NHMRC Public Consultations

Skip Navigation and go to Content
Visit NHMRC website

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

ID: 
47
Personal Details
Organisation Name: 
The Royal Australian College of General Practitioners
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?: 
  • The Guidelines are large and therefore a summary version for general use referenced to the more comprehensive Guidelines would be valuable, and more likely to be utilised by GPs.
  • A consumer version of the Guidelines, as this area is complex and dominated by commercial interest and mixed messages produced via the media.
  • An Implementation Tool Kit to complement the Guidelines.
Specific comments
Comments: 
6.2 Intensive interventions

In the Guidelines, medication receives a level A recommendation regarding evidence, whereas lifestyle receives a level C recommendation. This might imply that medications are more effective despite most not being available, for example, phentermine is available only by private script and orlistat has known side effects such as faecal incontinence and diarrhoea. This can be ameliorated in part by using psyllium*.

 

*Gastrointestinal side effects of orlistat may be prevented by concomitant prescription of natural fibers (psyllium mucilloid). Cavaliere H, Floriano I, Medeiros-Neto G. Int J Obes Relat Metab Disord. 2001 Jul;25(7):1095-9.

(http://www.ncbi.nlm.nih.gov/pubmed/11443512).

6.3 Developing an appropriate weight loss program

Self-management is widely promoted in general practice despite it being graded only as level C evidence. This section requires more detail as GPs will refer to this section frequently.

9.1 Identifying overweight and obesity

The waist circumference section could provide more practical advice to better assist GPs

General comments
Comments: 
  • The number needed to treat (NNT) is missing in some of the sections. It would be beneficial to include NNT for many of the sections as it provides some information about return on effort for both patients and General Practitioners (GPs). Additionally, it would allow comparison with other treatments.
  • Motivational interviewing is alluded to but not acknowledged, despite there being some level 1 evidence*.
  • Practical dietary advice is not easily located. The provision of a summary of this section would be very useful in the general practice setting.

  • Some GPs are not aware that the Dietary Guidelines have been changed from the recommended ‘2 fruit and 5 vegetables’ to ‘plenty of fruit and vegetables’ recommendation.
  • There is no review of the range of commercial programs available. Many GPs are bombarded with questions from patients about the value and effectiveness of such programs. This would help to better guide the GP to promote effective strategies to patients.
  •  
  • As a corollary, the Guidelines would benefit from a section on what isn’t effective. This could be a section in its own right or a summary table, which would be a useful tool for GPs.
  • Clarity on the criteria for bariatric surgery is required.
  • It would be helpful to have an outline of what a review visit might include. This could include the diabetes maintenance visit template.

 

* Motivational interviewing  to  improve  weight  loss  in  overweight  and/or  obese patients: a systematic review and meta-analysis of randomized controlled trials. Armstrong MJ, Mottershead TA, Ronksley PE, Sigal RJ, Campbell TS, Hemmelgarn BR. Obes Rev. 2011 Sep;12(9):709-23

Page reviewed: 6 September, 2012