As there is very little education in any health discipline around obesity, the 2020 Canadian Obesity Guidelines chapter on assessment of people living with obesity is nothing short of a treasure trove for any healthcare provider looking for some guidance.
One of the key messages in this chapter is to suggest the use of the 5 As Of Obesity as a framework to discuss weight management – starting with the first A which is ASK. Ask permission to discuss weight with your patient before diving into a discussion around weight. This helps to avoid any defensive reactions that may be founded in years of feeling stigmatized by this health condition.
The chapter recommends using body mass index (BMI) and waist circumference in assessment of obesity – but reminds us that it is the health issues related to obesity, not the numbers on the scale, that actually matter. The Edmonton Obesity Staging System (see Table 3 in the chapter) is another way to stage obesity based on presence and severity of complications, to help guide decision making.
There is a great discussion around the importance of identifying root causes of weight gain, and health complications of weight gain, using the 4M’s (see Table 4 in the chapter):
- Mental health: sleep disturbance, mood/anxiety issues, addictions, attention deficit disorders; as well as assessing what the person’s expectations are in weight management, their knowledge about their condition, self image concerns and internalized weight bias
- Mechanical: osteoarthritis, gout, sleep apnea, heartburn, urinary incontinence, etc
- Metabolic: type 2 diabetes, high blood pressure, fatty liver, high cholesterol, cardiovascular disease, cancers, blood clots, polycystic ovary sydrome in women, low testosterone in men
- social Milieu: financial barriers to treatment, access to healthy food, disabilities
The chapter also discusses:
- key components of the physical examination of a person with overweight/obesity
- blood tests and other tests that should be done
- when should cardiovascular testing be done, and how?
- medications that can cause weight gain, and alternatives (see Table 8) – including diabetes medications, antidepressants, blood pressure medications, antipsychotic medications, antiseizure medications, steroids, antihistamines, etc) – note that this point is emphasized in several chapters of the Guidelines
NOTE: This blog is not intended to be a full synopsis of the chapter. There is a wealth of information in this chapter that is beyond the scope of one blog post. I encourage everyone to read the recommendations and key messages in full, and to dig in to the entire chapter!
Stay tuned for much more on the Obesity Guidelines in coming weeks!
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