic, surgical or behavioural) For obese adults without obesity-related disease,† weight reduction is not effective in long term; methodologic limitations in studies preclude definitive conclusions relating to treatment of obesity RCTs (I);<51–56,65–76,78–82> nonrandomized trial (II-1);<65> cohort studies (II-2)<60–64,77,83–86> There is insufficient evidence to recommend for or against weight-reduction therapy in obese adults without obesity-related disease (C)

For obese adults with obesity-related disease,† weight reduction, at least in short term, can alleviate symptoms and reduce need for drug therapy for related diseases RCTs (I);<80–82,94,95,103,104, 109> nonrandomized trials (II-1)<89–93,96–102> There is fair evidence to recommend weight-reduction therapy in obese adults with obesity-related disease (B)

†Diabetes mellitus, hypertension, coronary artery disease, hyperlipidemia, obstructive sleep apnea.

‡Because of considerable health risks associated with obesity and the limited long-term effectiveness of weight reduction methods, the prevention of obesity should be a high priority for health care providers.

Link to Full Text of this review

Link to Structured Abstract of this review

Link to Selected References list of this review

Link to 1994 chapter: Prevention of obesity in adults

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MANEUVER	EFFECTIVENESS	LEVEL OF EVIDENCE <REF>*	RECOMMENDATION*
Detection
BMI measurement	In general adult population, BMI measurement is a reliable and valid method of determining body fat content and diagnosing obesity	Cohort studies (II-2)<35–39>	Because of lack of evidence supporting long-term effectiveness of weight-reduction interventions, there is insufficient evidence to recommend for or against BMI measurement in the periodic health examination of the general population (C)
	For obese adults with obesity-related disease,† weight reduction should be considered if BMI is > 27	RCTs (I);<80–82,86,94> cohort studies (II-2)<89–93,96–102>	There is fair evidence to recommend BMI measurement in the periodic health examination of obese adults with obesity-related disease (B)
Prevention
Community-based obesity prevention programs	These programs have not been proven effective in promoting weight reduction. Methodologic limitations in studies preclude definitive conclusions relating to the prevention of obesity	Nonrandomized trials (II-1)<48–50>	There is insufficient evidence to recommend for or against community-based obesity prevention programs (C)‡
Treatment
Weight-reduction therapy (dietary, pharmacologic, surgical or behavioural)	For obese adults without obesity-related disease,† weight reduction is not effective in long term; methodologic limitations in studies preclude definitive conclusions relating to treatment of obesity	RCTs (I);<51–56,65–76,78–82> nonrandomized trial (II-1);<65> cohort studies (II-2)<60–64,77,83–86>	There is insufficient evidence to recommend for or against weight-reduction therapy in obese adults without obesity-related disease (C)
	For obese adults with obesity-related disease,† weight reduction, at least in short term, can alleviate symptoms and reduce need for drug therapy for related diseases	RCTs (I);<80–82,94,95,103,104, 109> nonrandomized trials (II-1)<89–93,96–102>	There is fair evidence to recommend weight-reduction therapy in obese adults with obesity-related disease (B)