The goal of obesity treatment is to reach and stay at a healthy weight or your Best Weight, which improves your overall health and lowers the risk of developing obesity related complications. This means that you may need to work with a team of health professionals who can assess your condition and offer recommendations to best suit your condition.
Medical Weight Management
Medical weight management programs provide treatment in a clinical setting with a licensed healthcare professional, such as a medical doctor, nurse practitioner, registered dietitian and/or a psychologist. Overall, the physician management of obesity may include:
- Behaviour Modifications
- Meal Replacement Plans
- Pharmacotherapy (weight-loss medications)
- Assessment and referral to bariatric surgery as necessary
Psychological and Behavioural Interventions
According to the Canadian Adult Obesity Clinical Practice Guidelines, “the main goal of psychological and behavioural interventions is to help people living with obesity make changes that are sustainable, that promote positive self-esteem and confidence, and that improve health, function and quality of life.”
Some behaviour change strategies include:
- Increasing physical activity
- Becoming educated on an eating pattern that supports your best health and can be maintained over time rather than a short-term diet
- Engaging in group support programs
- Setting realistic goals
Cognitive-behavioural strategies (CBT) can be effective in helping you regulate your eating, improve mood and give you a sense of being able to control your emotions. For some people this healthier mindset can drive a change in eating habits and exercise behaviour, resulting in better overall health.
Your healthcare team may add medications based on your health history, BMI and other chronic conditions related to obesity.
In Canada, three prescription medications are available for the treatment of overweight and obesity.
Contrave® (naltrexone and bupropion)
Contrave® is a tablet that is a combination of low doses of naltrexone that is used to manage alcohol and opioid dependency, and bupropion, an antidepressant also prescribed for smoking cessation. These medicines work on two separate areas of the brain that control eating (hunger and cravings). In Canada, it is approved for use (along with a reduced-calorie diet and increased physical activity) in adult patients with:
- A body mass index (BMI) of 30 kg/m2 or higher; or
- A BMI of 27 kg/m2 or above with the presence of at least one weight-related condition such as hypertension, type 2 diabetes or dyslipidemia (abnormal amounts of triglycerides, cholesterol or fat in the blood).
Saxenda® is a GLP-1 therapy that is similar to the natural GLP-1 found in your body, that affects appetite and food intake. Studies with Saxenda® have also shown that it may also improve other health factors like blood sugar, blood pressure and cholesterol levels. Saxenda® comes in a prefilled pen that you can use to self-inject.
In Canada, Saxenda® is indicated along with a reduced-calorie diet and increased physical activity for chronic weight management in adult patients with an initial body mass index (BMI) of:
- 30 kg/m2 or greater, or
- 27 kg/m2 or greater along with at least one weight-related comorbidity (e.g., hypertension, type 2 diabetes or dyslipidemia) and who have failed a previous weight management intervention.
Xenical® works by preventing enzymes called lipases from working and decreases the amount of fat your body absorbs from your food, which results in weight loss due to lesser calorie intake. Xenical® does not decrease or change your appetite. Studies have also shown that Xenical® may improve other health factors beyond such as waist circumference, blood sugar, blood pressure and cholesterol levels. Xenical® is a capsule taken during or just following each main meal.
Reference: Obesity Canada. Additional information is available on Prescription Medications in Canada
Bariatric surgery can be a safe and effective treatment option for obesity management as it impacts hunger and satiety, as well as the absorption of calories and nutrients from food. While it may be recognized as one of the treatment options for severe obesity, there are certain eligibility criteria that need to be taken into account to qualify an individual as it can pose certain risks and side effects.
Currently there are three bariatric surgical procedures that are offered in Canada.
Roux-en-Y (roo-en-wy) gastric bypass: This procedure is the most common method of gastric bypass. This surgery is typically not reversible and works by decreasing the amount of food you can eat at one sitting and reducing the absorption of nutrients.
The surgeon cuts across the top of the stomach, sealing it off from the rest of the stomach, then cuts the small intestine and sews part of it onto the pouch. Food goes into this small pouch of stomach and then directly into the small intestine sewn to it thus bypassing most of the stomach.
Sleeve gastrectomy: With sleeve gastrectomy, about 80% of the stomach is removed, leaving a long, tube-like pouch. This smaller stomach holds less food and also reduces the appetite-regulating hormone ghrelin, which may lessen your desire to eat.
Advantages to this procedure include significant weight loss and no rerouting of the intestines. Sleeve gastrectomy also requires a shorter hospital stay than most other procedures.
Adjustable Gastric Banding: This procedure involves placing an adjustable silicone band around the top portion of the stomach intended to reduce food consumption. This band can be tightened by adding saline and is connected to a port which is used to increase or reduce the amount of saline in the band. This slows the passage of food to the intestine creating satiety with less food consumption.
Most surgeons in Canada are not using this procedure due to unfavourable long term results.
Eligibility for bariatric surgery
Canadian Adult Obesity Clinical Practice Guidelines recommend that, “adults with clinically severe obesity (BMI ≥ 40 kg/m2 or ≥ 35 kg/m2 with severe comorbid disease) may be considered for bariatric surgery when behavioural and or pharmacological intervention is inadequate to achieve healthy weight goals. Eligibility criteria may vary from province to province. Most surgical programs require a referral from a primary care physician.”
The type of weight-loss surgery suitable for you depends on your specific situation. Your surgeon will take many factors into account, including body mass index, eating habits, other health issues, previous surgeries and the risks involved with each procedure. Overall lifestyle changes are key for maintaining a healthy quality of life after surgery.
Commercial Weight Management Programs
There are several commercial weight management and meal replacement programs available such as Weight Watchers (WW), Jenny Craig and Nutrisystem, as well as health coaches, diet books, over-the-counter (OTC) medications, body monitoring devices and support groups. There is usually a cost associated with these programs and they may promote specific foods or supplements.
While some of their claims may seem reasonable, many are unrealistic like losing 30lbs in 30 days. It is important to remember that not all methods and claims are reviewed by Health Canada, who ensure the safety and effectiveness of medical devices and prescription weight-loss medications, but not over the counter weight-loss products and supplements, natural products or commercial programs.
The Canadian Adult Obesity Clinical Practice Guidelines have established criteria that should be considered before committing to a commercial weight management program:
- Behavioural counselling, including the use of food and activity records;
- Discussion around social determinants of health and their impact on weight;
- Discussion around the risks and benefits of medications for obesity management;
- Ongoing feedback, monitoring, and support from the program;
- Weight loss goals of 0.5–1.0 kg weekly;
- A component specifically designed to address maintaining lost weight; and
- Long program durations.
People should be leery of weight loss programs that:
- Promise weight loss without diet or exercise;
- Promise weight loss while eating as much food as you want;
- Promise reduction of weight from particular locations on the body;
- Promise overly rapid loss (for example: losing 30 pounds in 30 days);
- Include before and after photos and personal endorsements that seem too good to be true.”
Additional information on: Commercial Products and Programs in Obesity Management
Obesity Matters encourages and supports people in larger bodies to be advocates for themselves and seek help as needed, arming them with knowledge to access evidence based treatments and referrals. Often when individuals book an appointment with their healthcare provider (HCP), other conditions take priority over weight management so it is important to plan ahead of the consultation.
Book an appointment specifically to discuss weight and be prepared with a list of questions and concerns. It is important for the HCP to know your story – family and medical history, duration of weight problems, pattern of weight gain, as well as behavioural triggers, previous weight loss interventions and medication side effects.
Other points of discussion with the HCP:
- Ask about the practitioners comfort in discussing obesity management, as they are often hesitant to bring up the topic fearing push back or the individual being in denial.
- Discuss your previous experiences discussing weight, especially if you had a negative experience where the practitioner was critical or stigmatizing in any way. It is important to use the right language when discussing obesity.
Have realistic expectations, and the first visit could just be an introduction to a program that is focused on health versus numbers on a scale. In the Best Weight concept, weight loss is more the side effect of the good and enjoyable lifestyle, so the focus from weight should be replaced by more energy, less knee pain, better self esteem, healthier relation to food and overall health.
The Clinic Locator compiled by My Weight What To Know is to help you find potential treatment and support centres in your area. The public plans are not always covered under some of these services, but the majority will be free at least partially paid for through provincial healthcare systems with a referral from your doctor when needed.