498 Obesity in Canada: Key Concepts

Key Messages About Obesity in Canada

• Obesity is a chronic condition.
• Treatment strategies should be realistic and sustainable.
• Obesity management focuses on improving overall health and well-being, not just reducing numbers on a scale.
• Even modest weight reductions can lead to significant health improvements.
• Early intervention addresses the root causes of weight gain and removes any roadblocks.
• Identifying both the root causes of weight gain and barriers to weight management is essential.
• Success in obesity management is different for each individual.
• Success is defined as better quality of life, greater self-esteem, higher energy levels, improved overall health.
• Preventing further weight gain, modest (5%) weight loss, or maintenance of the patient's "best" weight are also indicators of success.
• A patient's “best” weight may not be the same as an “ideal” weight.
• An “ideal” weight or BMI is not a realistic goal, potentially setting patients up for failure.

The 5 A’s of Obesity Management for Adults

• The 5A's include ask, assess, advise, agree, and assist.

ASK

• Obtain permission to discuss the patient's weight.
• Be non-judgmental in your approach.
• Explore the patient's readiness for change.
• Use motivational interviewing to help patients move through the stages of change.

ASSESS

• Evaluate obesity-related risks and potential root causes of weight gain.
• Determine the patient’s obesity class and stage.
• Assess obesity drivers, potential complications, and barriers, including mental, mechanical, metabolic, and monetary factors (the 4Ms).

ADVISE

• Provides guidance on obesity risks, discussing benefits, and options.
• Advise on the risks associated with obesity.
• Explain benefits of even modest weight loss.
• There is a need for a long-term weight management strategy.
• Advise on available treatment options.
• Treatment options include sleep, time and stress management, dietary interventions, physical activity, and psychological support.
• Other treatment options include low-calorie diets, anti-obesity medications and bariatric surgery.

AGREE

• Agree on realistic weight-loss expectations and a SMART (Specific, Measurable, Achievable, Rewarding, Timely) plan to achieve behavioral goals.
• Agree on weight loss expectations of 0.5 to 1.0 kg per week, targeting a 5-10% reduction in initial weight.
• Agree on sustainable behavioral goals and health outcomes.
• Arrive at an agreed-upon treatment plan.

ASSIST

• Addressing drivers and barriers, providing education, and offering resources.
• Refer to specialists and arrange follow-up appointments.
• Assist patients in identifying and addressing environmental, socioeconomic, emotional, medical, and medication-related barriers.

Treatment Options: Obesity and Pharmacological Therapy

• Medications should be used in addition to nutrition, physical activity, and behavior modification.
• Pharmacological interventions are recommended for patients with a BMI of 27 kg/m² or greater and existing co-morbidities.
• Recommended for patients with a BMI of 30 kg/m² or greater.
• Drugs that are approved for weight loss decrease nutrient absorption (Xenical).
• Drugs approved decrease food intake by reducing appetite or increasing satiety.
• Drugs that increase energy expenditure are not approved.
• Nurses play a role in educating patients about proper medication administration.

Treatment Options: Obesity and Surgical Options

• Surgery is a treatment option for morbidly obese patients to sustain weight loss.
• Patients must meet the specific criteria for surgery.
• Restrictive surgeries reduce the size of the stomach or the amount of food entering it such as Vertical banded gastroplasty and Adjustable gastric banding.
• Malabsorption surgery involves bypassing specific lengths of the small intestine to reduce food absorption which includes Biliopancreatic diversion and Biliopancreatic diversion with duodenal switch.
• Combination of Restrictive and Malabsorptive Procedures are available.
• A Roux-en-Y gastric bypass is the most commonly performed bariatric procedure.

Bariatric Surgical Complication: Dumping Syndrome

• Gastric contents empty too rapidly into the small intestine, overwhelming its digestive capacity, resulting in dumping syndrome.
• Symptoms include vomiting, nausea, weakness, sweating, faintness, and diarrhea.
• Patients should be encouraged to avoid sugary foods after surgery to prevent this complication.
• Poor iron absorption from bypassing the small intestine can cause iron deficiency anemia.
• Multivitamin supplements with iron, calcium, or cobalamin injections may be necessary.

Bariatric Friendly Hospital Initiative in Alberta Health Services

• Approximately 29% of adult Albertans are living with obesity.
• Health care providers lack knowledge about how complex the nature and causes of obesity are.
• The primary misconception is that energy in must equal energy out; a person just needs to exercise or eat less.
• Weight bias involves negative attitudes toward obesity and those affected by it.
• Weight stigma includes social stereotypes and misconceptions about obesity.
• Weight bias and stigma contribute to weight discrimination.
• It is important health care providers understand their own bias and knowledge about obesity.
• Bariatric Friendly Hospital Initiative focuses on implementing standards and guidelines.
• There are 7 Standards for a Bariatric Friendly Hospital.

Healthcare Professional Resources

• Canadian Celiac Association: https://www.celiac.ca/
• Canadian Digestive Health Foundation: https://cdhf.ca/digestive-disorders/irritable-bowel-syndrome-ibs/
• Crohn’s and Colitis Canada: https://crohnsandcolitis.ca/
• Canadian Liver Foundation: https://www.liver.ca/
• Obesity Canada: https://obesitycanada.ca/