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Body Weight Words Matter! Reflecting on the New Canadian Adult Obesity Clinical Practice Guidelines

For most people their body weight is a personal issue. However people living in larger bodies face hurtful stigma including language surrounding obesity and overweight.  Developed by Obesity Canada and the Canadian Association of Bariatric Physicians and Surgeons, the new Canadian Adult Obesity Clinical Practice Guidelines represent the first comprehensive update in Canadian obesity guidelines since 2007.[1]

Decades of research in behavioral and nutrition science suggest that it’s time to update our clinical approach and recognize that some patterns of communication about body weight are more helpful than others. Registered dietitians are deeply involved in this discussion and here are some of the topline messages from leading experts that stood out to us:

  1. Body Mass Index (BMI) is NOT an accurate tool for identifying obesity related complications [2]
    BMI is a widely used tool for screening and classifying body weight but it’s been controversial for decades.  A person’s BMI number is generated by considering their height in relation to their weight and it tells us about the size of the person’s body.  Experts now agree that more information than BMI is needed to determine whether a person is sick or healthy.
  2. Patient-centered, weight-inclusive care focuses on health outcomes rather than weight loss 1,2
    Remember to ask permission before discussing body weight and respect the person’s answer. Health issues are measured by lab data and clinical signs. These can include blood pressure, blood sugar or reduced mobility. Shift the focus toward addressing impairments to health rather than weight loss alone.
  3. Obesity is NOT simply a matter of self-control and the ‘eat less, move more’ advice is insufficient1
    The effects of a dieting lifestyle are burdensome. Evidence-based advice must move beyond simplistic approaches of ‘eat less and move more’. For example, in recent years researchers gained a better understanding of clinical evidence and body weight biology. These include the amount of food energy absorbed through the gut, the brain’s role in appetite regulation and the thermic effect of eating.[3] Environmental factors such as where people live, work and food availably also have an influence on body weight.
  4. People of higher weights should have access to evidence informed interventions, including medical nutrition therapy
    There is a lot of misinformation about body weight so evidence-based health management is key. One of the recommended interventions is to include personalized counselling by a registered dietitian with a focus on healthy food choices and evidence-based nutrition therapy.
  5. Recognize and address weight bias and stigma
    People with excess body weight experience weight bias and stigma. Weight bias is defined as negative weight–related attitudes, beliefs and judgements toward people who are of higher weight. This thinking can result in stigma which is acting on weight-based beliefs such as teasing, bullying, macroaggressions, social rejection and discrimination towards people living in larger bodies. People may also internalize weight stigma and criticize themselves or others based on body weight.
    Experts consider that changes to language can alleviate the stigma of obesity within the health-care system and support improved outcomes for both people living in a larger body and for the health-care system. 3,[4],[5],[6]

In our Body Weight Words Matter! chart below we provide several examples of communication interventions to help assess your attitude and reduce body weight bias. Body Weight Words Matter INFOGRAPHIC N4N (Click here to download your copy of the PDF Body Weight Words Matter INFOGRAPHIC N4NN ) Body Weight Words Matter

References:

[1] Obesity Canada (2020) Canadian Adult Obesity Clinical Practice Guidelines (CPGs) https://obesitycanada.ca/guidelines/

[2] Obesity Canada (2020) CMAJ Obesity in adults: a clinical practice guideline https://www.cmaj.ca/content/cmaj/192/31/E875.full.pdf

[3]   Rubino et al. (2020) Joint international consensus statement for ending stigma of obesity. Nature Medicine  www.nature.com/medicine

[4] Obesity UK (2020) Language Matters: Obesity https://cdn.easo.org/wp-content/uploads/2020/07/31073423/Obesity-Language-Matters-_FINAL.pdf

[5] Puhl, R. et.al (2016) Cross-national perspectives about weight-based bullying in youth: nature, extent and remedies. Pediatric Obesity,

[6] Puhl R., Peterson J. L., Luedicke J. (2013). Motivating or stigmatizing? Public perceptions of weight-related language used by health providers. Int. J. Obes.  https://www.nature.com/articles/ijo2012110

How to Prevent Cancer – The Latest Recommendations from the Experts

2018 06 - cancer prevention recos

Just last month, the World Cancer Research Fund (WCRF) and the American Institute for Cancer Research (AICR) released their Third Expert Report Diet, Nutrition, Physical Activity and Cancer: A Global Perspective. This new report builds on the information from the two previous reports in 1997 and 2007, and brings together the very latest research, findings and cancer prevention recommendations from an Expert Panel. Here are the 10 recommendations which promote an overall healthy lifestyle and holistic way of life, including healthy patterns of diet and physical activity.

1. Be a healthy weight. Maintaining a healthy weight (as measured by Body Mass Index and Waist Circumference) throughout life is one of the most important ways to protect against cancer. Excess body weight is associated with over a dozen types of cancer.

2. Be physically active. There is strong evidence that physical activity protects against cancers of the colon, breast and endometrium. Be physically active as part of everyday life. The Expert Panel recommends walking more and sitting less.

3. Eat wholegrains, vegetables, fruit and beans. Make these foods a usual part of your daily diet. Aim for at least 30 grams of fibre every day from food. Eat a diet high in all types of plant foods including at least five servings of a variety of non-starchy vegetables and fruit every day.

4. Limit consumption of ‘fast foods’ and other processed foods high in fat, starches or sugars (such as pre-prepared dishes, snacks, bakery foods, desserts and candy). Limiting these foods helps control calorie intake and maintain a healthy weight.

5. Limit consumption of red meat and processed meat. There is strong evidence that consumption of red meat and processed meat are both causes of colorectal cancer. The Expert Panel notes that this recommendation does not mean that you have to completely avoid eating meat. However, if you do eat red meat, limit consumption to no more than about three portions per week (a maximum of about 350 to 500 grams or 12-18 ounces of cooked red meat, or about 700-750 grams of uncooked red meat). Eat very little, if any, processed meat.

6. Limit consumption of sugar sweetened drinks. For hydration, drink mostly water and unsweetened drinks such as tea or coffee without added sugar. When it comes to fruit juice, the Expert Panel advises to not drink fruit juice in large amounts.

7. Limit alcohol consumption. For cancer prevention, it’s best not to drink alcohol. If you do drink alcohol, don’t exceed the national guidelines.

8. Rely on diet rather than supplements. For most people, consuming the right foods and drinks is more likely to prevent cancer than taking supplements.

9. Breastfeed your baby. For mothers, breastfeed your baby if you can. Breastfeeding is good for both mother and baby – it helps protect the mother from breast cancer, and it protects children against excess weight gain, overweight and obesity.

10. Cancer survivors. Whether you’ve just been diagnosed or are going through treatment, get nutritional care and guidance on physical activity from trained professionals. If you can, follow the Cancer Prevention Recommendations as far as possible unless otherwise advised by your health care professional.

Click here to read the complete report.