Health

New obesity guidelines shift focus to root causes rather than weight loss

New Canadian guidelines for treatment of obesity call for a shift in focus to the root causes rather than weight loss alone, which means doctors working with patients to understand underlying issues like genetics, trauma and mental-health issues.

Clinicians pushed to recognize any bias they may have against overweight patients

New Canadian guidelines for treatment of obesity call for a shift in focus to the root causes rather than weight loss alone, which means doctors working with patients to understand underlying issues like genetics, trauma and mental-health issues. (designer491/Shutterstock)

New guidelines for treating obesity call for a shift in focus to the root causes rather than weight loss alone.

That means doctors working with patients to understand the "context and culture" that underlie the issue, which could include genetics, trauma and mental-health issues.

The advice by Obesity Canada and the Canadian Association of Bariatric Physicians and Surgeons also pushes clinicians to recognize any bias they may have against overweight patients — such as assuming they lack willpower or are non-compliant.

One of the lead authors, Dr. Sean Wharton of Hamilton's McMaster University, says treatment depends on "showing compassion and empathy" and using evidence-based interventions that focus on patient goals. 

People should follow healthy eating patterns, said Wharton, an internal medicine specialist focused on obesity and Type 2 diabetes. "If you have diabetes, you may want to have lower carbs. If you have heart disease, you may want to have a Mediterranean diet."

WATCH | Obesity guidelines move away from focus on weight loss:

New Canadian medical guidelines for the treatment of obesity move away from a focus on weight loss to addressing “the root drivers of obesity" along with tackling issues of stigma and bias toward overweight patients. 1:57

The guide recommends a holistic approach in which doctors consult patients on goals they consider important, and then collaborate on a plan that is personalized, realistic and sustainable. 

"Obesity in adults: a clinical practice guideline" was published Tuesday in the Canadian Medical Association Journal.

"Working with people to understand their context and culture, integrating their root causes, which include biology, genetics, social determinants of health, trauma and mental health issues, are essential to developing personalized plans," added Dr. David Lau, co-lead of the guideline and professor at the University of Calgary.

The advice is an update to the 2006 guideline and targets primary health-care professionals, policy-makers, people living with obesity and their families.

Move away from judging

Ian Patton, a patients' advocate with Obesity Canada who helped create the new guidelines, wants people living with obesity to no longer feel defensive about being hit with bias when they go to see a clinician and to use the document in their discussions. 

"I've experienced situations where doctors and health professionals kind of brush off my concerns and attribute it to my weight, rather than actually addressing the concerns," Patton said.

Obesity needs to be seen as a complex, chronic disease that needs to be treated with empathy and compassion, says Dr. Sean Wharton. (Skype/CBC)

Dr. Iris Gorfinkel, a family physician in Toronto who was not involved in developing the guidelines, welcomes them.

"Patients understand that being overweight is bad for their health. They totally get that. But they don't need judging," Gorfinkel said. "I think that the old thing of 'You know you weigh too much. Why don't you just eat less? Why don't you just exercise more?' is actually potentially damaging."

The experts say Canada has seen a threefold increase in obesity over the past 30 years. Severe obesity has increased even more, with more than 1.9 million Canadian adults affected.

With files from CBC's Thomas Daigle

now