The Canadian Obesity Society advocates for a therapeutic approach to obesity that removes stigma, focuses on individual patient goals, and favors body health over body weight.
Treatment for overweight and obesity remains freighted with destructive notions and prejudices embedded during decades of diet culture, according to authors of the Canadian Adult Obesity Clinical Practice Guidelines.
The guideline recieved signficant attention during the recent European Congress on Obesity (May 4-7, 2022), with the European Association for the Study of Obesity (EASO) the most recent organization to adopt the tenets of the Canadian approach.
A key difference in development of the Canadian guideline was the early recognition that weight bias and stigma have been fundamental barriers to increasing and improving obesity research, education, and policy. The committee prioritized weight bias and stigma and "used this lens in every aspect of our work," according to an EASO statement.
One of the clearest reflections of use of this lens is a shift throughout the document from a focus on a healthy weight to a focus on healthy behavior change, regardless of body size or weight. Healthy behavior change is the new definition of "success."
The following Guideline Topline presents the 5 steps in the "patient arc" to guide the primary care clinician in this type of care for people living with obesity.
STEP 1: Recognition of obesity as a chronic disease by health care providers who should ask patient permission to offer advice and help treat the disease in an unbiased manner.
Step 1: Check personal bias, ask permission
Self assessment: Implicit Associations Test: Weight Bias
STEP 2: Assessment of an individual living with obesity, using appropriate measurements and identifying the root causes, complications, and barriers to obesity treatment.
Step 2: Identifying and integrating root causes of obesity into care helps individualize treatment plans.
STEP 3: Discussion of core treatment options and potential adjunctive therapies (medical nutrition therapy, psychological, pharmacotherapeutic, and surgical treatments).
STEP 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.
Reference: Wharton S, Lau DCW, Vallis M, et al. Obesity in adults: a clinical practice guideline. CMAJ. 2020;192:E875-91. doi: 10.1503/cmaj.191707