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New Canadian obesity guidelines represent major shift away from more exercise, cutting calories

Report published Tuesday by CMAJ takes focus off the individual, puts onus on doctor-supervised treatments

New guidelines have been published in Canada for the medical treatments provided to people with obesity. 

The recommendations represent a major shift away from the conventional approach of cutting calories, dieting and exercise. 

The new guidelines suggest doctor-supervised treatments as therapy, weight loss medication and bariatric surgery, depending on each patient’s individual needs.

The changes are being welcomed by Public Health Sudbury and Districts. The rate of obesity in this part of Northern Ontario is considered "significantly higher" than the rate for the rest of Ontario.

"We know that the rates for adult obesity in our Public Health Sudbury and Districts service area are higher than the provincial average,” said Melanie Martin, a public health nurse in the PHSD's Health Promotion Division.

“What we don't know is exactly why. We know that weight is very complicated and contrary to what is often promoted, it is really influenced by a number of factors which includes our biology, our genetics, our socio-cultural experience that built the environment around us, our life experience, our mental wellness, you know all those things.

"So yes there is a statistical difference in the rates of obesity in our service area compared with the rest of Ontario. It is significantly higher than the rest of the province. For 2017 to 2018, the rate in our service area was 31.9 per cent of adults. For all of Ontario as a whole, the rate was 25.9 per cent. 

The new approach looks at ways to keep the patient healthier instead of trying to force the patient to eat less or exercise more, said the report published Tuesday by the Canadian Medical Association Journal.  

"There is a recognition that obesity management should be about improved health and well-being, and not just weight loss,” said the report.

“Because the existing literature is based mainly on weight-loss outcomes, several recommendations in this guideline are weight-loss centred. However, more research is needed to shift the focus of obesity management toward improving patient-centred health outcomes, rather than weight loss alone.”

Martin said the changes are welcomed by the public health community. 

"We have been working in this area for a very long time and we do know what is considered healthy when it comes to weight varies from person to person,” she said. 

“These new guidelines really shift that focus I think from target weight or BMI (Body Mass Index).” 

She said the causes for weight gain differ on many levels and many different experiences for people.

"We know that the impact this will have on any individual's health is different for every person, so the science is evolving and these guidelines are speaking to that," said Martin. "It also reinforces the need to address the biases and stigma that really exists.”

Dr. Sean Wharton, a co-author of the report, said there are three pillars to effective long-term weight loss, those being cognitive behavioural therapy (CBT), weight loss medication and bariatric surgery. 

Wharton said while most people understand diet and exercise, they also need to understand that the three pillars are necessary to inspire more exercise and healthier diet.

Martin agrees with the new approach because she said it is more focused on success.

"So switching the focus to behavioural goals and outcomes really will set people up for more success and will have a good positive impact on health outcomes, regardless of the outcome on weight,” she said.

“If we are not moving our bodies as much as we should be or not getting as much sleep as we should be, regardless of our weight status, if we can improve our behaviours, we can improve health. 

"These guidelines really do present an updated approach to individualized assessment and treatment for people living with obesity. On a larger scale, on a public health scale, we really have to recognize and address those broader, social and environmental factors that really make it easier or more difficult for people to engage in those health promoting behaviours.

"We are often targeting the individual, but when we look at things from the public health perspective, what is it in their environment and in our society that makes those health promoting behaviours easier or more difficult.

About the Author: Len Gillis, local journalism initiative reporter

Len Gillis is a Local Journalism Initiative reporter at covering health care in northeastern Ontario and the COVID-19 pandemic.
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