Rosa Fortin Marie-Michèle, Brown Christine, Ball Geoff D C, Chanoine Jean-Pierre, Langlois Marie-France
Centre de recherche clinique Étienne-Le Bel, Centre Hospitalier Universitaire de Sherbrooke, Québec, Canada.
BMC Health Serv Res. 2014 Feb 12;14:69. doi: 10.1186/1472-6963-14-69.
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.
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).
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.
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.
加拿大的肥胖问题日益受到关注，但对于成人肥胖管理的现有服务了解甚少。我们的目标是：（a）调查并描述致力于体重管理的项目；（b）评估项目对既定护理建议的遵循情况。
2011年我们进行了一次在线环境扫描，以识别加拿大各地的成人体重管理服务。我们检查了各项目遵循《2006年加拿大成人及儿童肥胖管理与预防临床实践指南》（CCPGO）以及魁北克公共卫生协会（ASPQ）制定的分析标准的程度。
共识别出83个非手术项目（34个基于社区、42个基于初级保健、7个基于医院）和33个手术项目。所有项目都鼓励患者自我管理。然而，很少有非手术项目遵循CCPGO关于评估和干预的建议，并且所有项目普遍缺乏对饮食失调、抑郁症和其他精神疾病的筛查。基于初级保健的项目与ASPQ标准的一致性最好，但在其他环境中则较少见，多学科健康评估/管理和身体活动咨询方面的不足最为常见。
超过60%的加拿大人超重或肥胖，我们的研究结果突出表明体重管理服务的可获得性远远落后于需求。我们观察到基于证据的建议在全国范围内应用不一致，这证实了对成人肥胖管理有效健康服务进行知识转化的必要性。
