Weight management in Canada: an environmental scan of health services for adults with obesity

Abstract

Background: Obesity in Canada is a growing concern, but little is known about the available services for managing obesity in adults. Our objectives were to (a) survey and describe programs dedicated to weight management and (b) evaluate program adherence to established recommendations for care.

Methods: We conducted an online environmental scan in 2011 to identify adult weight management services throughout Canada. We examined the degree to which programs adhered to the 2006 Canadian Clinical Practice Guidelines on the Management and Prevention of Obesity in Adults and Children (CCPGO) and the analysis criteria developed by the Association pour la Santé Publique du Québec (ASPQ).

Results: A total of 83 non-surgical (34 community-based, 42 primary care-based, 7 hospital-based) and 33 surgical programs were identified. All programs encouraged patient self-management. However, few non-surgical programs adhered to the CCPGO recommendations for assessment and intervention, and there was a general lack of screening for eating disorders, depression and other psychiatric diseases across all programs. Concordance with the ASPQ criteria was best among primary care-based programs, but less common in other settings with deficits most frequently revealed in multidisciplinary health assessment/management and physical activity counselling.

Conclusions: With more than 60% of Canadians overweight or obese, our findings highlight that availability of weight management services is far outstripped by need. Our observation that evidence-based recommendations are applied inconsistently across the country validates the need for knowledge translation of effective health services for managing obesity in adults.

Figure 1

Number of programs per million of overweight or obese population in Canada in 2011*. (* Source: Statistics Canada, CANSIM, table 105-0501 and Catalogue no. 82-221-X.Last modified: 2012-06-19).

Figure 2

Types of intervention offered by the different categories of programs. Surgical programs n = 33 (for intervention components other than bariatric surgery n = 25 and for psychological/behavioral component n = 24), Community-based programs n = 34, Primary health care programs n = 42 and Hospital-based programs n = 7. Bariatric surgery = *, †, ‡. Pharmacotherapy for the management of weight = §. Nutritional counselling = none. Physical activity counselling = †. Psychological/behavioral component = none. *Significant difference between surgical programs and community-based programs. † Significant difference between surgical programs and primary health care programs. ‡ Significant difference between surgical programs and hospital-based programs. § Significant difference between community-based programs and primary health care programs.

Figure 3

Different types of professionals involved in weight management programs. Surgical programs n = 24, Community-based programs n = 34, Primary health care programs n = 42 and Hospital-based programs n = 7. *, †, ‡. *Significant difference between surgical programs and community-based programs. † Significant difference between surgical programs and primary health care programs. ‡ Significant difference between surgical programs and hospital-based programs.