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Health, not weight, emphasized in new Canadian obesity guidelines

ObesityDrSeanWharton_supplied
Dr. Sean Wharton, lead author of new obesity guidelines, said patients and doctors need to take a different approach to what is a chronic disease. Photo: supplied.

Jodi Krah knows firsthand the mental health ups and downs that accompany living with obesity. Her experience with weight loss is a roller coaster of countless diets, of being left to contend on her own and even of demoralizing responses from the medical community.

“Losing weight is easy. Keeping it off, that’s the tough part. I still battle with it,” said Krah, 57.

Dealing with obesity since her childhood in Ontario, Krah said the journey toward health is more than determination and focus. It requires clinical support and intervention--something often lacking in the past. 

“Back in those days doctors did not discuss weight management,” she recalled. “Occasionally I would have success on my own and wanted to voice it with my doctor but they never gave feedback. In fact, their replies were sometimes detrimental to mental health.” 

These days, Krah offers a patient perspective through speaking engagements with Obesity Canada, located at the Li Ka Shing Centre for Health Research Innovation, University of Alberta (U of A).

New obesity guidelines

With the Canadian Association of Bariatric Physicians and Surgeons, Obesity Canada has published new guidelines that hold promise as a turning point for reducing obesity in the country. 

Published in the August 2020 issue of the Canadian Medical Association Journal, (CMAJ) the Canadian Adult Obesity Clinical Practice Guidelines (CPGs) replace the 2007 guidelines.

The new guidelines shift the premise of weight management from a stigma-loaded condition with outdated science, to an approach that sees obesity as a complex and relapsing disease in which a patient’s emotional and physical health are vital. Cognitive behavioural therapy, bariatric surgery and medications are some treatments shown to offer success.

In a 2016 TEDx Talk for the U of A, Dr. Arya Sharma, professor of medicine and founder of Obesity Canada, explained why. 

Patients with diabetes or high blood pressure are put on medication and a proper diet, he told the audience. But when they stop, the complications return. 

The same is true for obesity. 

“You stop the treatments..the disease comes back," he said. "Once you have obesity you’ve got to look at it as a chronic disease, because it behaves like a chronic disease.” 

Sharma developed a 5-stage obesity classification system which is a better predictor of mortality when compared with body mass index (BMI) or waist circumference measurements alone. 

BMI should no longer be used as the defining characteristic of obesity, he contends.

Dr. Sean Wharton, medical director at the Wharton Medical Clinic in Ontario and lead author of the new guidelines, said will power is also ineffective for weight management, because it’s an exhaustible resource. 

Krah prefers to think it doesn’t even exist, because that forces her to find strategies that actually work.

“I have lost and gained thousands of pounds during my life. That is 48 years of dieting,” she said. “How many people do something for that long and never win, yet still continue to try? If will power did exist, I would be the grand champion of effort.”

Doctors need new approach

The new guidelines advise medical practitioners on how to look past presumptions and biases.

“We’ve been getting obesity wrong almost from the beginning,” said Wharton. “We lacked compassion and empathy. We were paternalistic. The patients themselves helped us understand what we were doing wrong.”

For older adults, there’s good news. Studies show that obesity management works for older patients as well as, if not better, than for younger patients.

“A number of my patients aged 60 or older recognize that what they tried in the past--diet and have more will power--it doesn’t work,” said Wharton.

“This is a complicated disease. Clients need to incorporate strategies into their life, and doctors need to focus on the person. We’ve been hand-cuffed by the numbers for a long time.”

For Krah, a more interactive relationship between patient and physician is long overdue. 

“If simply laying out the facts worked, all Canadians would be a healthy size. I understand what to do, my body and my brain struggle so very hard to do it,” she said. 

“I applaud any new approach that can improve the lives of those living under this dark cloud.”

A summary of the new guidelines can be found at www.obesitycanada.ca/guidelines.


Obesity by the numbers

  • 26.8% of Canadians 18 and older (7.3 million adults) reported height and weight that classified them as obese
  • 9.9 million adults (36.3%) were classified as overweight – bringing the total population with increased health risks due to excess weight to 63.1% in 2018
  • Studies suggest that if Canada invests $4.2 billion in treatment for obesity, the obesity rate could be significantly reduced
  • Weight management for seniors
  • Older individuals had greater weight loss success than younger individuals
  • The greater success in weight loss in the elderly was associated with a greater number of visits to doctor


 





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