The Canadian Adult Obesity Clinical Practice Guidelines: Why They’re A Big Deal

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By: Ansley Dalbo

On Tuesday, August 4, the Canadian Medical Association Journal published a summary of the long-awaited Canadian Adult Obesity Clinical Practice Guidelines, which were developed by Obesity Canada and the Canadian Association of Bariatric Physicians and Surgeons. The guidelines themselves are composed of 19 chapters (that can be seen here) covering topics ranging from the genetics of obesity, commercial weight loss programs, to behavior change interventions.  

As the overwhelming press coverage of this release would indicate (see a list of  mainstream media coverage at the bottom of this article), these guidelines are a very big deal. Why?

Reason #1: This is the first comprehensive update to Canadian obesity guidelines since 2007, and as Dr. Sue Pedersen says, the new guidelines reflect the tectonic shift in the knowledge and understanding of obesity that has occurred in the last thirteen years.  The guidelines were put together by more than 60 Canadian health professionals, researchers and individuals living with obesity, and they assessed well over 500,000 (!) published peer-reviewed articles to build consensus on a wide range of issues, ultimately identifying 80 key recommendations.

Reason #2: They incorporate the impact of weight bias / stigma, which the guidelines define as “the assumptions and judgments that are held about people living in larger bodies,” into every single chapter. Given that weight bias / stigma is the fundamental barrier to people living with obesity seeking and receiving adequate and appropriate medical treatment, the importance of this inclusion cannot be overstated. By asking physicians and patients to consider the impact of weight bias (both society’s and their own), the guidelines begin to mitigate this corrosive reality which negatively impacts many people’s access to care and the quality of care they receive. 

Reason #3: It bears repeating these guidelines make clear that obesity is a chronic disease, which should be medically managed just like every other chronic disease. They also provide comprehensive and up-to-date information about the evidence-informed treatments available to manage it. It’s our sincere hope that the key messages provided for health policy makers in every section will guide the development of public health policy that will lead to a more nuanced understanding of obesity and enable coverage of these necessary treatments. 

As Dr. Shahebina Walji (an obesity expert in Calgary and one of the authors of the guidelines) puts it, “I am thrilled to see a comprehensive discussion about the science of obesity, including both the neurobiology of appetite control and energy balance dysregulation as well as the cross talk that occurs between the brain and the body.  Really, I believe it is the deeper understanding of this science that will underpin the shift in attitudes towards people living with obesity along with the shift in how we treat it.”

Reason #4:The guidelines will fundamentally change the nature of the conversation around obesity and healthcare, representing a true shift in the way medical experts think, talk about, and treat obesity. A few of the ways these guidelines reflect new thinking:

  • They shift the conversation from weight to health—defining obesity as the presence of excess body fat that impairs health and well-being. 
  • They thoroughly debunk the idea that the eat less / move more approach is the “answer” for long term, obesity management
  • They move away from BMI as the only diagnosis criteria for obesity, and instead look at whether excess body fat is impacting a person’s health
  • They acknowledge that for many people living with obesity, diet and exercise alone is not enough—additional treatments (prescription medications, psychological treatments, and/or bariatric surgery) may need to be considered

Reason #5: Last but certainly not least, these guidelines are a big deal because as Dr. Yoni Freedhoff puts it, they are the first to take a patient-centered approach to obesity.  They put a significant emphasis on the patient journey and an improved patient / provider relationship. They also encourage patient agency by recommending that providers ask permission to discuss a patient’s weight and recommend that physician and patient TOGETHER develop personalized goals for the individual beyond just a number on the scale. (For several articles that cover some very practical takeaways from the guidelines that can be applied to your specific journey to a healthier weight, click here.)

With the release of these guidelines, Canada has taken a truly significant leadership role in the management of obesity that will be watched by countries and public health officials around the world. In the meantime, they will hopefully make the conversation that people living with obesity in Canada have with their family physician one that’s based on science and not blame / shame.  

Media Coverage Of The Guidelines:

CNN

MSN

The Star

BBC

The Guardian

CBC

The Conversation

The Australian

Digital Journal

The Globe and Mail

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