Redefining Obesity & Understanding it as a Chronic Disease with Dr. Sean Wharton

– Hello and welcome to the Scale Up Your Practice podcast, brought to you by Obesity Canada. I’m Roshan Abraham, an associate professor in the Department of Family Medicine at the University of Alberta. Besides educating medical learners, I’m deeply involved in the Obesity Canada Education Action team. And as a family physician, I witness daily the complex challenges of obesity, both at individual and system levels.

 

– And I’m Michelle McMillan, a lived experience expert with Obesity Canada and your co-host. We’re here to help you navigate the ever-changing landscape of obesity medicine from multiple perspectives. Myself, a patient, Roshan, a medical professional, as well as the insights of our guests, all of whom work in the field of obesity.

 

– Our goal to blend science, clinical insight, and real world experiences to help you feel more confident, informed, and connected in your practice.

 

– And to shed a light on all the different perspectives that are crucial to the understanding of obesity. Whether you’re a healthcare provider, a person living with obesity, or simply someone wanting to learn more.

 

– Today’s episode is not sponsored. Today we’re thrilled to welcome global obesity expert, Dr. Sean Wharton. We hope you enjoy the discussion. As the lead author of the Canadian Adult Clinical Practice Guidelines, can we start with a few questions aligning to the guideline development? I mean, it’s a huge accomplishment. It’s one of the top read papers, pretty much year after year since it was published, which is again, huge kudos.

 

– And and thank you for spearheading that. What was the process to develop the guidelines? What was that like?

 

– Yeah, it was, thank you for that. You know, it was a challenge, but it was a welcome challenge. Almost like the decision to go into obesity medicine was because the space was a big void. So, it felt like I could do something here because there’s not something that is solid that makes sense, that shows the compassion, that shows the humility or shows the new biological understanding that we actually have, that’s going to change all the time. But there’s very few documents out there. I know that I can make a impact in this field and I know that the guidelines will make a impact. So, I think gathering the specialists was particularly easy because everybody was excited about, ’cause they were doing research in the field and they didn’t have one place that it all sat in a appropriate manner. And the previous guidelines didn’t really address people living with obesity as part of the architecture of the entire guideline process. It was an academic document that didn’t really address compassion and didn’t really address the fact that people living with obesity are part of that process. Nothing about us without us. I mean, people say that on a regular basis, but we actually put it into play, not popular 2016, 2017, when we started to do the guidelines, the idea of doing that was not popular. But it was absolutely needed. And because it was such a, let’s say, unpopular or not done, we knew that whatever we did was gonna be new and fresh and different than any other guideline that had been made previously. So, we really led the charge there and as a result, we got together a beautiful document that has the science, which is easy for a bunch of scientists to do. That part was not that hard. The part that was hard was really, and everybody was on board with this, the understanding that using first-person language and first-person language came out of the fact that we’re respecting people living with obesity. We’re being kind. We are showing compassion. We’re asking them questions, we’re designing it with them in mind, not just with us in mind and our scientific biological aspects and what medication is next and what complication is next. No, what are the things that the people with the disease are actually asking about and missing? And this is probably something I could have done in the hypertension field, or in other fields ’cause I have that, you know, black people are damaged by certain disease states because of the oppressive nature of medicine, particularly in the States and in North America. But it’s a worldwide problem. That was probably a bigger mountain to climb. This was a excellent challenge and I think we made a big impact in making a change.

 

– Yeah. So, speaking as someone who’s lived with obesity for most of her life, maybe we could say all of it. You know, I come from a culture of, well, if you just ate less and moved some more, you know, you’d solve your problems. What I find most interesting about the guidelines is that, that is not what the guidelines say. So, I can talk a lot about fascinated things here and there, but I’m not an obesity specialist. So, I’d like you to talk about what you find most new and innovative, in addition, to bringing in lived-experience people to the document.

 

– Yeah. And so, thank you for that and asking about that. So, bringing in the lived experience people into the document was kind of part and parcel in a constant reminder to us that we don’t know all the answers. Because the people with the lived experience, when we would talk to them about certain concepts, certain answers, they were like, “Yeah, that’s pretty good, but that’s not the entire answer because it’s still not addressing a bunch of things that I deal with or I live with.” And then we have to concede that we don’t know all of the answers. And when we went to the idea of eat less and exercise more, so, there’s, clearly no significant weight loss or weight change without having less calories. There’s just no debate about that, it’s not possible. And moving does, you know, increase muscle strength and makes you live longer, et cetera. So, those two things are necessary, but they’re outcomes. And so, we made the bold move, and it’s still a bold move because it’s not necessarily accepted today in a number of other documents, and we still champion it, that these are outcomes of interventions that the person has to put in place. And one of the most important outcomes, one of the most important interventions to get this outcome of consistently lower calories and moving more was the psychological piece. And we put the psychological piece as a pillar. Why? Because we believe that if you believe that you are loved, you are loved at the highest weight that you’ve ever been. You were loved through, through it by multiple people throughout your life because you are a good person. If you believe that and understand it and feel it, you have a much greater chance of having lower calories and moving. And many people dispense of that psychological aspect and put it into other aspects. We put it as a pillar, because again, this came back to the people living with obesity who are architects in the entire guideline process. You have to remember that it’s more than a medication or surgery and biology. It’s being loved. It’s being cared for, it’s being understood, it’s being heard, it’s compassion. It’s a reminder of that in a world that doesn’t give you that on a regular basis. So, that for us was central. It’s almost like that intervention is the love pillar. Know that you’re loved, know that you’re cared for, know that we hear you and recognize you and that all these aspects are absolutely needed. And then the other pillars were that there is a genetic, biological aspect to this disease state. So, therefore pharmacotherapy factors in and it’s scalable. So, coming from the hypertension world, we don’t even know what high blood pressure really is and how it functions. But we know that if you can give a pharmacotherapy option, you can scale it and you can decrease the blood pressure and you can end up having a better outcome. And so, we’ve always understood that pharmacotherapy can help extend life by allowing for the outcome that we are actually looking for, which in this case is lower caloric intake and also movement, ’cause as the weight goes down, the movement can get better. The person feels better about themselves psychologically. And then the surgical aspect also addresses the number of those neurological and neurohormonal changes. So, those three pillars, and again, my favorite pillar is the psychological love pillar as opposed to the two other ones. I still like them, but I like the psychological one more than anything else. And I think that, that’s what made us different. And that’s what we still strive to explain to everybody, that is that lower calories and movement are outcomes of being cared for and doing the right pillars.

 

– Wow, I hope that this resonates as much with our listeners as it does for me. And as someone who works and lives in primary care, that love piece is something at this stage in my career, both as an academic and as a clinician is something I’m gravitating towards more and more. And definitely the obesity education and practice space and the guidelines definitely show through how important love is and feeling that connectedness to your community as well as to the people who are taking care of you. With these innovations, with these standout sort of features, if you will, of the guidelines, there were also sort of a new approach to the, even the definition of obesity. Can you speak to that a little bit more, as lately that’s been coming up in the world of obesity, medicine is about the actual definition of obesity.

 

– Yeah. Excellent. And what we really wanted to do here is, is we wanted to change the definition of obesity, not because we were pushing to do something radically different, but we, again, it comes back to the fact that if you are speaking and working and living with people living with obesity, they will tell you it’s not just about their weight. There’s more than, it’s not just about their actual size. It’s about toxic fat tissue causing medical conditions. And that toxic fat tissue causes type two diabetes, osteoarthritis is inflammation that that ends up happening. But there’s even psychological aspects that end up happening. And that may not be directly due to the inflammatory causes, but it can be due to the experience that the person has. So, we’re also fighting that. And so, that led us in a direction to say that we’ve got to get rid of body size and just weight as a marker for obesity. It’s not just about their BMI, but it’s about the excess or toxic and fat adipose tissue, fat tissue that causes a impairment to a person’s health. And we were the first guideline, I believe, I didn’t see any others at the time to actually move away from this BMI status and really talk about the impairment to a person’s health from psychological to mechanical to a metabolic. If that impairment is there due to the fat tissue, whether it’s toxic fat tissue, whether it’s just fat tissue period, but there’s impairment then that is somebody living with obesity. So, what we wanted to really do was say that, so, if you’re a African American woman or a Hispanic woman or a woman period, who has a BMI of 32 and you have hips and and thighs, but you don’t have a belly, you don’t have any pre-diabetes, you don’t have any osteoarthritis, you don’t have any medical conditions, you shouldn’t be labeled as somebody living with obesity. You should be labeled as beautiful. That’s your definition. Your definition is beautiful. And unfortunately, they’ve been labeled with a definition of obesity because of a BMI cutoff that was established for white European males. It wasn’t established for women, it wasn’t established for black women, Hispanic women, for white women. And it wasn’t established for South Asians or Asians. So, if you’re a South Asian woman with a BMI of 26, you’re not supposed to be in the obesity classification. But if you have pre-diabetes and your parents have type two diabetes and you have a waist circumference that’s a little bit bigger than than your hips and there’s toxic adipose tissue there, then you’re living with obesity and you should be able to get treatment if you want treatment. If you want treatment, you should have access to treatment ’cause you’re living with obesity at a BMI of 26. And that’s what we wanted to change it around. So, because I’ve been asked like, does BMI overestimate or underestimate problems? The BMI cutoffs do both. They overestimate and they underestimate and they cause further stigma and bias for people who are just given labels without the actual definition of what their medical condition is or whether they even have a medical condition.

 

– So, I guess to follow up on that, I mean, that presents a challenge for clinicians, right? Because I can teach someone who’s 10 how to do a BMI calculation. I could probably teach someone who’s four how to do a BMI calculation, right? It’s quick, it’s simple, there’s charts, you know, maybe you could talk a little bit about what’s the alternative and how could you apply that to a clinical practice where you don’t always have all the time in the world to, you know, individually evaluate patients?

 

– Great. Yeah. So, I think that using the BMI cutoffs, which are a proxy for a person’s health, right? And so, we’re saying that if your BMI is 33, you’re at a higher risk of high blood pressure and heart disease and toxicities. And that does apply, those cutoffs apply for white European males ’cause it was made for them and it does make sense. So, it is a appropriate proxy. And so, you can still use those cutoffs, although I would try to adjust them based on whether you’re looking at women or South Asians or black women, Hispanic women, et cetera. But those are proxies. But if you’re a doctor in a first-world country and you’re a patient in a first-world country, what’s better than getting a proxy? Well, getting your actual blood pressure, getting your actual blood sugar, so if your blood sugar is elevated, it’s elevated. If your blood pressure is elevated, it’s actually elevated. And if you had toxic fat tissue, you think was the reason that caused that elevation in the blood sugar, then the obesity is causing it. And then you are living with obesity and then treatment should be accessible to that person. So, what should a busy clinician do instead of just doing BMI? Well, a busy clinician should do what busy clinicians do every day, do their blood pressure, do their blood work, and make their own judgements. So, when we do things just like BMI, we take away the capacity for the doctor to be a doctor. Like I’m a doctor, I’m able to find out the person’s past medical history, their family history, ’cause I’ve got that, I’m a good doctor and I did their blood pressure. Now, I make the assessment. The assessment is, is that based on all these things that I have for you, because this is our medical system, it’s good, and I can make a judgment, I went to medical school for a bunch of years, that you are in a position where there are some metabolic conditions possibly due to your excessive toxic adipose tissue. And you would be deserving of treatment if you wanted treatment, leave it with the doctors to use their clinical judgment. All those years of school had to result in something. So, it should result in your ability to know that a hemoglobin A1C of greater than seven is a problem and it can be addressed and we know how to do it, and the person should know about it and then be able to make the decision as to whether they want to do anything about it. But don’t just say, your BMI is 33 and I think you should do da da da da. No, your A1C is 7.5, and if you would like to do something about it, we can. And oftentimes, it does mean trying to get rid of some of that toxic adipose tissue or fat tissue and that would be beneficial.

 

– I think part of the challenge, and again, living and working in primary care and then in my roles in education, I think bias and stigma play a pretty substantial role in, I would say changing just sort of what we’re taught on a regular basis. And even influencing what we’re taught on a regular basis throughout our undergraduate training, throughout our postgraduate training, such that when we actually do have those conversations with patients, yes, we have all the medical knowledge, we have our CanMEDS roles, which are supposed to allow us to assist patients with advocacy, with communication, with collaboration. And yet, the bias and stigma that’s so tightly interwoven into the disease state of obesity makes it extremely challenging to actually provide that patient-centered care that our population so desperately needs. How did the guidelines sort of look at addressing that? Because that is a huge component of obesity care and for patients living with obesity.

 

– Excellent. And that’s a great question, and I think that we addressed it by putting the bias and stigma chapter as the first chapter. And I think that the start of that bias and stigma chapter should say, if you’re a doctor reading this, you don’t know everything. You know a bunch of medicine, but you don’t know everything about the person sitting in front of you, and don’t be biased against them and remember, or don’t stigmatize them. Don’t discriminate against them and remember that you are biased. So, I think that that should be the headline of the obesity guidelines is that everybody reading this is biased. And once you remember that you’re biased, you have a chance of not stigmatizing and not discriminating. If you don’t even acknowledge that you have bias, then you have no chance of really, of doing the best that you possibly can. I think we are at times reminded that we’re biased against the indigenous population here in Canada. Everybody in Canada is biased against the indigenous population. Indigenous are biased against the indigenous population. So, when an indigenous person walks into your clinic, you have to remind, oh, I’m biased against an indigenous population. I need to treat this person differently. Everyone says, “No, you should treat them equally,” to the person that just walked through. That’s not true at all. You’re biased, so, you have to treat them different. So, that means that you have to address them with a recognition of that bias and how to not discriminate against them because it’s not equal treatment, it’s equitable treatment. And equitable treatment may mean that you may need a translator or you may need to understand their years of trauma. And that’s why they’re not, may not take in your recommendation as readily. You may need to move in a different direction with them as you speak to them. That is a recognition of bias because you don’t live in the indigenous world. And you see things on TV and you’re biased, and that you cannot discriminate and not stigmatize. So, I’m biased against black people. I’m a black man, I’m biased against black people. Why am I biased against black people? Because of everything I see on TV, because of every Disney movie that I’ve watched, because of every Marvel movie with the few black characters that are there as they try to change that. I recognize that, and they’re doing that because of racism and the discrimination. So, I’m biased, so I have to remember just like everybody else, when I’m walking down the street and it’s late at night and there’s a black person walking next to me, I have to remember, oh, I’m biased. I’ve seen a lot of TV shows where the black guy is the bad guy or going to mug somebody. Oh, that’s bias thinking Sean, don’t stigmatize don’t discriminate. Oh, I’m biased against people living with obesity. I’m seeing somebody walking into a Tim Hortons and they’re 250 pounds. I’m like, what are they doing going into Tim Hortons? They really think that they should be going to Tim Hortons. Come on. Oh, wait a minute, Sean, you’re biased against people living with obesity. Maybe that person is going in there for one donut instead of 10. Why can’t they have a donut? They’re in Canada, they’re human. They should be able to have a donut. Why are my biases so intense? And once I recognize them, I can now not stigmatize and not discriminate. And I think that, that’s not easy to do. It’s not easy because we’re inundated with the Disney princesses and Disney villains that, I mean, if you think of The Little Mermaid. So, The Little Mermaid is little, and thin and the bad person is living with obesity. And she’s got, and that’s the portrayal. And and we’ve all seen that movie and probably didn’t even recognize it, but this recognized it. And my son, who’s four and a half years old, he recognizes it already, is already making statements like that, that recognized who’s bad and who’s good. So, if the guidelines did anything, ’cause I think the science part is easy and what’s the biology and the maternal history, chapters and all those parts, they’re difficult to do ’cause they’re science and they’re biology. So, kudos to everybody who did all that work. But the real work was done by recognizing that bias infects us tremendously and changes our practice, our way of thinking and our way of delivering care. And without that recognition, you’re not going to be able to practice good medicine in any field, but particularly in obesity medicine.

 

– Absolutely. I mean, it’s so wonderful to hear someone say it. Listen, I liked what you said about black people. ‘Cause listen, I have the same thing with people living with obesity. ‘Cause I live in this society. I have children, I have seen The Little Mermaid too many times to count. And, you know, and that stuff gets into your brain. And I will, you know, you talked about Tim Hortons, I’ve been in the grocery store and saw someone living in a larger body who has ice cream in their thing or pastries or something. And that automatic thought, like what are they thinking? Are, you know, are they that dumb? Right? And then I, like you said, I have to check myself like, I don’t know that person. Maybe that’s not for them. Maybe, you know, they’re entitled to occasionally have ice cream with their birthday cake too. Right, I think what you said was so amazing and so insightful and the fact that it’s in the guidelines is the reason why, you know, people go to these guidelines and they’re so often referred to. So, thank you. Thank you-

 

– Yes.

 

– For your participation in it.

 

– Awesome, thank you. Yeah. And I wanted to mention as well that when I think about the biases that people have against people living with obesity, you see somebody in a larger body size, they may not recognize at times that, that person is likely has, because they think this person doesn’t have any willpower. That person has so much willpower, they live with the need to do willpower every single day. Whereas, a person who’s naturally on the thinner side doesn’t even think about it. And we think that the thin person has the willpower. No, the person living with obesity has willpower. They could be 50 pounds bigger in like half an hour, in like a couple of weeks, very easily. So, the fact that they’re staying at 250 or 300 pounds means that they could have been 350, easily and they’re keeping off 50 pounds! That’s a lot! And we couldn’t even, if we lived in their brain for just a couple of minutes, we’d be like, whoa, this person has resilience and restricting incredibly, regardless of the fact of their elevated weight. So, that’s what I sometimes have to remind myself and remind them that even at their highest weight, they’re doing so much and working so hard and I’m so proud of them, and proud of them to even want to step to doing even, even more, which is just terrific. And that’s what I’m there to help them to actually do.

 

– I think we covered our bias break.

 

– I think so, yeah!

 

– For any new listeners, we usually have a segment called bias break, but I think Sean has definitely taken the top award here. I do not know if anyone has so succinctly described sort of the everyday interactions and the everyday occurrences that can contribute to the infection that is bias. Just the, the use of that term is so valuable for our listeners because it is only, unfortunately through my work with Obesity Canada that I started to think about bias. It’s fascinating. I’m at an academic institution where we talk about the IAT, the like tons of bias testing we have to do it for our interviews for med school interviews, and we have to go through different meetings and classes. It’s only when you start thinking about it in the way that I’d say Obesity Care has approached bias because it infects almost what we do, at sort of every stage of our life. And I think it’s probably one of the last, I would say, I guess agreed upon biases, right? And it’s one of those things that in society, oh, that’s okay, right? It’s a willpower issue, right? So, that’s fine, right? There’s a lot of biases that yes, we might not realize that, that we are contributing to it, but we understand- outwardly that it’s wrong.

 

– Yeah.

 

– Right.

 

– Right, right, right.

 

– Weight bias and weight stigma are things that are still generally speaking, felt to be approved by large segments of the population because they feel that’s only going to help the person, if we sort of encourage that weight bias and stigma because it’s just a matter of willpower. So, I think the way that you situated even these everyday experiences, bringing in Disney, hopefully, we don’t get a copyright issue with that, but I doubt it, right. But I love that you brought Disney because it starts from when you’re young.

 

– Yep.

 

– It starts from the very beginning. And I so appreciate you bringing that out. Thank you.

 

– Yes. Yes. And it was Ursula, I think, who is the bad one. I have to remember those type of things. Yes.

 

– So, I think we’re going to start looking at closing out the episode just because we’ve had an amazing opportunity to discuss so many, so many things about the guidelines. And I wish we could have even more time. Because there have been some sort of recent developments, I’d say, in the world of obesity medicine, given that we have this definition of obesity and we understand the limitations of BMI, can you explore some alternative measures and indicators that can be used in diagnosing obesity? Because I do think it’s important for us to talk about that, especially from what we hear, I mean, on a regular basis in obesity medicine, but definitely quite recently.

 

– Yeah. So, I think what we’ve recently had is The Lancet Commission. So, The Lancet is a journal and they are talking about the definition of obesity and what other things we can use. So, I applaud The Lancet Obesity Commission for stating that BMI is not the only thing we should look at. And it’s really about BMI cutoffs. BMI cutoffs are not the only thing. And if we are going to look at BMI cutoffs, let’s make it different for different people. All these things are kind of approximations of a person’s health. So, what a number of people have recommended, let’s use other things like waist circumference, waist-to-height ratio, waist-to-hip ratio, the body roundness. I think that all of these things have merit, but they’re still not as good as doing the blood work and doing your blood pressure and taking a family history and a medical history. My knee hurts and it’s osteoarthritis and the x-ray shows that at 25 years old, I have osteoarthritis. And it may be due to my BMI of 45, that may be a factor. Or if you have a BMI of like, you know, 35, and you’re a football player and you have no knee osteoarthritis, you don’t have obesity, so you don’t need the body roundness or the waist circumference. You’re a strong, healthy football player with blood work that shows it. And there isn’t a major issue. So, I still think that all of every other measurement, any measurement that we talk about pales in comparison to actual metabolic testing and physician histories. Okay, if we are going to use certain parameters, I like the EOSS parameter, the Edmonton Obesity Staging System, because what it essentially says is, if a person has excess adiposity or thinks they have some excess adiposity, you can kind of see it from across the room. They feel that they have it and they have type two diabetes, it’s probably due to, so again, the Edmonton Obesity Staging System looks at doing actual tests, right? You test the person’s knee with an x-ray for osteoarthritis, you do their blood work. And then you look at, so they have this medical condition type two diabetes. And then you look at, do they have excess adiposity and you probably don’t even need a waist circumference to do it, you can probably just look at them and they can tell you as well, it’s not fancy, it’s pretty clear. And then they would be in a certain stage. So, if you have type two diabetes and excess adiposity is the likely cause then you’re in Edmonton Obesity Stage Two. And all that, that stage two tells us is it’s a bit of a proxy for who should get the most intervention or who should get money for an intervention. If you have a limited amount of money, who should be awarded the money? Well, the person with the highest EO scale should get the most. And then as we move down, so somebody who has EO stage zero, they have some toxic fat cells or elevated weight and they have a family history of some stuff, but they don’t have anything themselves. They don’t have any pre-diabetes, they don’t have any medical problems, they’re in EO stage zero. Do they deserve treatment? Yes, they do. If they had, if we had to differentiate who gets the treatment first, based on money, then it wouldn’t be them. If we had a limited amount of money they would get, so that person would get lifestyle options as much as we possibly could. But if we had money for them, then we should treat them too, because they’re on their way to getting these problems. And so, even EOSS doesn’t necessarily tell you about the medical condition. The medical condition tells you about the medical condition. All EOSS was there to do was to tell you who should get funding based on a limited amount of actual funding. So, I don’t really feel that we should be doing a ton of DEXA scans, so the recommendation of The Lancet set as well was to do other measurements like DEXA scans. Well, if you know how, what a DEXA scan is, it’s a CT scan that looks at body fat versus muscle, et cetera. How much is a CT scan? Not a small amount of money? Oh, who has access to CT scan? How many CT scanners are there in the indigenous population? How many CT scanners are there in the black female Southern United States population? How many are there in Mexico? How many are there in the Polynesian islands? Oh, let’s do, The Lancet Commission, let’s do DEXA scans on people. No, let’s not do DEXA scans on people. Let’s talk to people, let’s do their blood pressure, let’s do their blood work that cost under $10. Let’s assess people properly and give doctors and patients the capacity and that they’re smart and they’re capable instead of a proxy of a DEXA scan that tells you exactly what the blood sugar would tell you. So, I’m disappointed in the thought that we would have to use all of these expensive, inaccessible, causing more lack of access to care, measurements, instead of using things that are accessible, like a medical history and blood work and a blood pressure cuff. So, that’s my take on it.

 

– I don’t want my millennial roots to show, but Where’s The Love from the Black Eyed Peas makes me think like what, just based on what you were saying before- about.

 

– Where’s The Love, that’s a good song.

 

– Where is the love in- all this, right?

 

– Yeah. Yeah.

 

– I mean that’s what you talked- about as a pillar.

 

– That’s right.

 

– The psychological health and the love that we need to show in clinical practice as individuals, as groups, none of that in my opinion, seems to come out of, let’s say, recent developments and not just this one-

 

– Not just, right.

 

– From the education realm too, right? When we were making the COEX, or the education competencies and what we’ve seen that have existed so far, there’s very little about understanding who that person is-

 

– Right, right. Let’s use the highest tech that we possibly can to try to diagnose a person who’s right in front of us and can talk to us. Like, where, as you said, where is the love when your recommendation is to use a multimillion-dollar piece of equipment that people don’t have access to? You clearly did not develop this in the Polynesian Islands. If you were writing the guidelines and you were in the Polynesian Islands or in the Louisiana suburb, you would not recommend this. There’s no love or appreciation or appropriateness when you recommend an expensive diagnostic test that people do not have access to. You’re recommending it for people in your group of people. If you’re on one of these guidelines, you’re probably an academic and you’ve got money and you’ve got capacity, so you’re recommending it for you, not for poor people, people who don’t have access to actual care. Why don’t you recommend things that, that they can actually access and probably would be just as good, if not better than just that diagnostic test, that may mess things up in the first place. Just do the right proper medical diagnostics.

 

– Yeah. That’s just, yeah. From a patient point of view, you know, I think we’re going to wrap this up, but you know, from a patient point of view, like really you need a DEXA scan? Like, I can’t sit in a chair in front of you in your office, and you go, “Hmm, I think she might “have some excessive fat tissue.” Right?

 

– Right.

 

– So, I think.

 

– And things like DEXA scan

 

– Common sense.

 

– And things like.

 

– Should prevail.

 

– DEXA scans.

 

– And things like DEXA scans are not just one, you have to do more than one because you’ve gotta repeat it and see how the change is happening and da, da, da, da, da. I mean, that’s not reasonable.

 

– Well, thank you so much for joining us today, Dr. Wharton. To our listeners, we hope our discussion has been informative and has opened your mind to be curious about the evolving science in the fast moving field of obesity.

 

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– And until next time, keep scaling up your practice. This podcast is intended for informational and educational purposes only, and does not constitute medical advice. The content shared in this podcast should never be used as a substitute for professional medical advice, diagnosis, or treatment. Always seek the guidance of a qualified healthcare professional with any questions you may have regarding your health or a medical condition. The information and treatments discussed in this podcast are based on Canadian guidelines and approved practices, as of the time of recording. If you’re listening from outside of Canada, please consult your local healthcare professional to ensure compliance with your region’s medical standards, guidelines, and recommendations. The creators of this podcast disclaim all liability for any decisions or actions taken based on the content discussed. Listening to this podcast does not establish a professional or patient-client relationship.