Obesity

Rationale

Obesity is a chronic multifactorial disease that is complex and progressive. It develops from social, behavioural, physiologic, and metabolic interactions. Characterized by dysfunctional or excess adipose tissue that impairs health, obesity is a risk factor for a wide range of serious illnesses.

Causal Conditions

(list not exhaustive)

1. Social milieu (e.g., socioeconomic status, occupation, disability, lifestyle)
2. Neuroendocrine factors (e.g., hypothyroidism, Cushing syndrome, polycystic ovary syndrome)
   1. Genetic (e.g., Prader-Willi syndrome)
   2. Epigenetic
3. Substances and medications (e.g., smoking cessation, psychiatric medications, cancer treatment)
4. Life cycle changes
5. Mental health conditions

Key Objectives

Given a patient with obesity, the candidate will assess the root causes and severity and collaborate on a care plan that is based on the patient’s values.

Enabling Objectives

Given a patient with obesity, the candidate will

1. list and interpret critical clinical findings, including those based on
   1. determination of the presence of obesity using defined criteria in adult and pediatric populations,
   2. assessment of the severity of obesity using a validated scale (e.g., Edmonton Obesity Staging System),
   3. measurement of waist circumference, waist-to-hip ratio, and body mass index,
   4. screening for propagating factors (e.g., mental health conditions, mobility impairment, socioeconomic status), and
   5. screening for complications (e.g., sleep apnea, type 2 diabetes, fatty liver disease);
2. list critical investigations and interpret their results as indicated, including
   1. investigations for neuroendocrine causes of obesity, and
   2. screening for accompanying conditions;
3. co-construct an effective initial care plan with the patient and their designated support person as required, including
   1. determining value-driven goals for treatment,
   2. assessing the role of mental health supports, nutrition support and education, and physical activity,
   3. formulating an intervention strategy with an emphasis on a multidisciplinary approach and long-term treatment, including nonpharmacologic interventions (e.g., diet and exercise), pharmacologic interventions, and surgical interventions,
   4. demonstrating sensitivity to the social and psychosocial consequences of obesity, and
   5. identifying opportunities to address socioeconomic factors leading to obesity.