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fat shaming is officially over

new obesity guidelines aim to transform obesity from a stigmatized condition to a medical condition.

fat shaming is officially over
study aims to end stigma around obesity. stock/getty

“exercise and diet.” that’s the advice doctors have given patients living with obesity for far too long, says dr. sean wharton, an internist who has authored new clinical guidelines for treating obesity in the canadian medical association journal (cmaj). he says canadians living with obesity have traditionally been viewed as lazy and unmotivated and dismissed by the healthcare system.

but as of tuesday, the day they were released, patients who struggle with obesity now have a document they can bring with them to their next medical appointment.

and it’s based on over 500,000 published peer-reviewed articles — “not something printed off of google,” says wharton, medical director of the wharton medical clinic in burlington, ont. the new guidelines were developed by obesity canada and the canadian association of bariatric physicians and surgeons , and authored by over 60 medical professionals as well as people living with obesity.

in other words, fat shaming is officially over. “we’re definitely hoping physicians and people work on their own biases,” says wharton.
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obesity canada

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the guidelines are intended to end the stigma around obesity and to ensure patients get the care they need. obesity should be treated as a chronic illness, he says. and that requires a three-pronged approach to treatment that doesn’t just focus on diet, as it has in the past.
“our fixation on diet has been failing us for 50 years,” says wharton. “going on a diet guarantees you’re going to lose a little bit of weight but you’ll gain a significant amount back.”

instead, says wharton, obesity needs to be viewed as a neurobiological issue, driven by a variety of hormones which influence people’s eating habits and behaviours. to that end, patients need approaches to managing how those hormones react in their bodies. this can be achieved through bariatric surgery – which reduces the size of the stomach, but also affects hormones and gut bacteria that affect hunger. medications such as glucagon-like peptide 1 (glp-1) agonists can also increase the levels of hormones that make people feel full after eating, while antidepressant/anti-addictive medications can also manage cravings and hunger pangs. cognitive behavioural therapy can also help people retrain the way they think about food.

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obesity matters

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as for diets, forget the moniker. dr. wharton refers to them as medical nutrition therapy, or changes to eating patterns. this means eating to solve a medical condition without obsessing about calories, whether that’s choosing the mediterranean diet if you’re suffering from heart disease to limiting carbohydrates if you’re diabetic. he says if a person makes sensible nutritional choices, the “lower calories will come.”
the holistic approach highlighted by the guidelines aims to transform obesity from a stigmatized condition to a medical condition in its own right. and it’s not intended as a free pass for patients, says wharton. “we need these other tools,” he says. “we still want the patient to do their part — but we don’t deny them medication and treatment.”

wharton says the guidelines come at a time when obesity is seen as a major risk factor for diabetes and covid-19. research has shown that the adipose tissue of people who live with obesity can lead to inflammation that complicates these conditions and can lead to more severe symptoms. people with obesity are also less likely to receive treatments for other health issues, as physicians are less motivated to treat them, says wharton.

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“for physicians, patients and policymakers, we want them to see this as a disease that deserves treatment,” he says. “and it deserves empathy and compassion.”
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