What are my thoughts on the new guidelines on obesity and Dr’s who treat them?
Canadian Dr’s have updated their guidelines on practices an how to deal with obese patients while guiding them to improve their lives in a non-bias way.
This guideline update reflects substantial advances in epidemiology, determinants, pathophysiology, assessment, prevention, and treatment of obesity, and shifts the focus of obesity management toward improving patient-centered health outcomes, rather than weight loss alone.
This came out last month and I’ve been sitting on this for a few weeks, reading the research paper and thinking about how I feel about these new guidelines and what I’m going to write about.
In a joint effort between the Canadian Obesity Task Force and the medical staff at McMaster University, they have set forward different practices for patients who are obese and giving Dr’s more tools they can work with.
My thoughts on this new guideline are mine and mine only. There is some bias in my views because of my profession I am in, however, I’m open to listening and talking to others and learn as much as I possibly can so that I can better understand different practices and help better my clients’ lives.
At first, the media made a headline that said “ new guidelines to how Dr’s approach obesity”. There is more to this than a quick headline, there is a 19-page report discussing obesity and the types of treatments that can best fit each client and how doctors can approach the topic which can be a sensitive issue.
Let’s not kid ourselves that reaching a fat loss goal for someone that’s overweight is easy. Losing fat isn’t as quick as the media and marketing companies want you to believe. If you think losing 30 lbs of fat for someone that is slightly overweight is hard, you can imagine how difficult it would be for someone that is obese to lose a greater amount of body fat.
A lot goes into losing fat. It takes mind control, will power, dedication, and finding out the root causes or triggers. In other words, it’s creating healthy habits and overriding the unhealthy ones to live a healthier life.
I do believe cognitive behavior is something that needs to change in someone’s life if they want to reach their goals and create good habits.
If you have been following my fitness stuff for the last few years, you’ll notice that I continuously state that getting fit “is a lifestyle change” and “not a quick fix”. This is something that I believe is a hundred percent is true. Getting fit doesn’t just mean the physical, it also means the mental and spiritual.
Here are some of the takeaway notes that I feel are important in this research paper.
Obesity care should be based on evidence-based principles of chronic disease management, must validate patients’ lived experiences, move beyond simplistic approaches of “eat less, move more,” and address the root drivers of obesity
Obesity is a complex chronic disease in which abnormal or excess body fat (adiposity) impairs health, increases the risk of long-term medical complications, and reduces lifespan.1 Epidemiologic studies define obesity using the body mass index (BMI; weight/height 2), which can stratify obesity-related health risks at the population level. Obesity is operationally defined as a BMI exceeding 30 kg/m2 and is subclassified into class 1 (30–34.9), class 2 (35–39.9), and class 3 (≥ 40). At the population level, health complications from excess body fat increase as BMI increases.2 At the individual level, complications occur because of excess adiposity, location, and distribution of adiposity and many other factors, including environmental, genetic, biological, and socioeconomic factors.
Over the past 3 decades, the prevalence of obesity has steadily increased throughout the world, and in Canada, it has increased threefold since 1985. Importantly, severe obesity has increased more than fourfold and, in 2016, affected an estimated 1.9 million Canadian adults.
Obesity has become a major public health issue that increases healthcare costs, and negatively affects physical and psychological health. People with obesity experience pervasive weight bias and stigma, which contributes (independent of weight or BMI) to increased morbidity and mortality.
Cognitive functions in the prefrontal cortex exert executive control on food choices and the decision to eat. The interconnectivity of these neural networks drives eating behavior and has been shown to be altered in obesity.
**There is a recognition that obesity management should be about improved health and well-being and not just weight loss.**
The dominant cultural narrative regarding obesity fuels assumptions about personal irresponsibility and lack of willpower and casts blame and shame upon people living with obesity. Importantly, obesity stigma negatively influences the level and quality of care for people living with obesity.
1. Recognition of obesity as a chronic disease by health care providers, who should ask the patient permission to offer advice and help treat this disease in an unbiased manner.
2. Assessment of an individual living with obesity, using appropriate measurements, and identifying the root causes, complications, and barriers to obesity treatment.
3. Discussion of the core treatment options (medical nutrition therapy and physical activity) and adjunctive therapies that may be required, including psychological, pharmacologic, and surgical interventions.
4. Agreement with the person living with obesity regarding goals of therapy, focusing mainly on the value that the person derives from health-based interventions.
5. Engagement by health care providers with the person with obesity in continued follow-up and reassessments, and encouragement of advocacy to improve care for this chronic disease.
Weight bias in health care settings can reduce the quality of care for patients living with obesity. A key to reducing weight bias, stigma, and discrimination in health care settings is for health care providers to be aware of their attitudes and behaviors toward individuals living with obesity.
Health care providers should not assume that all patients living with obesity are prepared to initiate obesity management. Health care providers should ask the patient permission to discuss obesity, and if the patient permits, then a discussion on treatment can begin.
Primary care clinicians should promote a holistic approach to health with a focus on health behaviors in all patients and address the root causes of weight gain with care to avoid stigmatizing and overly simplistic narratives.
**All individuals, regardless of body size or composition, would benefit from adopting a healthy, well-balanced eating pattern and engaging in regular physical activity. Aerobic activity (30–60 min) on most days of the week can lead to a small amount of weight and fat loss, improvement in cardiometabolic parameters, and weight maintenance after weight loss.**
The weight at which the body stabilizes when engaging in healthy behaviors can be referred to as the “best weight”; this may not be an “ideal” weight on the BMI scale. Achieving an “ideal” BMI may be very difficult. If further weight loss is needed to improve health and well-being beyond what can be achieved with behavioral modification, then more intensive pharmacologic and surgical therapeutic options can be considered.
Helpful actions in primary care consultations to mitigate antifat stigma include explicitly acknowledging the multiple determinants of weight-disrupting stereotypes of personal failure or success attached to body composition; focusing on behavioral interventions to improve overall health, and redefining success as healthy behavior change regardless of body size or weight.
In general, health care professionals are poorly prepared to treat obesity. Patients referred to bariatric surgery can wait as long as 8 years before meeting a specialist or receiving the surgery.
**The lack of access to obesity treatments is contributing to rising levels of severe obesity in Canada. Canadians affected by obesity are left to navigate a complex landscape of weight-loss products and services, many of which lack a scientific rationale and openly promote unrealistic and unsustainable weight-loss goals.**
More than 10 years after the release of the first Canadian obesity guideline in 2006, access to obesity care remains an issue in Canada.37,71 Obesity is not officially recognized as a chronic disease by the federal, provincial and territorial, and municipal governments, despite declarations by the Canadian Medical Association85 and the World Health Organization.86 The lack of recognition of obesity as a chronic disease by public and private payers, health systems, the public, and media has a trickle-down effect on access to treatment. Obesity continues to be treated as a self-inflicted condition, which affects the type of interventions and approaches that are implemented by governments or covered by health benefit plans.
Framework
1) Ask
2) Asses
3) Advise ( Medical Nutrition Therapy (MNT) or Physical Activity
The 3 pillars of Obesity Management
Psychological Intervention – Pharmacological Therapy – Bariatric SurgeryAfter reading these new guidelines, I feel confident that we can get help to those people who truly need it and without biases and judgment.
Sometimes it is less about “eat fewer calories and move more” and more about finding solutions that can create a healthy lifestyle through these 3 pillars.
This is a great day in the health industry.
What are your thoughts?
** key points taken from – https://obesitycanada.ca/guidelines/chapters/?fbclid=IwAR3TqhuqTwEugPYhSfr75vjjR-fMsx-DxHd0i_uCZUIg7aMiyZb8E7uVQcw
As well as
https://www.cmaj.ca/content/192/31/E875?fbclid=IwAR3oJ1d_tNnbk57-phAd5RVUmFrbOeMer_MTGybZ6UHFeDpuAsPjvq26TDI
Over the past 15 years, health and fitness have been a huge part of my life. As a kid, I grew up playing hockey during the winters and soccer during the summer to keep me in shape all year long. It wasn’t until the fall of 2005 that I fell in love with running, prompting me to run in four marathons, which led me to my new found passion in exercising.