Obesity: A Complex Chronic Disease (3/6)

In the first post in this series I introduced the paper that inspired me to write this series and went over my thoughts on the first of their proposed steps for better patient management when it comes to obesity. The paper, “Obesity in adults: a clinical practice guideline”, outlines over 70 recommendations made by experts on patient management for those living with obesity, divided into 19 full length chapters. While I have not read the full 19 chapters yet (I intend to do so due to my interest in this topic), I am outlining my thoughts on the summary arc of five steps that they proposed to better help patients.

In the last post, step 2: assessment, I emphasized on of the naturopathic values that this clinical guideline exemplified; addressing the root cause. This step in the system is looking critically at assessing for what the underlying reasons are for a person’s weight gain. This is an important direction as it steers away from what can be a culture of shame and blaming toward those who live obesity. It focuses on both physical and mental conditions that can lead to obesity and how we can determine which contributing factors have lead to obesity and therefore in this step, what factors can be addressed to help lose weight in order to decrease the risks that obesity can cause.

Step 3: Discussion of treatment options

Emphasis on discussion. The guidelines are not suggesting sitting down in your doctors office and being told what you need to do. These guidelines are addressing what has been gaining more insight as an important aspect of the therapeutic relationship, and that is collaborative care.

Collaborative care involves education, discussion, questions, and collaboratively arriving at a treatment plan that is feasible for both the patient and the health care team. But what does that mean?

It means that there is a frank discussion about the risks (which may have already occurred in step1) and education surrounding the different options that are available to help with obesity. These can include action plans that address the root cause like mental health concerns, or a lack of education around food and food preparation or concerns about exercising, or surgical options depending on the degree of severity of the obesity. What it does not include is items solely focused on weight loss because the authors report that these plans are not successful. These plans are all encompassing, and they are supposed to have more than one actional item.

However, the report does emphasize that the patient be educated on healthy eating habits and that long term change will be required on top of including exercise into the regime. They estimate that the lose with healthy eating and exercise that can be achieved is 3-5%, which can be very meaningful for those living with obesity.

Now collaborative plans are also time consuming, which is one of the drawbacks I talked about it step 2! A Naturopathic Doctors’ office appointments have enough time built into them to allow for this, but other professions may not and this may be detrimental to the guidelines outlined. Education and options are a process and processes take time to make sure that nobody in the conversation is left behind.

If a patient does not understand the options or they have not been given options, it is possible that they will not follow through with the plan. This is one item that the authors stress as important; the patient needs to feel empowered enough to follow through with a plan. Empowerment is important and powerful. But if it is not present it can lead to failure before the patient even leaves the office.

So overall, this step is a collaborative care step. It involves more education and having a discussion to work out what will work best for the patient. This is not a step to miss as it may lead to a failure to launch so to speak, and it would be of no fault to the patient. So let’s stress the importance of collaborative care and let’s make sure that this part of the guideline makes it into normal practice.

Work Together. Educate together. Heal Together.

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Below is the article to which I am referring

Wharton S, Lau DCW, Vallis M, et al. Obesity in adults: a clinical practice guideline. CMAJ. 2020;192(31):E875-E891. doi:10.1503/cmaj.191707