“Obesity should be defined by state of health and not by weight”

A new Canadian guideline says obesity should be defined by a person’s health, not just their weight.

She also advises doctors to go beyond just recommending diet and exercise.

Rather, specialists should focus on the root causes of weight gain and take a holistic approach to health.

The guideline, which was published Tuesday in the Journal of the Canadian Medical Association, specifically recognizes the stigma associated with the weight of patients in the healthcare system.

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“The dominant cultural discourse on obesity fuels assumptions about personal irresponsibility and unwillingness and throws responsibility and shame on people living with obesity,” says the guideline, which is intended for use by primary care physicians to diagnose and treat obesity in their daily practice.

Ximena Ramos-Salas, director of research and policy at Obesity Canada and one of the authors of the guideline argues that research shows that many doctors discriminate against obese patients. This can lead to worse health outcomes regardless of their weight.

“Weight biases aren’t just about believing what’s wrong about obesity,” she says.

“Weight bias actually has an effect on the behavior of health care practitioners.”

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Small reductions in weight, of around 3 to 5%, can lead to improvements in health and an obese person’s “best weight” may not be their “ideal weight” according to BMI, the guideline says.

She points out that obesity is a complex chronic disease that must be managed throughout life.

“For a long time we have associated obesity with lifestyle behavior … There has been a lot of shame and blame before,” says Ms Ramos-Salas.

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“People living with obesity need support just like people living with any other chronic disease.”

But instead of simply advising patients to “eat less, move more”, the guideline encourages doctors to provide support in the form of psychological therapy, medication and weight loss surgery like gastric bypass surgery.

The directive does not completely do away with the usual weight loss advice. “All people, regardless of their size or body composition, would benefit from adopting healthy and balanced eating habits and practicing regular physical activity,” she says.

However, she notes that it is often difficult to lose weight because the brain compensates by being hungrier, which encourages people to eat more. Numerous studies have shown that most people who lose weight through diet regain it.

“Diets don’t work,” says Ramos-Salas.

Doctors should also ask permission before discussing a patient’s weight and work with them to focus on the health goals that matter to them, instead of just telling them to cut back on their calories.

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