Cutting calories no more: New guidelines call for fundamental shift in obesity treatment

Published Aug. 4, 2020 6:00 a.m. ET

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TORONTO -- A new guideline to treat obesity in Canada recommends a fundamental shift in how doctors and physicians address people living with the condition.

The new guideline, published Tuesday in the Canadian Medical Association Journal and in partnership with Obesity Canada, suggests doctors begin focusing on goals that patients consider to be important, rather than focusing on weight loss alone, while also shifting away from the “diet and exercise” weight loss model to instead address the root causes of someone’s excessive weight.

“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, said in an phone interview with “We're going to more so focus on healthy eating, something we call medical nutrition therapy.”

Wharton said simply cutting calories and increasing exercise is not a sustainable way to lose weight and can ultimately lead to the patient regaining the weight.

“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.”

In the past 30 years, the rate of obesity in Canada has tripled, while the rate of severe obesity has increased tothe point that it includes more than 1.9 million Canadians today.

This guideline is the first major update since 2006 and includes the input of 60 authors who spent the past 2.5 years developing it. The 2006 guidelines recommended testing all adults for BMI and waist circumference for obesity, both of which are now outdated methods.

When it comes to treating obesity, the new guidelines suggest expanding the options to include cognitive behavioural therapy(CBT), weight loss medication and bariatric surgery, depending on the each patient’s individual needs.

Wharton calls these the “three pillars” of effective long-term weight loss.

“Most people understand diet and exercise,” he said. “They don't understand that the pillars that are necessary to keep the diet and the exercise going.”

Cognitive therapy, Wharton said, is essentially teaching the patient to be more cognisant of what they’re eating, especially when it comes to snacking on impulse. One strategy is to wait five minutes before eating a desired snack, to make sure you still want it.

“Some people can do that skill without even being taught that skill, but the majority of people have to be taught those skills and that's where CBT treatment and psychological intervention is coming from,” Wharton said.

Among the key recommendations for physicians include asking permission to discuss a patient’s weight, understanding the root causes of their obesity, discussing treatment options, collaborating with the patient on long-term goals, and helping patients with barriers to accessing proper treatment.

The report also aims to address some misconceptions about people with obesity, including that they are unwilling to handle the matter or have been irresponsible when it comes to their eating habits, which can create stigma and negatively impact how they’re treated.

Obesity is not officially recognized as a chronic disease by any level of government in Canada, despite declarations from the Canadian Medical Association and the World Health Organization.

“Obesity continues to be treated as a self-inflicted condition, which affects the type of interventions and approaches that are implemented by governments or covered by health benefit plans,” the report states.

The guidelines note that there are instead several root factors for someone’s excessive weight, including genetics, sociocultural practises, adverse childhood experiences and mental health conditions, among others.

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