By Ximena Ramos Salas, Director of Research & Policy & Miguel Alejandro Saquimux Contreras, Research Assistant, Obesity Canada
In January 2021, Obesity Canada launched a pilot project to create a process for adapting and implementing the Canadian Adult Obesity Clinical Practice Guidelines (CPG) in two countries.
Obesity Canada has been working with the European Association for the Study of Obesity (EASO), the Sociedad Chilena de Cirugía Bariátrica y Metabólica (SCCBM) and the Association for the Study of Obesity on the island of Ireland (ASOI) to adapt the Canadian guideline in Chile and Ireland.
Chile started the process of updating their clinical practice guidelines in 2020. Recognizing that the Canadian guidelines represent the latest and most comprehensive review of the literature in obesity care globally, Chile saw an opportunity to leverage the Canadian guidelines in their guideline update process. The SCCBM decided to participate in the pilot project to adapt the Canadian guideline (which have a broad scope of practice) and update the existing Chilean guideline for the management of patients with severe obesity (which had not been updated since 2008). This adaptation and update process could produce a new Chilean guideline that is scientifically valid, comprehensive in scope, and tailored to the Chilean health system, culture, and population.
To implement this pilot project, Chile created an interdisciplinary Executive Committee coordinated by SCCBM. Dr. Rodrigo Muñoz Claro, MD, PhD, Associate Professor of Surgery at the Pontificia Universidad Católica and Director of the Center for Treatment of Obesity (CTO) at the Health Network UC-Christus is the Chair of the Chilean Clinical Practice Guidelines Executive Committee. Dr. Yudith Preiss, MD, MSc Human Nutrition, member of the Hospital Dipreca in Santiago, Chile, Former National Coordinator of the Multidisciplinary Teams Section of SCCBM, Dr. Francisco Pacheco, President of the SCCBM, Dr. Claudio Canales, Former President of SCCBM and Francisca Maturana, Executive Director of SCCBM are coordinating and supporting the adaptation pilot project in Chile.
Multiple scientific societies have expressed interest in participating and collaborating in the adaptation process, including: the Asociación Chilena de Nutrición Clínica, Obesidad y Metabolismo (ACHINUMET), the Sociedad de Neurología, Psiquiatría y Neurocirugía de Chile (SONEPSYN), and the Sociedad Chilena de Medicina Familiar.
After reviewing the Canadian guideline, the Chilean CPG Executive Committee decided to adapt 18 out of the 19 chapters. A lead Chilean author was identified for each chapter and additional co-authors were invited as needed. More than 60 Chilean scientists and healthcare professionals are involved in the adaptation pilot project.
In addition to adapting the Canadian recommendations, chapter authors were also asked to create new research questions that were specific to the Chilean health system and population. An independent methods expert team, Epistemonikos Foundation, under the leadership of Dr. Gabriel Rada, Associate Professor in the Faculty of Medicine and Director of the Centre for Evidence of the Pontificia Universidad Católica de Chile and member of the GRADE Working Group, is supporting this initiative. Epistemonikos is conducting literature searches based on the additional Chilean specific research questions and preparing draft evidence-based recommendations for chapter authors to review and approve. Epistemonikos will also review the Canadian recommendations and support the authors to adapt them for the Chilean process using a systematic approach (GRADE-ADOLOPMENT).
On November 13, 2021, the Chilean team met in person to review the evidence that was generated from the new Chilean specific research questions. At this meeting, Chilean authors received training on the GRADE-ADOLOPMENT methodology and got an opportunity to review the evidence and exchange ideas on the key priority issues for the Chilean guidelines.
Obesity Canada’s Director of Research & Policy, Dr. Ximena Ramos Salas shared an overview of the Canadian guideline vision to shift the narrative from a sole focus on weight to improving health and wellbeing while also focusing on reducing weight bias and stigma in healthcare settings.
It is expected that the final Chilean Clinical Practice Guideline for the Management of Obesity in Adults will be published in a Chilean medical journal and launched in the spring of 2022.
So why is Obesity Canada doing this?
As a science-driven organization, Obesity Canada has always valued international scientific cooperation. Canada is seen as an international leader in obesity research, education, and clinical practice. Obesity Canada is also a leader in scientific and advocacy efforts to eliminate weight bias, stigma, and discrimination.
At Obesity Canada, we understand that the clinical practice guideline can help us advocate for respectful, unbiased, evidence-informed, and accessible obesity care worldwide. The guideline could fundamentally change the way healthcare professionals, people living with obesity, and policy makers understand and treat obesity.
By working within Canada and with international partners, OC aims to promote awareness, acceptance, adoption, and adherence to the guidelines so that we can:
- Optimize standards of obesity care through evidence-based strategies and respectful, and non-stigmatizing engagement of people living with obesity.
- Develop core competencies among healthcare professionals to optimize patient-centred obesity care;
- Provide guidance on how to strengthen patient-provider therapeutic relationships.
- Shift focus to health outcomes and not solely on weight targets;
- Support individuals living with obesity across the continuum of care; and
- Inform future policy change to facilitate access and coverage of obesity care programs, products, and services.
Our goal through this project is also to improve the representation of people living with obesity research, education, and policy initiatives. People living with obesity from Canada, Chile and Ireland will be participating in this pilot project and will help to plan, design, and guide the creation of a guideline dissemination and implementation strategy. This will ensure that the outcomes that are important to patients are supported and measured throughout the project.