Obesity is a prevalent, complex, progressive and relapsing chronic disease, affecting close to two million people in Canada.

Healthcare providers today recognize that adult obesity is caused by excessive body fat accumulation, something referred to in the medical community as adiposity. Obesity in linked to a wide variety of negative health outcomes, but generally speaking, obesity:

• Impairs good health

• Increases the long-term risk of developing dangerous medical conditions

• Decreases lifespan

Long-Term Care: A Multi-Pronged Approach

People living with obesity require long-term treatment by health care providers.

Unfortunately, even though obesity affects a large number of people in Canada and around the world, only a small fraction of them have access to the kind of treatment and care that could be enormously beneficial. Those who are overweight or obese can benefit from a multi-pronged approach that includes assistance not just from health care providers, but also support from interdisciplinary care teams.

This multi-pronged approach should address several key treatment avenues, including providing assistance with:

• Medical Nutrition

• Physical Activity (30-60 minutes of moderate to vigorous exercise per day)

• Psychological and Behavioral Interventions

• Pharmacotherapy (used to maintain weight loss, and in combination with behavior changes)

• Bariatric Surgery (after a medical and nutritional evaluation)

How is Obesity Defined and Calculated?

Obesity is measured and defined through the calculation of a person's body mass index, or BMI. Obesity guidelines define it as any BMI that exceeds 30 kilograms/m2. It is further sub-categorized into Class 1 (30-34.9), Class 2 (35-39.9) and Class 3 (a BMI over 40).

Besides the amount of fat accumulation (adiposity) and the location of that adiposity, threats to an obese person's health can also be related to environmental factors, as well as genetic, biological and socioeconomic factors.

What are the Challenges Faced By Obese People?

There are many challenges faced by those that are overweight, and obesity is linked to the development of Type 2 diabetes, gallbladder disease, nonalcoholic fatty liver disease, and gout, among others. It can also be attributed to an estimated 20% of all cancers, independent of diet.

The overweight or obese experience an increase in the risk of the following cancers:

• Colon

• Kidney

• Esophagus

• Endometrium (women only)

• Post-menopausal breast (women only)

Besides physical health challenges, there is a substantial amount of societal bias and stigma faced by those living with obesity. These factors are completely independent of a person's weight or BMI, but contribute to both increased morbidity and increased mortality nonetheless.

Luckily, there have been many recent advances in the epidemiology, determinants, pathophysiology, assessment, prevention and treatment of obesity in recent years. As a result, there has been a shift in focus in obesity management toward improving patient-centered health outcomes, rather than on focusing on weight loss alone.

Policy makers in clinical practice and primary care believe that obesity care should:

• Be based on evidence-based principles of chronic disease management

• Validate patients' lived experiences

• Move beyond simplistic approaches of "eat less, move more" by addressing the root drivers of obesity

What are the Root Drivers of Obesity?

Obesity is caused by the complex interplay of multiple factors, including genetic, metabolic, behavioral and environmental factors, the last of which is especially important in the disease's prevalence.

The Future of Obesity Care: A Holistic Approach

Today, those in clinical practice and primary care recognize that improving outcomes isn't just about weight loss, but about improving overall health and well being.

While policy makers and experts in the medical community believe that people living with obesity should have access to updated evidence-informed interventions that include medical nutrition therapy, physical activity, psychological interventions, pharmacotherapy and bariatric surgery, there is an increasing agreement that it is time to update the 2006 Canadian clinical practice guidelines.

An updated version of the guidelines would put an increased focus on changing the dominant cultural narrative, one that tends to lay blame and cast shame at the obese because of an alleged lack of discipline, willpower or a lack of personal responsibility.

Obesity Care: Clinical Practice Guidelines

For those that are overweight or obese, a modern approach to obesity management includes five distinct steps. Today's patient journey begins with guidelines related to permission.

1: PERMISSION: It is recommended that medical practitioners begin by asking the patient if it would be alright to discuss their weight. This demonstrates compassion and empathy, and helps build trust.

2: ASSESSMENT: Next, discussing goals that matter to the patient is important. By learning their story, the BMI calculation and a diagnosis of the disease's severity help move on to the next stage, advice.

3: ADVICE: Advising on the management of obesity should involve a multi-pronged approach that includes medical nutritional therapy from a registered dietitian with a focus on healthy food choices, a discussion of exercise (30-60 minutes a day), a psychological approach that may touch on sleep health, time management and stress among others, the prescription of medications that will aid in the journey to maintain weight loss, as well as a discussion related to bariatric surgery if appropriate.

4: GOALS: Next would be an agreement between the patient and primary care practitioner in which they collaborate on a customized and sustainable plan.

5: ASSISTANCE: The provider should then assist the patient over the long term as they grapple with the drivers and barriers to obesity and a successful management of the condition.

Following these steps not only empowers the clinician to guide the patient towards positive outcomes, but they can help the patient sustain the diet, exercise and behavioral changes necessary to achieve a successful outcome over the long term.

Contact Clinique Michel Gagner For More Information

For more information or a substantive discussion related to obesity management, including the possibility of bariatric surgery, contact us.

Dr. Gagner's experience and expertise are well-placed to guide you successfully through this life-changing process. Dr Gagner is a co-author of the new obesity treatment guidelines published August 4th, 2020, in the CMAJ (Canadian Medical Association Journal). https://www.cmaj.ca/content/192/31/E875