Tuesday, May 22, 2012

Core Principles of Obesity Management

Today sees the launch of the Canadian Obesity Network’s 5As of Obesity Management™, a step-by-step framework for the management of obesity in primary care.

The framework is based on five core principles (different from the 5As) that emerged from extensive consultation with patients, primary care providers and obesity experts – a process that involved numerous interviews, focus groups and surveys, spanning the past two years. In addition, the principles and messages were crafted and tested with primary care providers at conferences and workshops across Canada.

The following is a summary of the core principles, that emerged from these efforts and together provide a significant departure from traditional (‘all excess weight is bad’ and ‘eat-less-move-more’) approaches to weight management:

Obesity is a Chronic Condition: Obesity is a chronic and often progressive condition not unlike diabetes or hypertension. Successful obesity management requires realistic and sustainable treatment strategies. Short-term “quick-fix” solutions focusing on maximizing weight loss are generally unsustainable and therefore associated with high rates of weight regain.

Obesity Management is About Improving Health and Well-being, and not Simply Reducing Numbers on the Scale: The success of obesity management should be measured in improvements in health and well-being rather than in the amount of weight lost. For many patients, even modest reductions in body weight can lead to significant improvements in health and well-being.

Early Intervention Means Addressing Root Causes and Removing Roadblocks: Successful obesity management requires identifying and addressing both the ‘root causes’ of weight gain as well as the barriers to weight management. Weight gain may result from a reduction in metabolic rate, overeating, or reduced physical activity secondary to biological, psychological or socioeconomic factors. Many of these factors also pose significant barriers to weight management.

Success is Different for Every Individual: Patients vary considerably in their readiness and capacity for weight management. ‘Success’ can be defined as better quality-of-life, greater self-esteem, higher energy levels, improved overall health, prevention of further weight gain, modest (5%) weight loss, or maintenance of the patient’s ‘best’ weight.

A Patient’s ‘Best’ Weight May Never be an ‘Ideal’ Weight: An ‘ideal’ weight or BMI is not a realistic goal for many patients with obesity, and setting unachievable targets simply sets up patients for failure. Instead, help patients set weight targets based on the ‘best’ weight they can sustain while still enjoying their life and reaping the beneits of improved health.

Based on these core principles, the 5As of Obesity Management™, take the provider through a sequence of Ask, Assess, Advise, Agree, and Assist, to ensure sensitive, realistic, measurable and sustainable obesity management strategies that focus on improving health and well-being rather than simply moving numbers on a scale.

The 5As of Obesity Management™ tool kit can be downloaded or ordered by clicking here.

All proceeds from the sales of these materials go to support the Canadian Obesity Network.

AMS
New York, NY

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3 Responses to “Core Principles of Obesity Management”

  1. DebraSY says:

    This is much better than past approaches! I do, however, feel uncomfortable with your colleague in the video calling obesity (singular) a “chronic disease.” Some obesities may qualify for that moniker, but I think you are more on target above when you use the word “condition.” It isn’t a disease state for many people, and calling it such creates confusion and a default impulse to treat agressively that you’re trying to avoid.

    Another thing that makes me uncomfortable in the video is the absence in the “causes” section of “genetics.” If someone has a genetic strike against them, that should weigh heavily in treatment recommendations.

    In your words in the copy above, the sentence that makes me uncomfortable is this: “For many patients, even modest reductions in body weight can lead to significant improvements in health and well-being.” I would word it: “In many patients, changes in behavior can lead to significant improvements in health and well-being, and may sometimes include modest, sustainable reductions in body weight.”

    Two-cents worth. Thanks.

  2. MichelleHy says:

    I don’t consider myself unhealthy or as having a disease. It prefer to call it a condition or even perhaps a syndrome. The actual weight is just one part of the entire “syndrome”. Losing the weight will certainly help the complications of obesity but you are not cured. Some treatments are better than others.
    I believe the “weight wise” model is cutting edge and as a client almost through the program I have not lost weight nor have I gained any new weight, but I have learned much about managing my condition. I am much healthier than I was 18 months ago even at the same weight.

    Understanding the complexities of the “syndrome” really helps to look at the whole body. It is the holistic approach that is giving this program its success.

    The program is constantly changing and evolving. The only thing (personally) I would add is an endocrinologist to the list of clinicians. Diabetes and menopause and ageing has directly impacted my care. I believe having a dedicated endocrinologist would benefit clients.

    Thanks (my first post)

  3. Lucy A. says:

    I am much on the same line of thinking as MichelleHy when it comes to the weight wise modules. They helped me retrain my thinking an portion size and eating time–by following there council I have been able to shed 17 % of the extra weight that I had and get my cholesterol levels to normal. Even though I am healthier I am fully aware of the rate of weight lose relapse, and post surgery non-weight lose. The 27 months since I started Module one have been the most physically healthy time of my life–the mental health issues that caused me to start gaining weight has proved challenging. however, this should not be called a relapse with the depression because I am well trained to keep on top of what is going on with my selftalk: A good benefit from being in group theropy for so long.

    A good idea would be to send to persons being refered to surgery is that a letter be sent out, that out lines the other medical conditions that can really contribute to weight gain. Letting patients see if any of these conditions are a problem for the patient and to fully educate him or her on other medical conditions that can be treated to aid in healthy weight management. If the patient be empowered to find issues that can speed up time use in the weight wise clinic

    The singular versus plural picture of weight gain obesity is an interesting issue becuase what makes me gain weight is different to what the other person has the causes weight gain.

    Please note there are times that the journaling is something that I find at times to be a real chore.

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