BC’s Northern Health Takes an Enlightened Position on Obesity

British Columbia’s Northern Health authority has released one of the most balanced and enlightened public health position document on obesity that I have yet seen from any public agency.

Moving well beyond the populistic, but simplistic, stereotype-promoting focus on shaming, blaming, banning, taxing and other ‘negative’ responses to the obesity epidemic, this document takes an almost post-modern position on obesity prevention and control that could (and probably should) serve as a Northern ‘light’ to other agencies.

Just to quote some of the far-reaching statements that one certainly does not often read in such documents on obesity (hold your breath – here they come):

• Health can occur at a variety of sizes.

  • Support the development and maintenance of eating competence across the life cycle.
  • Promote enjoyable, active lives and support building lifestyles that integrate active transportation, active play and active family time.
  • Support the achievement of positive body image for all.
  • Support the message that healthy bodies exist in a diversity of shapes and sizes.

• Weight is not a complete and inclusive measure of health.

  • Support a health-promoting approach; prioritize reducing risk factors and weight-related complications.
  • Support optimal growth and development of children and youth.
  • In children and youth, support longitudinal growth monitoring as part of primary care. Weight divergence, particularly weight acceleration (rather than an absolute weight or percentile), requires further investigation.
  • Promote that all sizes are accepted and treated with respect.
  • Support that weight bias is a bullying issue; it may be overcome using awareness, education and other supportive measures.
  • Promote a do no harm approach in measures to support health at all sizes to prevent increases in negative body image, disordered eating and disordered activity.

• Obesity should be prevented, treated and managed using a do no harm approach.

  • Support and promote healthy eating: make the healthy eating choice the easy choice.
  • Support and promote active lifestyles: make the active choice the easy choice.
  • Support drawing attention to obesogenic environments where we live, work, learn, play and are cared for.
  • Support a graduated approach to healthy lifestyles; encourage actions toward improved health and well-being at all weights.
  • Support and promote the use of the Edmonton Obesity Staging System as a medical approach to manage obese patients.
  • Promote success as improved health and stabilized weight with attention to competent eating, active living and positive body image.
Management Principles
  • Focus on improving health and achieving best weight.
  • Obesity prevention is easier than management.
  • Employ a do-no-harm approach (to avoid increasing disordered eating/activity).
  • Address weight bias.
  • BMI is a screening tool to be used cautiously.

Needless to say, I am delighted to see the themes commonly found in many of my posts (including ‘best weight’, the ‘Edmonton Obesity Staging System’, the limitations of BMI, the multifactorial nature of obesity, etc.) reflected in this policy document.

In fact, it may well be that this document sets a new ‘record’ for the speed with which some of these concepts have found themselves reflected in a policy document. Thus, for example, the ‘definitive’ studies on the Edmonton Obesity Staging System, published in the CMAJ and APNM, are barely 12 months old – definitely a “research-to-policy” time record as far as I am aware.

But please read the summary or the entire position statement for yourself – I certainly appreciate your comments.

I am sure the folks at Northern Health would likewise welcome your feedback.

Toronto, Ontario