Obesity is not just a matter of weight
Obesity should be defined by a person's health - not just by their weight, says a new Canadian clinical guideline.
The guideline, which was published in the Canadian Medical Association Journal on August 4, 2020, specifically admonished weight-related discrimination against patients in the health system. It also advises doctors to go beyond simply recommending diet and exercise. Instead, they should focus on the root causes of weight gain and take a holistic approach to health.
Ximena· Ramos-Salas, the director of research and policy at Obesity Canada and one of the guideline's authors, said research shows many doctors discriminate against obese patients, and that can lead to worse health outcomes irrespective of their weight.
Although the latest advice still recommends using diagnostic criteria like the body mass index (BMI) and waist circumference, it also acknowledges their clinical limitations and says doctors should focus more on how weight impacts a person's health.
Small reductions in weight of about 3-5% can lead to health improvements, and an obese person's "best weight" might not be their "ideal weight" according to BMI, the guideline says. It emphasizes that obesity is a complex, chronic condition that needs lifelong management.
"For a long time we've associated obesity as a lifestyle behavior. It's always been with shame and blame," Ms. Ramos-Salas says. "But people living with obesity need supports like people living with any other chronic disease."
Weight off is often difficult because the brain will compensate by feeling hungrier, thus encouraging people to eat more. Many studies have shown that most people who lose weight on a diet gain it back. Physicians should work with the obesity patient to focus on health goals that matter to them, instead of just telling them to cut calories.
So instead of simply advising patients to "eat less and move more", the guideline encourages doctors to provide supports such as psychological therapy, medication and bariatric surgery like gastric-bypass surgery. But the guideline doesn't completely abandon traditional weight-loss advice. "All individuals, regardless of body size or composition, would benefit from adopting a healthy, well-balanced eating pattern and engaging in regular physical activity," it says.
1. admonish v. 警告
2. discrimination n. 歧视
3. holistic adj. 整体的
4. diagnostic adj. 诊断的
5. bariatric adj. 肥胖症治疗的
6. gastric-bypass n. 胃绕道手术