The first update to Australian obesity management guidelines in a decade suggest healthcare professionals should support obese and overweight patients to aim for an initial 5% weight loss.
In a comprehensive update to its 2003 guidance on weight loss for obese and overweight people, the NHMRC said the primary responsibility for weight loss rested with the individual, and the role of the health professional was to provide evidence-based advice and support.
As a result, the updated guidelines followed the primary care ‘5As' framework of "ask and assess, advise, assist, arrange".
For adults, a key message in the new guidelines is that even small amounts of weight loss will improve health and wellbeing, according to NHMRC CEO Professor Warwick Anderson.
"The evidence underpinning this new guideline tells us that a 5% initial weight loss can reduce the risk of health problems like diabetes and cardiovascular disease," he said.
"Support from primary healthcare providers through tailored weight management programs can make this personal challenge achievable."
The guidelines include practice points for weight loss such as setting goals for behaviour change, weekly self weighing and reviewing the initial weight loss plan after two weeks to tailor it to the individual's response.
Weight loss programs should also be reviewed after three months if there had been little or no weight loss, and more intensive weight loss interventions could be introduced, depending on the degree of obesity.
More intensive interventions such as very low energy diets, orlistat or bariatric surgery were recommended for more severe obesity.
The guidelines also included advice on weight management for obese children and adolescents, and said that "weight maintenance" was an acceptable approach in most situations.
Key points from the updated guidelines:
● Use BMI to classify obesity and waist circumference to refine risk of complications
● Aim for 5% weight loss initially
● Recommend diets that produce a 2500kj/day energy deficit
● Recommend 300 minutes of moderate exercise, or 150 minutes of vigorous activity, a week
● Consider orlistat for adults with BMI over 30 or BMI over 27 if co-morbidities present
● Consider bariatric surgery for adults with BMI over 40
● Weight maintenance advised for obese children to "grow into their weight"
● Gastric banding an option for postpubertal adolescents with BMI over 40