A new guideline aimed at treating obesity in Canada is recommending doctors evaluate the weight-related biases they may hold and to focus on outcomes a patient considers to be important, rather than weight loss alone.

The guideline, published Tuesday in the Canadian Medical Association Journal (CMAJ) in collaboration with Obesity Canada, is also moving away from a “diet and exercise” model and shifting focus onto the root causes of an individual’s weight.

“People with obesity experience weight bias and stigma, which contribute to increased complications and mortality, independent of weight or body mass index (BMI),” Dr. Sean Wharton, co-lead of the guideline and adjunct professor at McMaster University, Hamilton, Ontario, said in a statement.

“The first step to obesity management is to recognize your own bias. If you see people living with obesity as lacking willpower, or as noncompliant, then you likely have weight bias. Obesity needs to be managed with a focus on giving unbiased care to patients, showing compassion and empathy, and using evidence-based interventions with an emphasis on patient-centered outcomes.”


Recommendations from the guideline include:

1. Ask permission to discuss weight. Health care practitioners must recognize obesity as a chronic disease with stigma and should not assume all patients with obesity are prepared to address it.

2. Assess the patient’s story. Discuss the patient’s history to understand the root causes of obesity, combined with physical examination, calculation of BMI, and other investigations.

3. Advise on management. Discuss treatment options, such as nutrition and exercise, psychological interventions, medications to achieve and maintain weight loss, and bariatric surgery.

4. Agree on goals. Collaborate on a personalized, sustainable long-term action plan with realistic expectations.

5. Assist with barriers and drivers of weight gain. Barriers include lack of access to health care providers with expertise in obesity, lack of coverage of obesity medications by drug plans in Canada, and long wait times for bariatric surgery.



Studies have shown victims of weight bias are at risk of suffering from depression, anxiety, binge eating, or avoidance of health care.

While weight bias can be found in nearly all aspects of our society, its presence in the health care system may be among the most damaging.

Research has found it’s not uncommon for health-care providers to associate obesity with laziness or a lack of discipline, leading some to devote less time to treating obese patients.

This can lead to a feeling of embarrassment or shame, prompting some patients to avoid care. There is evidence some women living with obesity are less likely to seek recommended cancer screenings.


“Working with people to understand their context and culture, integrating their root causes, which include biology, genetics, social determinants of health, trauma and mental health issues, are essential to developing personalized plans,” Dr. David Lau, co-lead of the new guideline and a professor at the University of Calgary says.

“These plans can become part of a long-term therapeutic relationship with follow-up of obesity-related chronic diseases.”

Read more about the guideline here.