New Canadian Adult Obesity Clinical Practice Guidelines & Medical Nutrition Therapy
What are some changes and key messages?
New Canadian Adult Obesity Clinical Practice Guidelines were released in 2020, replacing the previous guidelines from 2006. Some key changes from 2006 is the declaration of obesity as a chronic disease, with the new guidelines using the following obesity definition, “a complex chronic disease in which abnormal or excess body fat (adiposity) impairs health, increases the risk of long-term medical complications and reduces lifespan.”
The guidelines explain how obesity is no longer viewed as a lifestyle choice and simplistic messages about ‘eat less, move more’ need to stop as everyone, irrespective of body size or health need to eat a well-balanced healthy diet that includes physical activity. The authors explain that weight regulation is highly complex and there are many factors that contribute to obesity; with many of these factors beyond an individual’s control.
Body Mass Index (BMI) should no longer be used at the individual level to diagnose obesity. A key message expressed is it’s important to recognize your health is not a number on a scale. The new guidelines have moved away from a focus on weight numbers, to focus on a comprehensive medical assessment and involving health-based outcomes for chronic disease risk reduction and quality of life (QoL) improvements using evidence-based nutrition interventions.
One of the key messages for people living with obesity is that there is no one-size-fits all healthy eating pattern. It is important to choose an eating pattern that supports your best health and can be maintained over time rather than opting for a short-term “diet”. A further key message is “dieting” or severely restricting the amount you eat may cause changes to your body that can lead to weight regain over time.
Nutrition interventions
The new guidelines outlined several different nutrition intervention options and the advantages for weight loss and maintenance along with benefits for cardiometabolic outcomes, including glycemic control, hypertension, lipid profile and cardiovascular risk.
In this blog, I will highlight the Mediterranean dietary pattern and the Dietary Approaches to Stop Hypertension (DASH) dietary patterns which are just two of the many nutrition interventions reviewed in the new guidelines.
What is the Mediterranean dietary pattern?
A Mediterranean dietary pattern is a plant-based diet that emphasizes a high intake of extra virgin olive oil, fruit and vegetables, whole grains, nuts and pulses; a moderate intake of wine, fish and dairy; and a low intake of red meats.
What are the benefits?
Research has shown the Mediterranean dietary pattern to reduce cardiovascular events, as well as reduce risk of type 2 diabetes and has shown an increased reversion of metabolic syndrome, with little effect on body weight and waist circumference.
In people with type 2 diabetes, the Mediterranean dietary pattern has shown weight loss and improvements in glycemic control and blood lipids compared with other dietary patterns.
What is the Dietary Approaches to Stop Hypertension (DASH) dietary pattern?
The DASH dietary pattern includes a high intake of fruit, low-fat dairy, vegetables, grains, nuts, and dietary pulses and a low intake of red meat, processed meat, and sweets.
What are the benefits?
Research has shown the DASH dietary pattern to improve blood pressure, reduce weight and waist circumference, as well as reduce the risk for cardiovascular disease, coronary heart disease, stroke and type 2 diabetes, and has shown improvements in blood lipids and glycemic control.
These two dietary patterns and their associated benefits are just two examples of the many different nutrition interventions reviewed in the new guidelines.
The guidelines concluded with explaining, “Medical Nutrition Therapy and coordination of care with a RD can help patients/clients improve health and QoL. Finding a nutrition approach a patient/client can incorporate into their lives that is nutritionally adequate, culturally acceptable, affordable, enjoyable and effective for lifelong health improvements should be the focus of all nutrition interventions.”
Source:
Brown J, Clarke C, Johnson Stoklossa C, Sievenpiper J. Canadian Adult Obesity Clinical Practice Guidelines: Medical Nutrition Therapy in Obesity Management. Available from: https://obesitycanada.ca/guidelines/nutrition. Accessed [June 10, 2021].
Wharton et al. Obesity in adults: a clinical practice guideline. CMAJ 2020 August 4;192:E875-91. doi: 10.1503/cmaj.191707
