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Guidelines for preventive activities in general practice 7th edition

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Full index

Introduction and user guide

Preventive activities before pregnancy

Genetic counselling and testing

Preventive activities in children and young people

Preventive activities in middle age

Preventive activities in older age

Communicable diseases

Prevention of chronic disease

Prevention of vascular and metabolic disease

Early detection of cancers

Psychosocial

Oral hygiene

Glaucoma

Urinary incontinence

Osteoporosis

Screening tests of unproven benefit

References

Appendices

Glossary

Acronyms

Acknowledgements

Disclaimer

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Overweight

Overweight age range table
Age 0 - 9 10 - 14 15 - 19 20 - 24 25 - 29 30 - 34 35 - 39 40 - 44 45 - 49 50 - 54 55 - 59 60 - 64 65 - 69 70 - 79 >80
  X X X X X X X X X X X X X X X

Body weight reflects the balance between levels of dietary intake and physical activity. Body mass index (BMI) and adult waist circumference should be measured every 2 years for those patients who appear overweight (A).230-232 Body mass index on its own may be misleading, especially in older people and muscular individuals, and classifications may need to be adjusted for some ethnic groups.233

Overweight: Risk
Who is at higher risk of developing obesity related complications What should be done? How often? Level of evidence and references

Average risk

  • All patients
  • Assess BMI and waist circumference in all adults over 18 years of age who appear overweight
  • In children and adolescents use age specific BMI charts (see Chapter 3.3 Overweight and obesity)
  • Offer education on nutrition# and physical activity*
Every 2 years
I A 234
Increased risk
  • Aboriginal people, Torres Strait Islanders, and Pacific Islanders
  • Patients with existing diabetes or cardiovascular disease, stroke, gout, liver or gallbladder disease

  • Assess BMI and waist circumference in all adults over 18 years of age.
  • Offer individual education on nutrition and physical activity
Every 12 months
I A 234
III A
Identified risk of obesity
  • Patients who are overweight or obese

  • Assess weight and waist circumference.
  • Develop a weight management plan
Every 6 months
III B 234
# For more information see the NHMRC Dietary guidelines for Australian adults
* For more information see the NHMRC Physical activity guidelines
For further information see pages 14–16 of SNAP guidelines and the NHMRC Overweight and obesity: a guide for general practitioners

Patients who are overweight or obese should be offered individual lifestyle education and skills training.201,234,235 Restrictive dieting is not recommended for children and adolescents. A modest weight loss of 5–10% of starting body weight in adults who are overweight is sufficient to achieve some health benefits.235 Even without weight loss, physical activity can accrue health benefits for overweight people.236

Overweight: Intervention
Assessment Technique References
Body mass index Body mass index = body weight in kilograms divided by the square of height in metres. A BMI of ≥25 conveys increased risk 230,234
Waist circumference

An adult’s waist circumference is measured half way between the inferior margin of the last rib and the crest of the ilium in the mid-axillary plane. The measurement is taken at the end of normal expiration

  • ≥94 cm in males and ≥80 cm in females conveys increased risk
  • ≥102 cm in males and ≥88 cm in females conveys high risk
 230,234

Combining measures to assess obesity and disease risk * in Australian adults234

Combining measures to assess obesity and disease risk in Australian adults
Classification BMI
(kg/m2)		 Disease risk
(relative to normal measures)
Waist circumference
Men 94–102 cm
Women 80–88 cm		 Waist circumference
Men >102 cm
Women >88 cm
Underweight <18.5 – –
Healthy weight 18.5–24.9 – Increased
Overweight 25.0–29.9 Increased High
Obesity 30.0–39.9 High to very high Very high
Severe obesity >40.0 Extremely high Extremely high

* Risk of type 2 diabetes and cardiovascular disease
Based on: NHMRC Clinical practice guidelines for the management of overweight and obesity in adults and NHMRC Overweight and obesity in adults and in children and adolescents: a guide for general practitioners

7.2.1 Different ethnic groups

Lower waist circumference measures should be used for those of Asian, Aboriginal or Torres Strait Islander descent:234
Increased risk Men 90–100 cm Women 80–90 cm Goal: 5–7% weight loss
High risk Men >100 cm Women >90 cm Goal: 5–7% weight loss

Strategy

Environmental, cultural, genetic and lifestyle factors all contribute to overweight and obesity. Physical inactivity and overeating are the major modifiable contributors to the problem of obesity.235 Strategies to increase screening in Aboriginal people and Torres Strait Islanders are discussed in the ‘green book’ and the National guide to a preventive health assessment in Aboriginal and Torres Strait Islander peoples.


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© The Royal Australian College of General Practitioners
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