Teachers & Obesity: New Clinical Practice Guidelines

As the school year approached in August, teachers, and those of us who support teacher wellness, were firmly focused on COVID-19 and the upcoming school year. And, rightly so. No one knew what was to come, and it seemed as though things were changing by the hour. However, buried in the non-stop health information that was coming at us before the start of the new school year was the fact that the Canadian obesity guidelines had been updated for the first time since 2007. While we don’t know exactly how many Canadian teachers are affected by obesity, we do know that approximately 26.4% (8.3 million) of Canadians over the age of 18 are classified as “obese” (Twells, Janssen, & Luk, 2018). And, if this proportion translates directly to the Canadian teacher population, we could estimate that roughly 202,849 teachers across Canada are struggling with obesity – a not insignificant number. 

Which is why these new guidelines are so important – they impact so many of us, Canadians and teachers alike. More significantly thought, is that these new guidelines represent what is likely the most extensive review of obesity-related evidence ever conducted. According to Obesity Canada (2020), the “Developed by Obesity Canada and the Canadian Association of Bariatric Physicians and Surgeons, the new CPGs were authored by more than 60 Canadian health professionals, researchers and individuals living with obesity. Together, they assessed well over 500,000 published peer-reviewed articles and built consensus on a wide range of clinical and scientific issues to identify 80 key recommendations.” A summary of these recommendations is published in the Canadian Medical Association Journal (Wharton et. al., August 04, 2020), which identifies the key points as:

• Obesity is a prevalent, complex, progressive and relapsing chronic disease, characterized by abnormal or excessive body fat (adiposity), that impairs health.
• People living with obesity face substantial bias and stigma, which contribute to increased morbidity and mortality independent of weight or body mass index.
• This guideline update reflects substantial advances in the epidemiology, determinants, pathophysiology, assessment, prevention and treatment of obesity, and shifts the focus of obesity management toward improving patient-centered health outcomes, rather than weight loss alone.
• Obesity care should be based on evidence-based principles of chronic disease management, must validate patients’ lived experiences, move beyond simplistic approaches of “eat less, move more,” and address the root drivers of obesity.
• People living with obesity should have access to evidence-informed interventions, including medical nutrition therapy, physical activity, psychological interventions, pharmacotherapy and surgery.

There are a couple of things that really stand out when it comes to looking at these new guidelines. The first is the movement away from the overly simplistic “eat less, move more” approach, towards addressing the root drivers of obesity. There is a much larger focus on the complexities of obesity and respective outcomes. And the new guidelines address the more global behavioural and psychological aspects of obesity, which is so vital. The key messages here are:

• All obesity management interventions involve behaviour on the part of the individual living with obesity (e.g., eating, activity, medication adherence, etc.), so behavioural change supports should be incorporated into all obesity management plans. This requires a shift in the patient-provider relationship from the provider as the expert (teach and tell) to that of the collaborator, sensitive to the psychology of the person.
• Obesity management interventions should be evaluated based on how sustainable the behavioural components of the intervention are for the individual. Obesity management plans that are sustainable for the individual should be prioritized over clinician- or program-led management plans.
• Individuals living with obesity should be encouraged to build self-esteem and self-efficacy (confidence to overcome barriers to the desired behaviour), based on results that are achievable from behavioural efforts and not on idealized ideas of body weight.
• Nutrition, medical adherence, and physical activities are outcomes of psychological and behavioural interventions and not interventions in themselves. Behaviour change strategies underlying dietary, medical and activity programs should be identified (i.e., what are the change strategies by which sustainable changes to eating, medical adherence and activity are achieved?)

The second point that really stands out is the guidelines lay out, for clinicians and health care professionals, what the patient journey should look like in obesity management. It is absolutely shocking the stories we hear from teachers about how they have been treated by their physicians and allied health professionals, when it comes to obesity. These are the people teachers go to for help, only to be treated at times with blame, as non-compliant, and lazy. The guidelines start with what we would think would be a common-sense approach to obesity management – asking permission, treating people with dignity, and treating the whole person, with collaboration and agreed upon goals. 

Despite the fact that now more than half the adult Canadian population (60%) presents with increased health risks due to excess weight, stigma and discrimination still exists around obesity. Teachers experience this, too. We often hear from our teachers that they’re landed in a cycle of frustration and shame because they are so busy and overwhelmed with their jobs that it feels almost impossible to make the changes necessary to address the barriers affecting their physical wellness. It is my hope that these new guidelines will at least make it easier for teachers to address their concerns with their medical supports and have the wholeness of their lives and wellness considered when making a longer-term plan for obesity management. For you readers, I don’t think you necessarily need to read all 19 chapters of the new guidelines, but if obesity is something that concerns you, I strongly recommend a review of the CMAJ article. It’s reassuring to see Canada leading the way in this necessary change with regards to improving evidence-based and humanistic weight and obesity health care supports.  

References

Wharton, S., Lau, D., Vallis, M. Sharma, A., Biertho, L., et. al. (August 04, 2020) Obesity in adults: a clinical practice guideline. CMAJ, 192 (31) E875-E891, DOI: https://doi.org/10.1503/cmaj.191707 

Statistics Canada (2018) Overweight and obese adults, 2018. Health Facts Sheets, 82-625-X. URL: https://www150.statcan.gc.ca/n1/en/pub/82-625-x/2019001/article/00005-eng.pdf?st=YJjFAeWD

Twells LK, Janssen I, Kuk JL. (2018) Canadian Adult Obesity Clinical Practice Guidelines: Epidemiology of Adult Obesity. URL: https://obesitycanada.ca/guidelines/epidemiology.

Obesity Canada (2020) Adult Obesity Guidelines Webinar Series – Part 2. URL: https://obesitycanada.ca/cpg/webinar-series-adult-obesity-guidelines-whats-new-part-2/

Additional Resources:

Obesity Canada (2020) www.obesitycanada.ca