Overweight, they argue, should be defined by a person’s health rather than just their weight.
“This is a big departure from the idea that you can step up and diagnose obesity,”
Five Steps to Better Obesity Treatment
The new guidelines provide clinicians with a five-step roadmap to follow when treating obese patients.
The first step – an approach Sharma joked was “very Canadian” – encourages doctors to ask their patients if they feel comfortable talking about their weight. If this is the case and they want to continue treatment, doctors can move forward.
At this stage, doctors should also learn to view obesity not as a personal failure, but as a chronic illness that is not curable with a temporary diet or even major surgery such as bariatric surgery. As a result, it requires long-term care from a doctor.
“Obesity management must be based on the principles or management of chronic diseases, which means a quick fix … none of which will have long-term effects,” Sharma told CNN.
It is a doctor’s duty to identify these causal factors in his patient, set a course for tailored treatment, and work with the patient, he said – steps two to four of the recommendations.
Not all treatment options for obese patients include losing weight, Sharma said. If a patient eats healthier foods, does a lot of exercise, and shows general signs of improved health without losing weight, they are successful.
“I don’t care what’s going on on the scales,” he said. “The real question is, does my patient feel better? The obesity-related problems – are these conditions better controlled now? That may mean weight loss or not.”
The fifth step is to help patients with obstacles achieve their goals regardless of what they are. It is a doctor’s job to support and identify these barriers before they occur so that they do not hinder a patient’s success under the new guidelines.
The tricky weight treatment of medicine
Weight has become a polarizing and gnarly topic in medicine.
The stigma of obesity has hindered existing treatment, the team of Canadian doctors wrote in their guidelines. Doctors could write off obesity patients as unwilling or irresponsible, Sharma said, or they could even increase their weight if it is not relevant. The biased treatment is enough to finally drive people with obesity out of medicine, he said.
These guidelines are an “excellent improvement” to the previous approach to obesity, said Sylvia Ley, an assistant professor in the Epidemiology Department at Tulane University, who was not involved in the study.
“The new directive seeks to treat obesity as a complex disease that needs to be treated using a combination approach …” Ley wrote in an email to CNN. “It also recognizes the importance of patient-centered, individually tailored approaches.”
But the guidelines are not perfectly aligned with the fat acceptance movement, although Sharma said that the guidelines were created in collaboration and with contributions from people with obesity. Many fat positive activists reject the belief that fat is a disease or defect.
Ali Thompson, a writer, YouTuber, and fat activist, told CNN that characterizing fat as a disease “turns a normal human variation into a problem that needs to be solved.”
The guidelines could also leave room for discrimination between doctors, Thompson said.
“Any standard of care for fat people that doesn’t start and end with treating them like thin people is inadequate,” she said.
“It is extremely inhumane to be spoken the same way as talking about a virus,” she said.
Public health researchers and fat acceptance advocates may disagree on obesity, how to describe it, and whether medical intervention is needed. But Sharma said that the guidelines are not meant to force people to accept treatment. If someone is not interested in changing something in themselves, they shouldn’t be made to do so until their health is at risk, he said.
“We used to have a recommendation: eat less, exercise more,” said Sharma. But that was just a close view of a complicated state for which there is no single cause.
The guidelines, Sharma and his colleagues hope, open a window for a more understanding view of obesity, which is about patients.