O Canada: A Synopsis of the Canadian Obesity Practice Guidelines

The American Board of Obesity Medicine has listed the Canadian Adult Obesity Clinical Practice Guidelines (accessed here) as one of the newer recommended exam resources. Although there are differences in approved anti-obesity medications, metabolic and bariatric surgery criteria, etc., between the United States and Canada, there are several similarities, with the more recent Canadian guidelines highlighting numerous testable points. This is a much-needed update to the 2006 Canadian practice guidelines, which serves to equip primary care providers with the most up-to-date practices. By aiming to set the tone for practitioners, these guidelines work to reverse long-standing stigma and personal biases and provide a framework for options to address this chronic disease. These important aspects will be discussed here and categorized into 5 main steps.

Step 1: Recognition that obesity is a chronic disease

While this step may not be surprising to those practicing obesity medicine, the concept that obesity is a treatable, chronic, progressive, and relapsing disease is not yet universal in healthcare. Charred with bias and stigma, many patients have been scarred by the mantra of “eat less, move more,” which has plagued the trust of the medical community. Canada is candid in admitting that this idea of patient irresponsibility and willpower deficiency causing obesity is rampant within its medical community. With obesity rates tripling in the past 35 years, it is vital to tackle this epidemic and stigma head-on.

Step 2: Assessing individuals living with obesity

BMI has long been the primary classifier of obesity. On a population level, you can make correlations between the general health of the country and BMI trends. However, on an individual level, it does not consistently correlate with obesity-related comorbidities. The integration of waist circumference with BMI, especially in those in the BMI range between 25-35 kg/m², helps more accurately correlate visceral adiposity and subsequent cardiometabolic risk. Beyond anthropometric measures, the Canadian-based Edmonton Obesity Staging System, a 5-stage classification of obesity influence, is a primal way to 290 re-classify obesity into its interference with quality and quantity of life (read more here). Therefore, a goal to reduce complications of obesity, not specifically target arbitrary BMI values, is broached. In other words, long-term comprehensive treatment for those with obesity should focus more on the health of the individual, targeting the patient’s “best weight” rather than simply an “ideal weight”. This assessment should also go beyond simple assessment tools and should include a comprehensive history and understanding of the root causes and drivers of obesity, which will help with individualized treatments.

Step 3: Providing treatment options

Identifying the individual factors that contribute to excess weight will guide a patient-centered approach to effective treatment. Some of the main themes of treatment are covered briefly below.

• Physical activity: Regardless of ability or body size, regular aerobic activity is often achievable, although varied amongst individuals. Timewise, a goal of 30-60 minutes, most days of the week, is recommended. We should encourage our patients to find enjoyable activities that will help sustain this level longitudinally. Initial weight loss is generally minimal, and this expectation should be discussed with patients to prevent frustration. Instead, cardiovascular health and weight maintenance after weight loss (i.e., preventing weight regain) are the primary benefits.
• Nutrition: Combined with other therapies, sustainable nutritional changes and dietary patterns help achieve caloric deficits and may treat adiposity-based chronic diseases. Plans must be individualized and ideally constructed with the help of nutritionists/dietitians. Dietary plans that are too restrictive will not stand the test of time. Compensatory mechanisms that occur with weight loss drive the promotion of increased caloric intake. Thus, nutritional changes cannot be done in isolation and should be combined with behavioral interventions and other advanced therapies.
• Behavioral interventions: Motivational interviewing principles and strategies are the crux for jump-starting patients’ intrinsic motivation, leading to self-empowered changes. Be familiar with these processes (engagement, focusing, evoking, and planning), skills (OARS: open questions, affirmation, reflective listening, summaries), framework (FRAMES: feedback about personal risk, responsibility of the patient, advice to change, menu of strategies, empathetic style, self-efficacy), principles (RULE: resist the righting reflex, understand your patient’s motivation, listen to your patient, empower your patient), stages of change, the 5 A’s, etc. but also understand the practical applications through setting specific, measurable, achievable, relevant, and timebound (SMART) goals, self-monitoring (tracking calories, activity, etc.), analyze setbacks, problem solving, reframing, etc. These behavioral changes incorporated into lifestyle modification can achieve 3-5% total body weight loss.
• Pharmacotherapy: Similar to our FDA-labeling, Canadian anti-obesity pharmacotherapy indications recommend use adjunctively with lifestyle modifications. Approved pharmacotherapy treatment options differ between the U.S. and Canada, which will not be tested.
• Metabolic and bariatric surgery: Although the Canadian BMI cut-offs do not align fully with the ASMBS (again, not something to get fixated on; this is country-dependent, and you are studying for the American Board of Obesity Medicine), the multidisciplinary approach and perioperative recommendations (i.e., smoking cessation, pregnancy prevention, vitamin supplementation, etc.) match closely.

Step 4: Agreement regarding goals

Goals that are realistic, sustainable, and patient-centered lead to long-term success. Patients should understand that treatment is long-term (ideally lifelong). This includes pharmacotherapy if desired. Adverse side effects, costs, medication attainability, etc., all should be considered. In addition, setting realistic goals and expectations upfront can prevent unnecessary frustrations in the long run. It should be discussed that what may work for one person may not be effective for another. Changing approaches, intensifying therapies, rekindling motivation, and addressing relapses are all part of ongoing medical care.

Step 5: Follow-up and advocacy

This last step goes beyond the walls of a patient-physician clinical encounter and hits a broader goal. It involves advocating within the medical community to provide high-quality education and resources to clinicians to broaden the availability of obesity care. By taking the ABOM exam, you understand the importance of gaining medical knowledge to best treat your patients. Standardization of care and treatment for those with obesity should be woven into every primary care practice. Knowledge expansion for providers through education (lectures, grand rounds, CME opportunities) assists those not pursuing certification in accessing the knowledge base and tools to appropriately and unbiasedly treat obesity, or at a minimum, refer. In addition, advocacy goes outside of the healthcare system and into communities, municipalities, and government to provide resources to prevent and treat obesity and improve health on a larger scale.

In total, the Canadian guidelines have 19 chapters that go into great depth, discussing epidemiology, physiology, etc. Summarizing that level of depth cannot be achieved in this short blog. However, I hope that the testable similarities of treatment approaches between the USA and Canada are clearer. Finally, I wanted to leave you with a short summary of highlights that I found to be the most high-yield from a board exam prep perspective:

• Healthcare providers should initiate a discussion and treatment within the 5 A’s framework, starting with ‘Ask.’ Asking for permission is the first step in assessing obesity.
• Measure the waist circumference in those with a BMI between 25-35 kg/m² to stratify cardiovascular risk.
• ALT is recommended as the initial screening test for metabolicassociated liver disease
• Metformin should be considered for the prevention of weight gain in those on obesogenic antipsychotic medications.
• Lisdexamfetamine and topiramate should be considered in those with binge-eating disorder, adjunctively with psychological treatment/therapy.
• The best dietary pattern is the one that can be adhered to long-term.
• Patients should target 5-7% weight loss via intensive behavioral interventions to improve glycemic control, lipids, and cardiovascular/all-cause mortality, and target 7-15% to increase the remission of type 2 diabetes, obstructive sleep apnea, and depression.
• Aerobic physical activity of 30-60 minutes most days of the week, consisting of moderate to vigorous intensity, may help achieve small amounts of weight loss, but reduces abdominal visceral fat in the liver and heart even in the absence of weight loss. It also improves cardiorespiratory fitness, preserves fat-free mass during weight loss, and prevents weight regain. Resistance training helps increase muscle mass, preserve lean mass during weight loss, and improve mobility.
• High-intensity interval training can more effectively increase cardiorespiratory fitness in less amount of time (15-30 minutes daily, most days of the week).
• Avoid choosing obesogenic medications to treat comorbidities.
• Metabolic and bariatric surgery should be considered in those with type 2 diabetes that is poorly controlled despite optimal medication management for those with class I obesity.
• Adjustable gastric banding is not recommended, given the long-term failure rate.
• Clinical educators should provide courses and clinical experience in treating those living with obesity to close knowledge gaps and reduce bias in the next generation of providers.
• Wearable activity trackers should be part of a comprehensive weight management strategy.
• Anti-obesity medications should be avoided during pregnancy and breastfeeding.
• Post-partum women should be provided additional support for breastfeeding given the decreased rates of initiation/continuation.
• Pre-conception counseling discussing behavioral intervention, physical activity, healthy dietary patterns, expected weight gain during pregnancy, etc., should be provided to improve health and prevent excess weight gain during pregnancy.

One final summation of the key principles necessitating these guidelines: obesity is a complex, chronic disease driven by underlying biology, not choice, that is treatable. The nearly 200 weight-related complications associated with this disease can start early, and thus earlier interventions, including prevention, are key. Healthcare providers should also avoid assuming that all health-related ailments are a result of excess weight. Weight bias and discrimination are harmful, and everyone deserves appropriate access to care.

Next Week: ABOM Test-Taking Tips and Final Studying Recommendations

Final blog (Bonus): I took the exam….now what?! by Carolynn Francavilla, MD, FOMA, ABOM

For more practice questions, check out the following:

• Obesity Medicine Board Review Questions (2026)
• Obesity Medicine Practice Tests (2026)

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