Managing obesity in primary care

By Amanda Johnson 16/05/2012

A new paper published yesterday (14 May 2012) in the Canadian Medical Association Journal has reviewed the literature from January 2006 to July 2011 to establish the most effective methods for managing the ever increasing problem of obesity in the primary care setting.

Say the authors, ’there is an urgent need to find simple, effective strategies for improving weight loss counselling in clinical practice’.

This is an interesting review that covers the whole spectrum of treatment from diet to exercise and psychological interventions.

Overall, there is clear evidence that a holistic approach is the most effective. Dietary interventions show that dietary adherence and calorie restriction are more important than macronutrient composition. In terms of physical activity, interventions that combine exercise and diet certainly resulted in a greater reduction of weight than dietary interventions alone. Behaviour change is also an important component of weight loss and cognitive behavioural therapy, when combined with diet and exercise intervention, resulted in greater weight loss than diet or exercise alone.

This latest review confirms that the best approach to tackling weight management is the one that is currently recommended in the New Zealand Ministry of Health Clinical Guidelines on Weight Management, which promotes the FAB approach (this stands for ‘food’, ‘activity’, and ‘behaviour’). The FAB approach is a comprehensive lifestyle approach that incorporates diet, physical activity and behavioural strategies as the first treatment option for weight loss and sustained weight maintenance.

Weight maintenance is also addressed in this review paper, with a nice summary of the key indicators of successful maintenance of weight loss from the National Weight Control Registry, which includes information on more than 5000 people who have lost more than 30kg and kept it off for an average of six years. The keys to success are to engage in a high level of physical activity, to eat a diet low in fat and calories, to eat breakfast, to self-monitor weight on a regular basis, to keep a consistent eating pattern, and to catch ‘slips’ before they turn into larger re-gains in weight. All pretty sensible advice really!