By Maria Fleet
When Dr. Tasneem Sajwani talks about her patients and their struggles with weight management, she often slips into saying “we.” That’s because she herself has struggled with weight her entire life and knows the challenges firsthand.
“I guess my first diet was at the age of three,” Dr. Sajwani, an Edmonton specialist in obesity treatment, recalls, laughing. When she was just a toddler, the pediatrician told her parents she was overweight and recommended cutting high-fat foods like cheeses and other dairy out of her meals – effectively starting her down the path of lifelong dieting. “That’s what the science was back then – or lack thereof,” she says. “And it’s not something that has changed so drastically along the way until very recently.”
She can sympathize with patients who’ve been told they need to cut calories and exercise more in order to shed excess pounds. She says she was continually told the same thing – by doctors, the diet industry and society, in general. Even medical school didn’t really offer any new insights into weight management.
Over the past four years, Dr. Sajwani has added a specialization in treating excess weight to her practice. She’s been on a professional and personal journey of discovery as she acquired new knowledge about the emerging science of obesity.
Research over the past two decades has shone a light on the complex interconnection between diet and the way our bodies regulate weight. There is an array of neurohormonal processes that can powerfully counteract the straightforward measures we take to lose weight by reducing what we eat and getting more exercise. The latest research has begun to unlock the confounding mystery of why it can be so difficult to shed excess pounds and keep them off.
Now, the challenge for Dr. Sajwani is to impart that exciting, new knowledge to her patients and to the community at large. Dr Sajwani is chipping away at the ingrained notions about weight loss that we all thought we “knew.” For Dr. Sajwani and her patients, it’s a process that begins slowly with acknowledging that meal planning and exercise are indeed part of the equation – but that isn’t the whole story. Obesity is, in fact, a chronic disease that needs to be managed like any other disease. This, in itself, is a rather new concept – the Canadian Medical Association has only recognized obesity as a chronic illness since 2015.
The science is quite complicated, but Dr. Sajwani breaks it down for her patients in successive visits. She says that merely mentioning a few of the hundreds of pathways in our bodies that deal with weight and how our bodies hold onto it “is almost like a weight lifted,” she says without irony. It’s an “aha” moment for patients, as they realize that it isn’t their “fault” and there are scientific explanations for why they have had such difficulty managing their weight.
From there, Dr. Sajwani works with each patient to devise a tailor-made plan to help them achieve their weight loss goals – taking into account what has worked for them before and outlining the practices and treatments that are available. Beyond diet and exercise, there are newer treatment options that Dr. Sajwani can offer, ranging from nutritional and behavioral management, referral to bariatric surgery, and anti-obesity medication. She wants her patients to be fully informed about all the options from the beginning. “So, I talk about medications as a tool from day one, saying, ‘Look, this is what we’ve got in our toolbox here. We’re going to try nutritional and behavioral management. We may or may not add pharmacotherapy from the get-go.’”
Dr. Sajwani is part of a vanguard of Canadian doctors trying to have obesity recognized as a chronic disease in her province of Alberta, as Yukon, Saskatchewan, and Ontario have done. It’s a time-consuming process – but she and her colleagues are making steady progress. With that recognition can come funding for research and prevention, and, above all – the elimination of weight bias. Her own experience with bias motivates her. She says before she delved into the research, she had a bias against her own weight, which made her hesitate to talk to her patients about theirs. Studying the science of obesity liberated her from her own self-judgement and gave her a new way to approach her patients. She keeps working to expand that open space of communication as widely as possible – into the community, and beyond.
Dr. Sajwani is hopeful that in five to ten years, treatment for obesity will be a commonplace part of a family physician’s practice. She likens it to the evolving science around mental health treatment, which has come a long way since the 1970’s. Back then, when patients came in with what would now be recognized as a mood disorder, doctors didn’t have much to offer beyond suggesting the patient get a hobby or spend more time with family. In the ‘70’s, researchers established that a mood disorder is really a biological, neurohormonal condition that requires a multi-faceted approach to manage, she says. “Only then did we start to do so much in the name of mental health disorders – public advertising, education for physicians, for the public — and only then did we move forward.” Dr. Sajwani’s practice and her policy-making work are signs that managing obesity with the latest evidence-based medicine is already moving into the mainstream.
Diet and exercise alone aren’t enough to help many people reach a healthier weight. Medical treatments are needed to address the biological changes happening in our bodies that can drive weight regain. To find a physician near you who specializes in weight management, click here.