Treating/Curing Obesity

"We're definitely hoping physicians and people work on their own biases."          "Our fixation on diet has been failing us for fifty years. Going on a diet guarantees you're going to lose a little bit of weight but you'll gain a significant amount back." "People with obesity are also less likely to receive treatments for other health issues, as physicians are less motivated to treat them."                                       "For physicians, patients and policy-makers, we want them to see this as a disease that deserves treatment. And it deserves empathy and compassion."            Dr.Sean Wharton, Internal Medicine Specialist, Wharton Medical Clinic, Hamilton, Ontario

Obesity guidelines move away from focus on weight loss

Over 60 Canadian health professionals, researchers and individuals living with obesity worked together to help develop -- in tandem with Obesity Canada and the Canadian Association of Bariatric Physicians and Surgeons -- the Canadian Adult Obesity Clinical Practice Guidelines. Dr.Wharton is one of the authors of the new clinical guidelines. It took two years to produce the guidelines to treat obesity in Canada, representing the first major update to obesity treatment since 2007.

The new recommendations for treatment of obesity in Canada where its authors assessed over 50,000 published peer-reviewed articles on obesity to arrive at their considered conclusions, has been published in the Canadian Medical Association Journal. According to the new guidelines, medical professionals are instructed that obesity be viewed and treated as a chronic illness. And as such recommending diet and exercise as a solution will no longer suffice. 

An integral part of treatment is to realize that the stigma surrounding obesity must be ended.

 Genetics, trauma and mental-health issues. (designer491/Shutterstock)

Henceforth, obesity requires viewing as a neurobiological issue, one driven by hormones influencing people's eating habits and behaviours, requiring  patients to be invested in understanding and managing their bodily reactions to the hormones. Medications like glucagon-similar peptide 1 agonists have the potential to increase levels of hormones making people exp0erience a full feeling after meals; similarly antidepressant/anti-addictive medications can be prescribed to manage cravings and hunger pangs.

Bariatric surgery can be contemplated, having the effect of reducing stomach size, an approach which also affects hormones and gut bacteria involved in affecting hunger. People suffering from obesity can be taught through cognitive behavioural therapy to readjust the way in which they view food. The attending physician is the guide, leading the patient to a fuller understanding of the condition afflicting them, who then becomes an invested partner in treatment, through acquiring knowledge.

 A new guideline to treat obesity recommends a shift  (Tsuji/Istock.com)

Dr.Wharton feels the language aura around obesity and treatment should undergo a change as well, transitioning from the old familiar word 'diet' to "medical nutrition therapy", an effort to aid in changing eating patterns. The understanding is that one's eating habits which have undergone a voluntary change are based on the understanding that a medical condition underlies the new changed eating pattern. And along with that patient cooperation in the therapeutic mode of eating, obsessions with calories should be abandoned.

"Lower calories", Dr.Wharton observes, "will come", as a natural corollary to committing to sensible nutritional choices. The new guidelines fit seamlessly into the pandemic situation, with obesity being viewed as a major risk factor for developing diabetes and contracting COVID-19. According to research, adipose tissue of people living with obesity can lead to inflammation, complicating these conditions which can ultimately result in more severe symptoms.