Obesity guidelines aim to take stress off weight loss
6 December 2002
Patients with obesity do not always need to have their weight measured and should be allowed to choose not to, draft clinical guidelines say.
The first National Health and Medical Research Council (NHMRC) evidence-based guidelines on weight control and obesity management in adults, released for comment last week, warn that use of body mass index (BMI) can be counterproductive in some people.
(BMI is determined by dividing your weight in kg by your height in metres squared. It is designed for use in men and women over the age of 18.)
Failure to lose weight could become a major emotional issue, said chair of the NHMRC working party, which has also produced draft new guidelines for children and adolescents, Professor Michael Callaghan.
'To focus on weight loss in a context where no single treatment is going to be a cure isn't always the best option,' Professor Callaghan said.
'It may be that lifestyle changes are more important and measurement can come later.'
A GP from Melbourne's Weight Management and Eating Behaviour Clinic, Dr Rick Kausman, said tracking behaviour changes in physical activity or stopping 'non-hungry' eating could be more valuable than looking at the scales every week.
'There is no evidence at all which says it's beneficial for a person to be weighed,' Dr Kausman, a member of the working party, said.
Weight measurement created anxiety for many people, sometimes leading them to 'starve themselves' before doctors' appointments, he said.
The draft guidelines say there is no perfect clinical measure of overweight and obesity, but the most useful indicator is a combination of BMI and waist circumference.
A Melbourne GP and working party member, Dr Elizabeth Banks, said BMI should be used with caution.
'BMI doesn't fit everybody,' Dr Banks said, adding that skewed results were likely if applying BMI to muscular rugby players, lightly built Asian people, or elderly people who had lost height.
The draft guidelines say that waist circumference adds little if BMI is above 35.
(A BMI between 20 and 25 is considered healthy.)
To reduce the risk of disease, the report recommends that Caucasian men should aim for a waist circumference below 102 cm and women below 94 cm.
'In Asian people and Indian people the target could be 10 cm lower and in Pacific Islander people it could be significantly higher,' it says.
The draft documents cover environmental and genetic risk factors, diets, behavioural therapy, pharmacotherapy (medication therapy) and surgery.
Last Reviewed: 06 December 2002
- 1. Medical Observer Weekly 06/12/02
