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NEW GUIDELINE ALERT: Is BMI now outdated? “Substantial Advances” in Obesity

Updated: Aug 13

A 2020 Canadian Obesity in Adults Guideline was just published in CMAJ this week, incorporating “substantial advances” in the field. It also includes a fantastic infographic for easy reference.

The faculty of the Vital FM Update conference are constantly searching for practice-changing medical literature. Here are the most clinically-relevant from the 80 recommendations:

“Would it be all right if we discussed your weight?” Start by obtaining permission. Clinical tip from an obesity expert: a sign in your office “Ask me about losing weight” may help reduce judgemental feelings experienced by your patients.

Determine your patient’s goals

Ensure your list of management options is up to date:

  • History Root causes, barriers to treatment, self-care activities, falls risk

  • Investigations Bilateral BP, diabetes & lipid screen, and may add ALT to screen for liver disease

  • Referrals Dietician, behavioural intervention, CBT, some commercial weight loss programs, and potentially bariatric surgery***

  • Exercise 30-60 mins most days

  • Medications* Only liraglutide**, naltrexone-bupropion combination, orlistat** are recommended * if BMI ≥ 30 kg/m2 or BMI ≥ 27 kg/m2 with related complications ** can be used for maintaining weight loss *** if BMI ≥ 40 kg/m2 or BMI ≥ 35 kg/m2 with at least 1 adiposity-related disease

Note: As BMI is not accurate at identifying obesity-related complications, be sure to measure height, weight, BMI and waist circumference and consider staging obesity with the proposed Edmonton Obesity Staging System.

Be sure to see the full 2020 Canadian Obesity guideline for further details and caveats. As well, take note that though the funding was from government, the conflicts of interest declarations of the committee take up an entire page of the publication.

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