Obesity Management in Canada 2024

• Obesity self study for 2024 was prepared by Cydnee Seneviratne, Catherine Fox, Kaleigh McCartney, Shelley de Boer, and Twyla Ens.

Key Messages About Obesity in Canada

• Obesity is a chronic condition requiring realistic and sustainable treatment strategies.
• Obesity management is about improving health and well-being.
• Modest weight reductions can lead to significant improvements in health and well-being.
• Early intervention addresses root causes and removes roadblocks.
• Identify and address the "root" causes of weight gain, as well as barriers to weight management.
• Success is defined as better quality of life, self-esteem, higher energy levels, improved overall health, prevention of further weight gain, modest weight loss, or maintenance of a patient's “best” weight.
• A patient's “best” weight may never be an “ideal” weight.
• "Ideal" weight or BMI is not a realistic goal.

The 5 A's of Obesity Management for Adults

• The 5 A's of Obesity Management for Adults include Ask, Assess, Advise, Agree, and Assist.
• Ask: Obtain permission to discuss weight.
  • Be non-judgmental.
  • Explore readiness for change.
  • Use motivational interviewing to move patients along the stages of change.
• Assess: Assess obesity-related risks and potential "root causes" of weight gain.
  • Assess obesity class and stage.
  • Assess for obesity drivers, complications, and barriers (4 Ms: Mental, Mechanical, Metabolic, and Monetary).
• Advise: Provide advice on obesity risks, discuss benefits, and options.
  • Advise on obesity risks.
  • Explain benefits of modest weight loss.
  • Explain the need for a long-term strategy.
  • Advise on treatment options: sleep, time and stress, dietary interventions, physical activity, and psychological.
• Agree: Agree on realistic weight-loss expectations and on a SMART plan to achieve behavioural goals.
  • Agree on weight loss expectations of 0.5 to 1.0 kg per week for a total of 5-10% of initial weight.
  • Agree on sustainable behavioral goals and health outcomes: Specific, Measurable, Achievable, Rewarding, and Timely.
• Assist: Address drivers and barriers, offer education and resources, and refer to a provider.
  • Assist patients in identifying and addressing drivers and barriers, including environmental, socioeconomical, emotional, medical, medications such as antipsychotics, anti-diabetes, anti-convulsants, or any physical barriers.
  • Provide patient education and resources.

Treatment Options: Obesity and Pharmacological Therapy

• Medications are used as adjuncts to nutrition, physical activity, and behavior-modification therapies.
• Medications prescribed to patents with a BMI ≥ 27 kg/m² + existing co-morbidities or a BMI ≥ 30 kg/ m².
• Approved weight loss drugs decrease nutrient absorption (Xenical)
• Certain drugs decrease food intake by reducing appetite or they increase satiety.
• A nurse's role is to educate the patient about proper administration.

Treatment Options: Obesity and Surgical Options

• Surgery is the only treatments that can sustain weight loss for morbidly obese patients
• Patients must meet the criteria for a surgical option
• Restrictive Surgery reduces the size of the stomach or the amount that enters the stomach.
• Vertical banded gastroplasty
• Adjustable gastric banding
• Malabsorption Surgery bypasses various lengths of small intestine to reduce food absorbtion
• Biliopancreatic diversion
• Biliopancreatic diversion with duodenal switch
• Combination of Restrictive and Malabsorptive Surgery
• Roux-en-Y gastric bypass is the most performed

Bariatric Surgical Complication: Dumping Syndrome

• Gastric contents empty too rapidly into the small intestine.
• Patients will experience vomiting, nausea, weakness, sweating, faintness and diarrhea
• Patients are encouraged to refrain from eating sugary foods after surgery
• Poor absorption of iron can cause iron deficiency anemia requiring multivitamin supplements with iron and calcium or cobalamin injections

Bariatric Friendly Hospital Initiative in Alberta Health Services

• Approximately 29% of adult Albertans are living with obesity.
• Many health care providers do not understand the complex causes of obesity.
• A common misconception is that energy in must equal energy out.
• Weight bias is negative attitudes and views about obesity.
• Weight stigma refers to social stereotypes and misconceptions about obesity.
• Weight bias and stigma can lead to weight discrimination.
• Understand personal biases and knowledge about obesity.
• The Bariatric Friendly Hospital Initiative focuses on implementing standards and guidelines.
• There are 7 standards for a Bariatric Friendly Hospital.

Healthcare Professional Resources

• Resources include provided links for the Canadian Celiac Association, Canadian Digestive Health Foundation, Crohn's and Colitis Canada, Canadian Liver Foundation, and Obesity Canada.