Recently, a group of doctors in Canada published new guidelines that suggested physicians should discontinue the use of body mass index as a diagnostic tool for assessing and treating obesity. They argue that doctors should look at the patient's overall health profile, as opposed to just weight alone.
In the United States, many governmental agencies have tried to tackle the obesity issue through proposed healthcare bills, national strategies and a variety of interventional programs. The problem only seems to worsen due to a variety of factors—primarily healthy inequity caused by socioeconomic, environmental and structural disparities. As it stands, the obesity rate for adults in America is now 40 percent, the highest it has ever been according to a report just released by the Trust for America’s Health. And COVID-19 is only exacerbating the problem.
However, the guidelines published in the Canadian Medical Association Journal could serve as a model for more effectively tackling obesity in our country. The recommendations aim to categorize obesity as a chronic illness that requires long-term care. They argue that obesity affects an individual’s overall physical and mental health, and while this may seem intuitive to some, we need to look further at what causes the problem and offer solutions.
In 1968, Dr. Kenneth Cooper, a former Air Force flight surgeon, introduced the term aerobics. At the time, it was a radical idea to perform cardiovascular exercise for extended periods of time. While his concept took time to be accepted and adopted, evidence confirmed the value of physical exercise for producing beneficial changes in the respiratory and circulatory systems. Modest increases in oxygen uptake through activities such as jogging and walking were associated with positive lifestyle changes and significant reductions in preventable disease.
As Dr. Cooper developed guidelines for aerobics, he also had the foresight to consider the whole person. He recognized that physical fitness alone would not change a person. It required eating a healthy diet, managing body weight, recognizing which diseases are preventable and controlling stress. Cooper ultimately had the wisdom to see that adopting healthier lifestyles would drive down healthcare costs not only for individual patients, but also for populations as a whole.
The guidelines published by the physicians in Canada take a similar approach. They are aiming to eliminate the stigma of obesity and focus on the individual to treat each patient as a whole person and meet their unique needs. It’s a patient-centered approach.
This approach places a premium on the relationship between the doctor and patient. It requires a physician’s ability to supplement evidence-based treatment with comprehensive, quality care. In addition, all aspects of the patient are taken into consideration—physical, emotional and spiritual. This is incredibly important as we address obesity as a chronic illness and long-term care issue.
I have spent my career at the intersections of healthcare, public health and exercise science thinking about the wide range of options for individuals who suffer from obesity. We have looked at the obesity problem from many different angles—employer wellness, local communities, menu labeling, etc.—and there is no silver bullet. We must work collaboratively, beginning in the doctor’s office, to treat people in a new way if we ever hope to effectively support and help individuals impacted by obesity as well as improve population health on a larger scale.