New Guideline for Obesity Treatment Suggests Addressing the Root Causes

August 4, 2020 Updated: August 5, 2020

As the prevalence of obesity continues to grow in Canada, a new guideline suggests some fundamental changes in how physicians should treat the condition, including addressing the root causes behind it.

“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,” says the guideline, published in the Canadian Medical Association Journal in partnership with Obesity Canada.

“This guideline update reflects substantial advances in the epidemiology, determinants, pathophysiology, assessment, prevention and treatment of obesity, and shifts the focus of obesity management toward improving patient-centred health outcomes, rather than weight loss alone.”

According to the update, the prevalence of obesity has increased threefold since 1985 and has become a major public health issue, affecting an estimated 1.9 million Canadian adults in 2016.

The new guideline is the result of two and half years’ research effort and includes input from 60 authors. It is the first major update since 2006.

“We’re no longer going to be focusing on speaking about calories when we talk about decreasing weight,” Dr. Sean Wharton, co-lead author of the guideline and adjunct professor at McMaster University, told CTV News. “We’re going to be more focused on healthy eating, something we call medical nutrition therapy.”

In the 2006 version, BMI and waist circumference are the two major measures to test adults for obesity, whereas the new guideline suggests options such as cognitive behavioural therapy (CBT), weight loss medication, and bariatric surgery, according to each patient’s condition.

Wharton describes these as the “three pillars” that help attain long-term weight loss, while increasing exercise and reducing calories are less effective and may not be sustainable. 

“We know that willpower and motivation will allow for a dietary plan that lasts for a short period of time and then our body compensates and regains the weight,” he said. “Any time we look at lowering calories, we always activate a very strong biological compensatory mechanism, which is why we are doing our best to deemphasize diet.”

The guideline lists the following five recommendations to guide health-care providers in the treatment of 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.

“Obesity is caused by the complex interplay of multiple genetic, metabolic, behavioural and environmental factors, with the latter thought to be the proximate cause of the substantial rise in the prevalence of obesity,” the guideline states.