Size Doesn’t Matter When It Comes to Health

As obesity rates continue rising in Canada, new guidelines call for a more compassionate and nuanced approach to its management.


Over the past 30 years, the prevalence of obesity in Canada has tripled. Severe obesity has rocketed even further, now affecting more than 1.9 million Canadians.

Despite these numbers, and the associated costs, obesity is poorly managed in our current health system. To make matters worse, weight bias and stigma can prevent people from getting the healthcare they need. But landmark guidelines could change that by switching the focus from weight to health.

Authored by more than 60 Canadian health professionals, researchers and individuals living with obesity, the advice is the first major update in Canadian obesity guidelines since 2007.

Published by Obesity Canada and the Canadian Association of Bariatric Physicians and Surgeons, the report draws on evidence from over 500,000 peer-reviewed articles. The result is a set of 80 key recommendations that encourage a more compassionate and comprehensive approach to obesity management.

The first major change is the description of obesity. Rather than weight or size, the guidance focuses on whether a person’s body fat negatively impacts their health.

“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,” Dr. Arya Sharma, scientific director of Obesity Canada told the Globe and Mail. “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 authors highlight that obesity is a complex chronic disease that can’t be fixed by simply eating less and exercising more. They also recognize that misplaced assumptions about personal responsibility and willpower can affect the quality of care provided.

“Historically, we have told people whose weight affects their health merely to eat less and move more, which on its own is ineffective and even dangerously simplistic advice,” explains Sharma, who is also a professor at the University of Alberta.

To combat this the report challenges care providers to dig deeper to understand the context and culture behind weight gain. By recognizing and addressing factors such as genetics, trauma, mental health and environment, clinicians can offer tailored care that is more successful long term.

Part of this individualized care means focusing on outcomes that are important to the patient. That might mean switching weight loss for goals like playing tag with the kids or walking the dog. To reach these goals, the authors recommend expanding treatment options to include cognitive behavioural therapy, medication or bariatric surgery alongside nutrition and physical activity.

“There’s this idea that if you’re using medication or using surgery, then you’re somehow cheating,” says Sharma. A thought that would never occur if you needed medication for diabetes or a heart condition.

While focusing on patient needs over numbers is not new in other areas of medicine, it’s a big step in obesity care. This guidance acknowledges obesity as a complex chronic disease rather than a lifestyle problem, and should help thousands of Canadians get the compassionate care they deserve.

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Amy Noise is a science communicator who is fascinated by how and why the world works. Always learning, she is passionate about science and sharing it with the world to improve and protect our health, society and environment. Amy earned her BSc (biology and science communication) at the University of Manchester, and MSc (nutrition science and policy) at King’s College London, UK. She tweets sporadically @any_noise