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

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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

Intermittent Fasting – the new weight loss trend?

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Clock made of spoon and fork, isolated on white background

Fasting has been practiced for centuries around the world, typically for religious reasons. Now, intermittent fasting is becoming a trendy way to lose weight. But does it really work and should you try it?

There are a few variations of intermittent fasting:

Alternate day fasting was researched by Dr. Krista Varady who is an Associate Professor of Nutrition at the University of Illinois in Chicago. The idea is to alternate back and forth between eating about 500 calories one day and then eating a moderate high-fat diet the next day. In her research trials, she found that adults lost an average of 11 pounds in 12 weeks. Plus, the alternate day fasting lowered the participants’ levels of the “bad” LDL (Low Density Lipoprotein) cholesterol which helps to lower their overall risk for heart disease.

The 5:2 fasting diet is a modified version of the alternate day fasting diet. The general idea here, according to proponent Dr. Mark Mattson, is to eat no more than 500 calories on two non-consecutive days each week. On the other five days of the week, you can eat your usual diet. Mattson is a Professor of Neuroscience at the John Hopkins University. In his research, overweight and obese women who followed the 5:2 diet for six months lost just slightly more weight than women who were following a low calorie diet. Mattson is now exploring whether this diet can help improve brain health in seniors.

Time-restricted eating is another type of intermittent fasting where you only eat during a small window of time. This includes ideas such as a longer nighttime fast (for example, not eating from 7 pm to 6 am) or eating just one big meal a day instead of three typical meals. Animals who fast in these ways do lose weight, but there are hardly any scientific studies with people.

Here’s our advice:

1. Intermittent fasting is not easy. In fact, 10 to 20% of participants who try intermittent fasting find it too difficult and quickly stopped. Those who stick with the diets admit that it is very challenging for at least the first few weeks.
2. Intermittent fasting isn’t a miracle weight loss cure. The studies show that you can lose about the same amount of weight whether you fast intermittently or just cut back on calories every day.
3. Intermittent fasting is NOT for everyone. For example, if you are pregnant, underweight or have type 2 diabetes, then intermittent fasting is not suitable and can be dangerous for you.
4. The best “diet” is the one you can stick with for the rest of your life. Healthy eating is about enjoyment, not deprivation. If you’re interested in trying intermittent fasting, perhaps start with the least extreme option of extending your nighttime fast. Think of the motto “Done after dinner.” Eat your dinner and then skip any bedtime snack. Refuel with a good breakfast in the morning.
5. Talk to a registered dietitian for safe and expert advice on diets and weight loss.