With the epidemic in obesity and the continuing rise in obesity, we are at epidemic proportions. Obesity translates into a number of serious health consequences and unless we can stem this frightening trend, we know that we will be in serious trouble.
 
In this week's Canadian Medical Association Journal is an article on managing obesity in adults. As the article points out, we know that the advice of a physician is important in helping patients to lose weight however they are often not given the support and advice they need to be successful in the long run.

The Canadian Health Measures survey (2007–2009) estimates that 62% of Canadian adults are overweight, and 24% are obese. Obesity is most common in middle-aged adults and declines after age 65. The economic costs of obesity are high, estimated at $4.6 billion in 2008, and when the health costs of related diseases are included, cost estimates rise to almost $7.1 billion. Obesity is linked to increased risks of high blood pressure, diabetes, heart disease, osteoarthritis, various cancers and other diseases.

The review discusses the 5A model to successfully counsel patients to change their eating habits and levels of physical activity. The 5A model, adapted from smoking cessation therapies, consists of:

  • Assess/ask
  • Advise
  • Agree
  • Assist
  • Arrange

Under assess and ask, physicians are encouraged to regularly measure body mass index and waist circumference and using prompts to record can lead to better management of obesity.

The authors in the CMAJ point out that dietary modification and caloric restriction have been shown to be effective. Increases in physical activity and/or intensity combined with caloric restriction increase weight loss. As well, behavioural therapy to change a patient's behaviour and habit has been shown to increase the success of dietary and exercise interventions, which also can help patients maintain weight loss.
 
Tips from successful dieters in the National Weight Control Registry, a group of 10,000 people who have lost 30 pounds or more and maintained that loss for a year or more, include:

  • Follow a low-calorie, low-fat diet
  • Keep track of food intake.
  • Catch slips
  • Walk about an hour a day
  • Eat breakfast regularly
  • Limit dining out
  • Eat similar foods often
  • Watch fewer than 10 hours of TV a week
  • Weigh in at least once a week.