Managing your weight is hard enough during the best of times. Add the challenges of a pandemic — with gyms, indoor tracks and hiking trails closed for quite some time — not to mention the added stress, and it’s no wonder people have gained weight.
A recent Canadian Leger survey revealed that out of 1,000 respondents 43 per cent have gained weight, with 65 per cent of the respondents blaming themselves for the added pounds.
“I thought that was shocking. I really felt sad when I saw that statistic. It’s not all about willpower, and it’s not their fault,” obesity expert Dr. Judy Shiau, said.
“There’s a certain amount of responsibility but it’s not worth beating yourself over it. The point is to move forward,” she added. Shiau is the Medical Director and Lead Physician at the LEAF (Live. Eat. Activity. Forever) Weight Management Clinic, a community-based multidisciplinary bariatric clinic in Ottawa.
Shiau wanted to put out a message of hope to those who are struggling with weight at this time. “Negative thoughts won’t help,” she said, and added that in a stressful environment, it’s harder for people to choose healthy choices all the time.
“There has been a change in structured schedule (during the pandemic). Structure is lost,” Jana Plaunt, a dietitian with the Rideau Community Health Services, explained. Since the pandemic started, Plaunt has definitely seen an uptick in demand for people needing weight management.
Shiau agreed that a change in pattern is a factor in weight gain. She cited students going to university — the “freshman 15” as an example.
As a response to stress, our ‘cave man brain’ hunkers down to “protect itself. It’s very natural to reach for something comforting such as ice cream,” Shiau explained. “The ‘executive brain’ must then try to control and overcome our ‘cave man brain’.”
She warned that “once you get to a higher weight it gets harder to lose it. Your ‘executive brain’ will naturally try to defend that higher weight.”
People who are struggling with obesity during the pandemic are especially at risk. Most already struggle with personal blame and shame, add to that society’s views on weight gain — that it’s their fault, and that they ate too much.
“People living with obesity face bias and stigma on a daily basis,” said Dr. Sean Wharton, medical director of the Wharton Medical Clinic, a community based internal medicine weight management and diabetes clinic. He is the co-chair of the newly released Canadian Obesity Guideline.
“In North America and in the developed world, people living with obesity are left out of jobs, friendships, medical treatment and privileges such as getting a bank loan. The discrimination is deep and can affect people,” Wharton explained in a phone interview.
“It goes to their very existence; who they are, who their friends are, what their jobs are.”
Shiau said that obesity has been recognized as a chronic disease by the Canadian Medical Association and should be treated as such. “There are eight million people in Canada who suffer from obesity.”
A complex disease, there are “multiple variables a person can’t control with obesity: genetics, environment, stressors, medication, lack of sleep and perimenopause for women,” she explained.
Surprisingly, Shiau said that “diet and exercise are but a small part of weight management. An important part, but a small part,” she said.
Wharton emphasized that “it’s important to understand that we are no longer talking about ‘diet’ in our (obesity) guideline. It is a loaded word. It implies the person is just restricting calories.”
Restricting calories “causes a cascade of hormones that will drive the weight back up to a weight that’s even higher than when they’re started. You are harming your patient if you tell them to go on a diet,” Wharton said.
“Wagging a finger and saying you need to go on a diet and exercise is the wrong approach.”
Wharton recommends an approach that looks at every individual and finding out the right food for them. “Medical nutrition therapy is eating for the condition that you either have or is at risk of having.”
Shiau gives a three-step recommendation for changing behaviours and taking control over one’s weight. She calls it the three C’s: Change, Connect and Cognitive Behavioural Therapy.
CHANGE
One of the most important things with weight management is prevention. Shiau recommends asking yourself “what change can I do in my behaviour that is realistic?” Some tweaks in behaviour could include exercising first thing in the morning, when your ‘executive brain’ is at its peak.
Changing the way you feel about yourself is another way to help combat weight gain. Wharton said that “people who have internalized these biases that it is their fault — it is very difficult for them to mobilize what is effective change. They will never mobilize if they think it’s their fault and that they’re the only ones who can fix it.”
Wharton explained that people go to doctors if they have cancer because they know they can’t fix it on their own. “It’s not your fault you got cancer. Same thing with obesity-it is not your fault and you shouldn’t be expected to fix this problem on your own.”
CONNECT
Connecting means reaching out to a partner such as a friend, family member, and in particular, a physician or nurse practitioner. “They are there to help you,” Shiau said. She mentioned that there are three medications approved in Canada for weight management, however, they don’t work on their own; they need to be taken in conjunction with other behavioural changes. The medications are expensive and are not covered by OHIP.
Another option is to have bariatric surgery.
Laurie Weir, editor of The Perth Courier and Smiths Falls Record News, decided to have bariatric surgery “when all other options — numerous weight loss plans, seeing a dietitian, going to the gym — were all failing. I was failing. I was frustrated with yo-yo dieting and spoke to my family doctor about it. She recommended a gastric bypass and started the paperwork. It wasn’t easy. It was a two-year process for me.”
Weir’s surgeon was Dr. David Robertson of the Kingston Bariatric Centre of Excellence, and she had her surgery at Kingston General Hospital in February.
She acknowledged that “the benefits far outweigh any risks or complications for me. I no longer take a daily inhaler or steroid for asthma. Freedom to breathe has been the best reward. I no longer have acid reflux, and sleep apnea has been minimal. My heart is healthier, as I had also had a silent heart attack.”
Weir has since dropped almost half of her excess weight. “I am struggling with some back and foot issues now and have been seeing a chiropractor/physical therapist. Apparently, your body changes as it shrinks. I’m all out of alignment and have some pain.”
She considers her aches and pains “a small price to pay for a healthier heart and the ability to tie my shoes without losing my breath. I no longer crave food. I eat to live, not live to eat.”
COGNITIVE BEHAVIOUR THERAPY
Cognitive behaviour therapy can sustain lifestyle changes to help with long-term weight management. This includes talking to therapists and dietitians about recognizing when you are most vulnerable and eat out of boredom, stress or feeling miserable.
According to Wharton, “dietitians in Canada have introduced the concept of cognitive behaviour therapy to the forefront. The majority of people need to be taught how to do psychological intervention.”
Wharton said that some people can do it without being taught. “But the rest of the world needs to be taught about coping mechanisms. Coming home from work, you’re sad, you’re tired, your soothing strategy is to have calorie-dense food or alcohol. With cognitive behaviour therapy, once you have that cognition, you can change that behaviour.”
Plaunt recommends to “eat mindfully. Ask yourself, am I hungry right now? Distract yourself by watching a movie on Netflix. Find a partner to exercise with.”
Cognitive behaviour starts within yourself: your thoughts, your motivations, your spirit.
A four-week course led by dietitians called “Craving Change” is available to everyone, at no cost through the Rideau Community Health Services. Those who wish to take part in the program may register at www.rideauchs.ca or call 1-613-283-1952.
For more information on the new Obesity Guideline, visit Obesitycanada.ca.
