Obesity in adults: a clinical practice guideline
Sean Wharton, David C.W. Lau, Michael Vallis, Arya M. Sharma, Laurent Biertho, Denise Campbell‐Scherer, Kristi B. Adamo, Angela S. Alberga, Rhonda C. Bell, Normand G. Boulé, Elaine Boyling, Jennifer Brown, Betty Calam, Carol Clarke, Lindsay Crowshoe, Dennis DiValentino, Mary Forhan, Yoni Freedhoff, Michel Gagner, Stephen Glazer, C. G. Grand, Michael Green, Margaret Hahn, Raed Hawa, Rita Henderson, Dennis Hong, Pam Hung, Ian Janssen, Kristen Jacklin, Carlene Johnson Stoklossa, Amy Kemp, Sara Kirk, Jennifer L. Kuk, Marie‐France Langlois, Scott A. Lear, Ashley McInnes, David Macklin, Leen Naji, Priya Manjoo, Marie‐Philippe Morin, Kara Nerenberg, Ian Patton, Sue D. Pedersen, Leticia Pereira, Helena Piccinini‐Vallis, Megha Poddar, Paul Poirier, Denis Prud’homme, Ximena Ramos Salas, Christian F. Rueda‐Clausen, Shelly Russell‐Mayhew, Judy Shiau, Diana Sherifali, John L. Sievenpiper, Sanjeev Sockalingam, Valerie H. Taylor, Ellen L. Toth, Laurie Twells, Richard Tytus, Shahebina Walji, Leah Walker, Sonja Wicklum
Abstract
besity is a complex chronic disease in which abnormal or excess body fat (adiposity) impairs health, increases the risk of long-term medical complications and reduces lifespan. 1 Epidemiologic studies define obesity using the body mass index (BMI; weight/height 2 ), which can stratify obesity-related health risks at the population level. Obesity is operationally defined as a BMI exceeding 30 kg/m 2 and is subclassified into class 1 (30-34.9), class 2 (35-39.9) and class 3 ( 40). At the population level, health complications from excess body fat increase as BMI increases. At the individual level, complications occur because of excess adiposity, location and distribution of adiposity and many other factors, including environmental, genetic, biologic and socioeconomic factors (Box 1). ver the past 3 decades, the prevalence of obesity has steadily increased throughout the world, Importantly, severe obesity has increased more than fourfold and, in 2016, affected an estimated 1.9 million Canadian adults. besity has become a major public health issue that increases health care costs People with obesity experience pervasive weight bias and stigma, which contributes (independent of weight or BMI) to increased morbidity and mortality. 17 Obesity is caused by the complex interplay of multiple genetic, metabolic, behavioural and environmental factors, with the latter thought to be the proximate cause of the substantial GUIDELINE