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The 4Ms of Obesity Assessment and Management

Regular readers will recall previous posts on the importance of assessing the 4Ms in order to understand the drivers and consequences of obesity and to come up with a realistic, feasible and sustainable management plan.

The 4Ms stand for the domains of Mental, Mechanical, Metabolic and Monetary health of each individual patient.

At the recent National Obesity Summit, I was asked by Paul Boisvert (Laval) to explain the 4Ms. This video is posted here (e-mail subscribers will have to visit to view).

Very much appreciate any and all comments.

Edmonton, Alberta

p.s. for more videos and interviews from the Obesity Summit visit the Chaire sur l’obésité channel on YouTube.

Sharma AM (2010). M, M, M & M: a mnemonic for assessing obesity. Obesity reviews : an official journal of the International Association for the Study of Obesity, 11 (11), 808-9 PMID: 21182728


  1. I am on my seventh year of successfully addressing the 4M’s (I didn’t know what is was called when you started me down this path). Each one is equally important and if I slip up on not taking care of one of them the weight comes back. With some patience, understanding and help from my doctor I have been able to find the combination that works for me.
    BTW, I like the mustache and beard.

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  2. As a obese person who works in the medical field. I am very happy to understand the 4 m’s. If my doctor isnt going to look into them. I know now what to ask about!! This really needs to be sent to all GP’s!!

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  3. That was so useful! Money is probably the most often mentioned ‘issue’ by my clients, however it can be a bit difficult to talk about. Now I will consider all four points with my clients rather than just working on the foods. Thank you for this reminder. And I agree with Brian….use your new look on your blog!!!

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  4. @Brian: “I didn’t know what is was called when you started me down this path”

    Guess what, Brian, I didn’t know what to call it either – I finally came up with the 4Ms to describe what I was doing in order to teach this to my staff and students – glad you’re doing great – can’t believe it’s been 7 years already!

    @Karina: “This really needs to be sent to all GP’s!!”

    Be my guest – post and repost – send to all your friends and they can send it to their friends and docs and whoever else cares – the more the merrier!

    @Mahri: “Money is probably the most often mentioned ‘issue’ by my clients, however it can be a bit difficult to talk about”

    I can’t solve my patient’s money problems either but at least I can focus on treatment strategies that they can afford and perhaps help them avoid wasting their scarce resources on stuff that doesn’t work. Remember, with a lot of commercial programs and products (especially the more expensive ones) – the only permanent weight loss is from your wallet.

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  5. It’s amazing how money ceases to be an issue when you don’t think of your weight as something that requires expensive “treatments,” how your mental health is improved when you’re not trying to micromanage your food intake and exercise as if you were a machine, and how your mechanical and metabolic health can be managed with gentle movement and mindful eating – even if your weight remains unchanged.

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  6. This is a useful framework. I like the directness of saying “Money” — no pussy-footing around. It’s a critical factor. And the commercial diet industry is all too happy to exploit whatever they may gouge out of people.

    I like that you address Mental Health by advocating treating issues separate from weight, and respecting the issues in a dispassionate way — ADD makes following recipes and complex food prep difficult, depression can preclude the energy required for exercise, etc. This is very different from current pop psychology that encourages tying psychology to weight — Jillian Michaels telling her wards that they MUST deal with whatever deep-seeded psychological issue has obviously possessed them to “hide” themselves in layers of fat, and other nonsense that only complicates a person’s understanding.

    Likewise, mechanical issues must be addressed to facilitate health and weight management (regardless of weight-loss). To exercise properly, for example, one needs working joints. Sadly, many medical providers withhold medical treatments from people until AFTER they “lose weight.” This is cruel and self-defeating.

    The one time I cringed during your talk was when you were talking about medical issues — PCOS, Diabetes, etc. — and you casually said they are often the consequence of excess weight. They are, indeed, associated with excess weight, but the direction of the causation arrow has not been determined. Moreover, there may be one or more outside factors that cause both a medical condition such as diabetes and excess weight. When we indicate that people get diabetes because they got fat, we start the judgment and discrimination wheel spinning.

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  7. Thank you for bringing light and enlightenment to thi subject. Could you share where the. Leading Info on binge eating?

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