http://thechronicleherald.ca/Front/636683.html
Battle of bulge expands
New document urges doctors to measure patients’ waistlines
By SHERYL UBELACKER
TORONTO — Doctors should add a tape measure to their blood pressure cuff, stethoscope and other key diagnostic tools, say new obesity management guidelines which recommend that all Canadian adults and adolescents have their waist circumference sized up during regular checkups.
The advice to measure belly girth is among key recommendations of the first Canadian Clinical Practice Guidelines on the Management and Prevention of Obesity in Adults and Children, a 120-page document put together by dozens of experts across the country under the auspices of Obesity Canada.
The guidelines are being called the first in Canada to provide a comprehensive, evidence-based framework for health-care professionals and policy-makers to battle the growing epidemic of obesity and the diseases that accrue from it, notably cardiovascular disease and Type 2 diabetes.
"We need to talk about the waist circumference measurement as a new ‘vital sign,’" said Dr. David Lau, president of Obesity Canada, a non-profit organization dedicated to dramatically reducing the number of overweight and obese Canadians.
Almost 60 per cent of Canadian adults are overweight and almost one-quarter obese, said Lau, an endocrinologist and a professor of medicine at the University of Calgary. Among children, one in four is overweight and one in 10 obese, he said.
"We are now seeing obesity occurring in children at an alarming rate," Lau said Monday from Calgary. He noted that endocrinologists are seeing overweight and obese teens with health conditions that at one time were seen primarily in adults, including diabetes, high blood pressure and high cholesterol.
"We’re now seeing Type 2 diabetes, previously a typical disease of the 40s and 50s in men and women, now we’re seeing this in teenage girls and as young as six years of age," he said, adding that today’s children are facing a life expectancy shorter than their parents’ if the rising tide of obesity isn’t dealt with now.
"The way I see it is the personal and societal consequences of inaction on obesity can no longer be ignored."
The guidelines, published as a supplement to today’s issue of the Canadian Medical Association Journal, involved an exhaustive review of the medical literature to determine exactly what weight-loss strategies have been proven to work.
Lau said the recommendations are a first step in giving family doctors and other health providers better tools for helping overweight patients to shed excess pounds and keep them off — and to prevent others from piling them on in the first place.
While that includes keeping tabs on waistline measurements — considered by many a much better indicator of unhealthy weight than body mass index — doctors should also keep a wary eye out for underlying contributors to obesity, including depression and mood or eating disorders, the guidelines advise.
Physicians and other health providers should also counsel patients on ways to overcome unhealthy eating and a sedentary lifestyle, such as priority-setting and time-management strategies, Lau said.
When appropriate, doctors should not hesitate to prescribe medications or refer patients for bariatric surgery, both of which have been proven to help some people lose weight and maintain trimmer bodies, said Dr. Arya Sharma, scientific director of the Canadian Obesity Network and a contributor to the guidelines.
"The key message from the guidelines for health professionals and to policy-makers and to the general public is that obesity is a chronic disease," Sharma said Monday from Hamilton.
"And we have to start thinking about obesity and start thinking about the treatments for obesity like we would any other chronic disease, which means we need to think about what are the best treatments out there that we can provide to patients who are struggling with this condition."
© 2007 The Halifax Herald Limited
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5 Comments
There are more dimensions to morbid obesity than just how much a person eats. I strongly protest when television shows present an obese person on camera, standing beside a table covered with piles of food that are supposed to represent the amount of food they eat daily. Without a shadow of a doubt, this is intended to bring tears and feelings of shame to the surface for these people, already struggling with an abysmal sense of self-worth. Typically, the person has been encouraged to try losing weight on camera, only to be faced with this terrible shame, usually triggering a comfort binge, that is then broadcast as further evidence of their "lack of will power".
I'm appalled. Obesity is to some degree part of genetic inheritance, partly due to amount of calories consumed versus burned through exercise, but it can be contributed very directly to our emotional states and sense of personal worth. Every obese person could tell you a unique story about who they are, apart from food, weight, and eating. Though being overweight does become inextricably linked to a person's identity, causing many to be ostracized in a society unforgiving about fat. And being publicly shamed on television does little to help matters.
I would like to add as well that obesity forms part of the tendency that our way of life promotes.
-stress and anxiety
-long hours of work in offices and mostly sedentary
-lack of time to prepare healthy food and look after one's health and body
-enworsening of the quality of food specially with the overwhelming presence of fastfood greasy food. Easy to eat, difficult to digest.
-lack of nutritional education at school.
I think supersize me movie is great to explain all this psicosis.
I would add that the availability of public transport has some influence. More Americans rely on driving from place to place, whereas other countries have reliable public transport systems which allow people to get out and walk. Causing more chubby Americans!
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