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

ID: 
35
Personal Details
Organisation Name: 
ANZAED
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?: 

If the guidelines included more ackbowledgement that obesity can co-exist with eating disorders, and that several weight loss interventions may raise the likelihood of developing an eating disorder, especially binge eating disorder.

Specific comments
Comments: 
4.3 Other factors in assessment of health risk in adults

We recommend adding that weight cycling is associated with eating disorders and an increase in weight over time

5.1 Explaining the health risks associated with overweight and obesity

Eating disorders (especially binge eating disorder) should be added to the list under Mental Health

6.2 Intensive interventions

The risk of mood disorder and binge eating should be added to the list of adverse effects of very low energy diets.  (Keys, A., Brožek, J., Henschel, A., Mickelsen, O., & Taylor, H. L., The Biology of Human Starvation (2 volumes), University of Minnesota Press, 1950; Kalm, L.M. & Semba, R.D., They Starved So That Others Be Better Fed: Remembering Ancel Keys and the Minnesota Experiment, J. Nutr. June 1, 2005 vol. 135 no. 6 1347-1352, http://jn.nutrition.org/content/135/6/1347.full)

 

PART D - AREAS FOR FUTURE RESEARCH

There is an urgent need for research into: a) the barriers to weight loss maintenance; and b) interventions that promote weight loss maintenance. Given that diet and lifestyle get A ratings they will continue to be used but they usually fail over time and can have adverse long term effects (i.e. repeated dieting leading to a higher weight over time).

References

We recommend making reference to the Academy of Eating Disorders guidelines on childhood obesity prevention programs which are very well-referenced and well-written:

http://www.aedweb.org/AM/Template.cfm?Section=Advocacy&Template=/CM/ContentDisplay.cfm&ContentID=1659

8.1 Assessment

B. Screening for eating disorders

We would like to suggest that GPs routinely assess for eating disorders, which are not always as apparent as obesity but which may co-exist with obesity. The following questions were developed for GPs and may assist in assessing if a patient has or is at high risk of an eating disorder.
 
1.    Do you think you have an eating disorder?
2.    Do you worry about your shape and weight?
 
Also - The SCOFF is a five-question screening tool for eating disorders, akin to the CAGE four-question screening for alcohol abuse.
      S- Do you make yourself Sick because you feel uncomfortably full?
      C- Do you worry you have lost Control over how much you have eaten
      O- Have you recently lost more than 6.35 KilO grams (One Stone) in a 3 month period?
      F- Do you believe yourself to be Fat when others say you are too thin?
      F- Would you say Food dominates your life?
One point for every yes; a score of > 2 indicates further questioning is warranted. (Morgan et al 1999).
 
A further two questions have been found to have a high sensitivity and specificity to bulimia nervosa (but are not diagnostic).
1.    Are you satisfied with your eating patterns? (‘no’)
2.    Do you ever eat in secret? (‘yes’)
A ‘no’ for question 1 and a ‘yes’ for question 2 indicates high suspicion for bulimia nervosa and further questioning is warranted.
 
Morgan JF, Ried F, Lacey JH. The SCOFF questionnaire: assessment of a new screening tool for eating disorders. BMJ, 319; 1467-1468.

 

Page reviewed: 6 September, 2012