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Revised draft Clinical Practice Guidelines for the Management of Overweight and Obesity in Adults, Children and Adolescents

ID: 
23
Personal Details
Organisation Name: 
Diabetes Australia
Additional Information
In regard to your comments, do you have a Conflict of Interest to disclose?: 
No
Specific questions
Question 2: What would help you implement these recommendations into practice?: 

Having an implementation and dissemination plan would be most helpful

(viz the process for the Guidelines for the Management of Absolute Cardiovascular Disease Risk).

Having an implementation and dissemination budget would be even more helpful.

Specific comments
Comments: 
Summary

The summary is well developed and easy to understand.

 

Summary of recommendations

The use of BMI may be complemented for consumers by the easier-to-grasp concept of waist measurement more than half height = risk.

For recommendations in the behavioural space for which there is only D class evidence, can NHMRC direct some of its funding to creating better / stronger evidence, e.g. section 4.3.4?

6 Assist

Bariatric Surgery is given a lot of attention.  Diabetes Australia has a policy position on bariatric surgery which can be viewed at our website: www.diabetesaustralia.com.au

6 Assist

The guidelines include a practice point stating that psychological interventions should be considered to assist in behavioural change and maintenance. One slightly worrying point was that they recommend that 'psychological therapies e.g. cognitive behavioural therapy, behavioural therapy' can be delivered in primary care, and referral to a mental health care professional should be considered if comorbidities such as eating disorder or depression exist, however we are not comfortable with the advice that psychological therapies' be delivered in primary care. This is probably an issue of definitions, whereby any discussion of behaviour or emotions in a structured way may be considered a therapy. However, if we are talking about proper therapies, these should be delivered by a mental health care professional, although we are not aware of any reviews that address this issue specifically.

 

Unfortunately the psychological recommendations appear only as a practice point, as they are considered to be outside the scope of the review, and therefore no systematic review has been conducted on these issues.

 

5 Advise

Overall there could be more and stronger mentions of type 2 diabetes as a major risk factor of obesity.   However, importantly, the guidelines do state that HCPs should advise their patients that even a 5% weight reduction can improve T2DM and cardiac risk or even of outcomes if person already has the condition.

General comments
Comments: 

We are very impressed by these guidelines. They are aimed mostly at primary health care professionals, or other allied heath professionals working in community or multidisciplinary settings. They state quite clearly upfront that detailed care provision recommendations are beyond the scope of the review, however they do advise health professionals to consider advising patients that even a small % weight loss can improve self-esteem and quality of life, and they provide some tools for assessing self-efficacy and readiness to change.  

In other ways, the guidelines tick all the boxes: they address the level of skill and issues of language and communication by the health care professional, and emphasise that blame and stigma should not be tolerated in a health care setting. They are also explicit that HCPs should strike a balance between emphasising personal and societal responsibility, and they state that while energy balance is part of the story, there is no one known fool-proof way to achieve and maintain a health weight, and diet and physical activty and directly and indirectly influenced by social, environmental, behavioural, genetic and physiological factors. It is good that the guidelines paint a complex picture.

Page reviewed: 6 September, 2012