- Canada is moving away from weight to define and manage obesity
- Their new clinical guide aims to find the root causes of the condition
- They also want to focus more on achieving health goals rather than just weight loss
For a long time obesity was mainly determined by how much you weigh. This has, however, met with considerable criticism in recent years, especially with the rise of the body-positivity movement.
Canada has taken note and had adjusted its new clinical guide for healthcare professionals to look beyond body mass index (BMI) when diagnosing obesity. This also includes working with the patient on what goals they want to achieve besides just losing weight.
"Obesity care should be based on evidence-based principles of chronic disease management, must validate patients’ lived experiences, move beyond simplistic approaches of 'eat less, move more', and address the root drivers of obesity," according to the guide.
Obesity is defined as a condition where excess body fat has a negative impact on a person's health, and various environmental, genetic and socioeconomic factors can influence this condition.
BMI has been a popular tool for determining the "healthy" weight of individuals based on height. Obesity was generally defined as having a BMI of 30 kg/m2 and is subclassified into class 1 (30–34.9), class 2 (35–39.9) and class 3 (over 40).
But the tool has continuously come under fire for being inaccurate and not accounting for muscle mass, and may lead to bias, especially when used without taking other measurements into account.
Health goals instead of weight loss
For decades physicians have been telling obese patients to eat less and exercise more, but according to the guideline it's more complex, and there are more factors that need to be addressed. Overdoing it can cause an imbalance between energy intake and exertion, causing its own complications.
The guide recommends that waist circumference used in conjunction with BMI would give a more accurate reading, as well as studying the individual's family and health histories.
One such guide is the Edmonton obesity staging system, which incorporates metabolic, physical and psychological parameters to diagnose and recommend the best treatment for obesity.
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The guide also points out medical bias, where obesity has a certain stigma around the world, where the condition is viewed as people's "own fault". This prejudiced perception could lead to lower quality healthcare when obese people seek medical aid for other ailments.
"With increased knowledge of the disease state and better approaches to assess and manage obesity, it is time to update the 2006 Canadian clinical practice guideline.
"The goal of this update is to disseminate to primary care practitioners evidence-informed options for assessing and treating people living with obesity. Importantly, this guideline incorporates the perspectives of people with lived experience and of interprofessional primary care providers with those of experts on obesity management, and researchers."
South Africa's obesity problem
South Africa has one of the highest rates of obesity in the world, where one-third of women over the age of 15 were classified as obese in contrast to 11% of men in the National Income Dynamics study of 2013.
While the South African Health Department's guidelines on obesity highlight BMI as a useful tool, "it should be used in conjunction with other methods of estimating body size, composition and risk".
They also highlight the use of measuring waist circumference, highlighting men at moderate risk for obesity when they're over 94cm and high risk when over 102cm. For women, moderate risk is over 80cm and high risk over 88cm.
In the South African context, they also found that that poverty is a significant driver for the prevalence of obesity in our lower-income communities.
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