The co-author of new clinical guidelines for treating obesity believes there’s a need for a re-think in helping people perceived to have a problem with weight gain since health science has evolved over the past few decades.
“We’re still using old terminologies and old ways of actually thinking about it,” says co-author Dr. Sean Wharton of Hamilton’s McMaster University, “And we need to update that because we know more about the biology, about the physiology, about the impairments and the health.”
The authors of the new guide — Obesity in Adults — says there’s a need for change due to “substantial advances” in the epidemiology, determinants, assessment, prevention and treatment of obesity which is shifting the focus of obesity management through weight loss toward an outcome centred on patients’ overall health.
Wharton argues that body mass index (BMI) — a person’s weight in kilograms divided by the square of height in metres — is no longer the right tool for defining obesity since it looks just at body size, and doesn’t look at a person’s actual health.
“Sometimes the placement of where the fat cells are are a major, major factor. White males tend to put their energy into the central area, not into the buttocks and to enter the thighs,” Wharton said. “So the downtown fat in the central area causes a lot of medical problems and the peripheral fat doesn’t.”
The guide, which updates a 2006 publication, also suggests a bias in beliefs about obesity can affect the level of care a patient could receive based on a narrative that assuming that the affliction is the result of “personal irresponsibility” and a “lack of willpower.”
“If we don’t treat them well, then their self-esteem keeps on going further and further down and they have less cognitive capacity to actually do any treatment option,” Wharton said.
Cognitive behavioural therapy is also one of the pillars of maintaining a healthy lifestyle, according to the guideline along with healthy eating, and keeping active.
“The word cognitive means that you’re aware of the problem.” said Wharton, “You’re aware of the fact that when you get home at night after a difficult day at work, that you end up using coping mechanisms and extra eating.”
Wharton says being cognizant and aware of a penchant to eat calorie-dense foods, means there’s an opportunity to divert it.
In the past three decades, rates of obesity have steadily increased in Canada, according to a federal government report. As of 2016, the disorder affected an estimated 1.9 million Canadian adults.
Wharton says medical treatment is something else that could be looked at to ward off obesity since hormones and neurochemicals also drive behaviours.
“So the use of medication can very effectively put somebody on the right track and help them to do behaviours properly. Bariatric surgery can do that, and cognitive behavioural therapy can also do it.”