Pondering Obesity Management (1/6)

Weight is not something that can easily be hidden and due to intense stigma, its something that a lot of people have been made to feel ashamed about. This is something that needs to change. Everyone has their own history, their own journey, and their own struggles, so why should it be on anyone else to judge someone else?

This call for de-stigmatization stems from a recently published article on how health care providers (HCPs) can better help those who live with obesity. This is what I am diving into over the next six posts and I hope that with this you can learn a little about the new guidelines for management and of course a little more about the complex chronic condition that is obesity.

The article is entitled “Obesity in adults: a clinical practice guideline” (Link here) and I found it on my news feed under this news article “Cutting calories no more: New guidelines call for fundamental shift in obesity treatment” (link here). What intrigued me to keep reading was a line that said that HCPs need to examine the root cause of obesity. Root cause? That is part of the Naturopathic oath! – to address the fundamental cause of disease. I thought it was a neat coincidence but, why did it take until now for it to be added into guidelines for HCPs? Was no one looking at the individual factors that can lead to weight gain and obesity? Of course, there are HCPs addressing the root cause already, these guidelines are meant to shift the general treatment from merely weight loss, to an individual plan that looks at goals beyond weight loss.

I was intrigued by this proposed shift to treating patients individually. What I was even more impressed about was that the authors of this article included a five-step system to helping patients. These steps are meant to serve as a framework to better help those living with obesity as they are following the WHOs (World Health Organization) definition of obesity as a complex chronic disease. This post will tackle the first proposed step in helping patients manage their weight. I should however mention that the authors of this article have proposed 80 different recommendations that they have broken down into 19 different chapters that are available on Obesity Canada’s website (link). I Have not extensively read the 19 chapters, and so these next six posts will be regarding the summary article and my analysis of the proposed 5 step arc guidelines.

Step 1: Asking Permission to talk about weight

This step is about removing assumptions and biases while empowering the patient and creating a healthy therapeutic relationship.

This step aims to remove assumptions by suggesting that HCPs first ask permission from the patient to talk to them about weight management. Instead of assuming that the overweight patient in their office wants to talk about their weight or that the patient is mentally and emotionally prepared to talk about their weight management, its adding in an extra step to gauge where the patient is at. Everyone has their own goals and having goals set by someone else when you are not ready to achieve those goals, means those goals will not be achieved. Goal setting is a collaborative activity. If someone living with obesity is not ready, the conversation should not proceed. If the HCP is just assuming that the patient is there to talk about weight or starts into the conversation about losing weight, the authors suggest that this will not begin a positive relationship required to help support someone through their chronic condition. The therapeutic relationship has been documented to be fundamental in providing care for patients with any condition and that the absence of a therapeutic relationship is detrimental to the patient’s progress.

What asking permission also does, is help the HCP deal with their own biases around obesity. The authors suggest that there exists intense stigma and biases toward people living with obesity – something I’m sad to say I’ve witnessed when with those I love who live with obesity. By using different tools to acknowledge their own bias, and then acknowledging that not everyone will see obesity as an issue, the HCP is in my opinion becoming more compassionate. If the HCP can understand that they may view those living with obesity as lazy or unmotivated or any number of generally negative descriptors, they can understand that these are simply not true and part of their bias, and therefore part of the stigma. Taking these steps help HCPs to recognize that judging a book by its cover may miss underlying medical conditions of mental health issues. They are recognizing that what they may have thought before, as the authors of the article suggest, may not be the reason someone is struggling and may also not be the reason someone does not want to talk about weight management yet.

Altogether, step one of asking permission is an empowering step and one that should help decrease bias. In empowering the patient to make their decision when they want to talk about the weight, it puts the patient in control of their health, something that can lead to a more positive experience, and down the road, potentially actually achieving goals. By recognizing bias and attempting to de-stigmatize the chronic illness of obesity, it is a step in the right direction for good patient management and hopefully the beginning of a good and healthy therapeutic relationship.

As we were taught in our health psychology class, the therapeutic relationship is the base for supporting patients to achieve their health goals, and so this makes sense as the foundational step. Over the next few posts I will walk through the other 5 steps and share with you my interpretation of them along with my own insight into why I believe these guidelines are a step in the right direct for supporting the chronic condition that is obesity.

AS always this not medical advice and is in no way meant to be the sole source of a guide. Do your own research and read the article for yourself to see what you think. If you have the time and are feeling brave, read all 19 chapters proposed and school me in something I missed!

As a take home activity, because stigma alone can contribute to increased mortality and morbidity, I encourage everyone to take a look at their own biases surrounding obesity because we can all lend a hand by acknowledging our own biases.

---

Sutin AR, Stephan Y, Terracciano A. Weight Discrimination and Risk of Mortality. Psychol Sci. 2015;26(11):1803-1811. doi:10.1177/0956797615601103