The 2006 Canadian clinical practice guidelines on the management and prevention of obesity in adults and children have been prepared as a supplement to this issue of CMAJ (a summary of the guidelines is included in the polywrap of this issue, and the complete set of guidelines is available online at www.cmaj.ca/cgi/content/full/176/8/S1/DC1).1 A rigorous, evidence-based approach was used to develop recommendations to guide practitioners and interested individuals to reach optimal health care decisions related to the individual and public health issues associated with obesity.
Despite major advances in our fundamental knowledge and steady progress in the management of obesity, Canada and the rest of the world are witnessing an alarming increase in the prevalence of obesity and its related health consequences, with 59% of adult Canadians being overweight and 23% being obese.2 What is more disturbing is the rapid increase in childhood obesity rates and the early onset of metabolic complications that track into adulthood and may lead to a shortened life expectancy.3 Health professionals can expect in their clinical encounters an increasing number of overweight and obese people at all ages presenting with a variety of physical and mental health issues. To date, interventions at the individual and population levels, with the latter focused mainly on individual risk factors, have been ineffective for the most part. Hence, sweeping prevention and intervention strategies are required to slow, and hopefully reverse, the alarming increase in obesity prevalence.
Previous clinical practice guidelines on the assessment and management of obesity have been based in large part on consensus statements by expert panels.4–7 Moreover, most focused on individuals rather than on communities or the population as a whole. Recognizing these deficiencies, Obesity Canada — a not-for-profit organization founded in 1999 to improve the health of Canadians by decreasing the occurrence of obesity — convened a panel of experts to determine whether a comprehensive set of clinical practice guidelines could be developed to address not only the management but also the prevention of obesity in both adults and children. Members of the Steering Committee and Expert Panel unanimously agreed on an evidence-based approach that adhered to the principles espoused by the Appraisal of Guidelines Research & Evaluation (AGREE) Instrument to provide a framework for assessing the quality of clinical practice guidelines.8 Through the process of developing the guidelines, which began in the spring of 2004, members of the Steering Committee and Expert Panel identified major gaps in knowledge regarding obesity treatment and prevention. The final set of clinical practice guidelines in the supplement to this issue of CMAJ are the culmination of work by a large panel of experts across Canada who freely volunteered their time and effort. Each recommendation in the guidelines is based on a systematic review of the literature and reflects the consensus of the relevant members of the Expert Panel and members of the Steering Committee. The recommendations have been graded based on the strength of the supporting evidence and in consideration of the harm and costs of the intervention, and its importance and value to the individual and population.
Ideally, clinical practice guidelines would inspire confidence by its users if they were developed with the necessary financial support to ensure the highest quality. Unfortunately, there is currently a lack of public funding for the development of practice guidelines in Canada. Therefore, funding was sought through sponsorships from pharmaceutical and food industry partners as well as through in-kind donations from nongovernmental organizations. The corporate sponsors were not involved in and had no influence on the development of the guidelines, the interpretation of the literature, the decision to publish or any aspect of publication of the guidelines. The arm's-length grants-in-aid solicited were managed in part by a third-party organization, independent of Obesity Canada, and were used to defray administrative and travel expenses incurred by members of the Steering Committee and Expert Panel to attend meetings and conference calls, and to defray publication, implementation and dissemination costs. None of the members of these committees received financial or in-kind remuneration for their contributions, other than reprint copies of the executive summary of the clinical practice guidelines.