The text... are paywalls now invoked automatically everywhere? In my day it was just asshole publications like the WSJ and The Times wouldn't even cop you a free first five.
Obesity is not defined by one’s weight or size, but by whether a person’s body fat impairs their health, according to new clinical guidelines for managing the condition.
The guidelines, developed by the Obesity Canada and the Canadian Association of Bariatric Physicians and Surgeons, describe obesity as a complex chronic disease, one that cannot simply be resolved by eating less and exercising more. And while obesity is traditionally defined as having a body mass index, or BMI, of 30 or more, the authors offer a new definition.
“It’s not about the amount of body fat, it’s not about where the body fat is. It’s not about the type of body fat,” said Arya Sharma, scientific director of Obesity Canada and one of the more than 60 authors. “It’s just a very, very simple question. And that is: Does this person’s body fat or excess body fat affect their health? If it does, we’ve got obesity. If it doesn’t, we just have a large person with a lot of body fat.”
The guidelines, summarized in a paper published in the Canadian Medical Association Journal on Tuesday, reflect a paradigm shift in approaching obesity, with a focus on improving patients’ health rather than merely on weight loss.
Traditionally, doctors and other health experts have regarded obesity as a risk factor for other health conditions, such as diabetes, cardiovascular disease and sleep apnea. While this still holds true, in recent years, a growing number experts have also come to recognize that obesity itself is a chronic disease, one that is caused by myriad genetic, metabolic, behavioural and environmental factors, Dr. Sharma explained.
“It’s not as simple as to say that people are getting fat because they’re eating junk food. No, it’s a lot more complex than that,” he said, explaining people’s bodies resist losing weight and regain it as soon as they quit adhering to any kind of diet or weight-loss strategy. “That’s what makes this a chronic condition. … You’re always going to be fighting this pretty much for the rest of your life.”
All of this has implications for how doctors should assess, treat and manage obesity, the authors said, drawing on more than 500,000 published peer-reviewed scientific articles.
Doctors should still measure patients’ weight, height, waist circumference and BMI as part of routine physical exams, they said, but noted physicians should dig deeper to identify the root causes of weight gain. They recommended taking additional measurements, such as blood pressure, fasting glucose and a lipid panel, as well as other exams and tests, depending on the doctors’ clinical judgment.
Adults with obesity should receive individualized care that makes sense for them over the long term, said Dr. Sharma, whose organization connects members of the public affected by obesity, researchers, health professionals and others with an interest in the health concern.
In addition to managing nutrition and physical activity, this can involve a combination of psychological and behavioural interventions, such as cognitive therapy, as well as medications and bariatric surgery.