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New Canadian guidelines represent fundamental shift in talking about weight: obesity specialist

This file photo shows a closeup of a beam scale.
This file photo shows a closeup of a beam scale. AP Photo/Patrick Sison, File

Canadian clinical guidelines on obesity are changing for the first time in over 15 years, recognizing obesity as a ‘chronic medical condition’ and calling for a fundamental shift in how we think about it.

Obesity Canada founder Dr. Arya M. Sharma says it’s a more complex issue than previously considered, and that the traditional formula of calculating a person’s body mass index (BMI) isn’t an accurate measurement for everyone.

“We have to make sure we’re not labeling people who just happen to live in large bodies,” Sharma told 680 CJOB.

“There are a lot of people who may not like their large bodies, because we live in a fatphobic society where people who live in large bodies are generally looked down upon — but they might not necessarily have health problems that can be fixed by losing weight.

“There’s a very clear distinction that you don’t measure by stepping on a scale. The body mass index is the old definition of obesity — obesity is defined as having excess body fat that affects health. If it’s not affecting your health, I don’t care how big you are, you don’t have obesity.”
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Sharma said he doesn’t want to downplay any of the hundreds of medical conditions that can be caused by obesity, but that there shouldn’t automatically be the stigma that a larger person is seen as unhealthy.

“It’s a very different way of looking at (obesity),” he said.

“So if there’s anyone out there who says, ‘I’m a big person and my doctors told me to lose weight, but I’m perfectly healthy and my bloodwork is all normal and I don’t know why I should be doing this’… that person might not have obesity.”
Among the key recommendations in the new clinical guidelines — a two-year project by a team of Canadian health experts — are asking patients’ permission to discuss weight; assessing their individual histories; advising on treatment methods including nutrition, exercise, psychological interventions; set personalized, long-term goals; and to help patients overcome barriers that are contributing to their disease.
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“These are much-needed changes,” said Andrea Katz of Winnipeg women’s health and fitness company FIT Women and Girls.

“The idea of ‘calories in, calories out’ does not work. It’s not a long-term strategy for people, and it really doesn’t take into account so many other pieces that come with weight loss or obesity.

“It doesn’t talk about your stress levels, it doesn’t talk about genetics, it doesn’t talk about any potential injuries that you have or other issues going on with your mental health or your hormones. There’s so many different pieces that come into play.”

Katz told 680 CJOB it’s a matter of understanding the individual context and circumstances behind why someone might be obese, rather than trying to solve it with a formula.

“Unfortunately, ‘eat less, exercise more’ doesn’t work, because if it did work, 95 per cent of the people who lose weight wouldn’t gain it back,” she said.
It really is talking about understanding where people are coming from. Why are they eating more than they need to? Why are they not exercising enough? Those types of questions need to be understood.”
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