Canadian Adult Obesity Clinical Practice Guidelines to help transform care standards

Obesity Canada, in collaboration with the Canadian Association for Bariatric Physicians and Surgeons, has developed the Canadian Adult Obesity Clinical Practice Guideline, to help transform care standards and ensuring patients receive the respect and support they deserve.

“Pharmacotherapy can help people living with obesity improve overall health, not just lose weight,” says Dr Sue D Pedersen, endocrinologist and obesity medicine specialist in Calgary, and lead author of this guideline. “The goal of obesity medications is to improve metabolic, mechanical, and/or mental health, and improve quality of life, incorporating treatment goals that are important to each individual patient.”

The guideline includes six new and seven revised recommendations, reflecting the latest evidence since the 2022 and 2020 versions of the guideline. It takes the emphasis off body mass index (BMI) and focuses on an individualised approach that uses additional indicators, such as waist circumference, waist-to-hip ratio, waist-to-height ratio, adjusted for sex and ethnicity where appropriate, and the presence of obesity-related complications.

Recommendations include two new medications, tirzepatide and setmelanotide, as well as new recommendations for obesity-related complications such as atherosclerotic cardiovascular disease, heart failure with preserved ejection fraction, osteoarthritis, and more.

The guideline recommends against using compounded obesity medications because of concerns about content, safety, efficacy and quality.

Recommendations are summarised in the Canadian Medical Association Journal, with 19 detailed chapters available to download. These open-source chapters will be updated as new evidence arises. Most recently, the chapter on pharmacotherapy in obesity management was updated in 2025 to reflect the latest research and treatment options.

The recommendations:

• Healthcare providers should assess their own attitudes and beliefs regarding obesity and consider how their attitudes and beliefs may influence care delivery (Level 1A; Grade A).

• Healthcare providers should recognize that internalized weight bias (bias towards oneself) in people living with obesity can affect behavioural and health outcomes (Level 2A; Grade B).

• Healthcare providers should avoid using judgmental words, (level 1A, grade A), images (Level 2B, Grade B) and practices (Level 2A, Grade B) when working with patients living with obesity.

• They recommend that healthcare providers avoid making assumptions that an ailment or complaint a patient presents with is related to their body weight (Level 3, Grade C).

Key messages for people living with obesity

Weight bias may affect quality of healthcare for individuals with obesity. For example, weight bias may negatively affect health professionals’ attitudes and behaviours toward individuals living with obesity.

Experiences of weight bias can harm your health and well-being. Experiencing unequal treatment because of your size or weight, for example, is not acceptable. Talk to your healthcare provider about your experiences with weight bias. Speak up and support action to stop weight-based discrimination.

Talk to your healthcare provider about addressing internalized weight bias. Bias can impact your behaviours and your health. Self-stigma and self-blame can be addressed through behavioural interventions, consistent with the principles of cognitive behaviour therapy and acceptance and commitment therapy. (See the “Effective Psychological and Behavioural Interventions for People Living with Obesity” chapter for more information on these therapies.)

Try focusing on improving healthy habits and quality of life rather than weight loss. Weight is not a behaviour and should not be a target for behaviour change.

Key messages for healthcare policy makers

Policy makers developing obesity policies should assess and reflect on their own attitudes and beliefs related to obesity.

Public health policy makers should avoid using stigmatizing language and images. It is well established that shaming does not change behaviours. In fact, shaming can increase the likelihood of individuals pursuing unhealthy behaviours and has no place in an evidence-based approach to obesity management.

Avoid making assumptions in population health policies that healthy behaviours will or should result in weight change. Weight is not a behaviour and should not be a target for behaviour change. Avoid evaluating healthy eating and physical activity policies, programs and campaigns in terms of population level weight or BMI outcomes. Instead, emphasize health and quality of life for people of all sizes. Because weight bias contributes to health and social inequalities, advocate for and support people living with obesity. This includes supporting policy action to prevent weight bias and weight-based discrimination.

Policy makers should know that most people living with obesity have experienced weight bias or some form of weight-based discrimination. Public health policy makers should consider weight bias and obesity stigma as added burdens on population health outcomes and develop interventions to address them. To avoid compounding the problem, we encourage policy makers to do no harm, and to develop people-centred policies that move beyond personal responsibility, recognize the complexity of obesity, and promote health, dignity and respect, regardless of body weight or shape.

Health care providers should ensure their clinical environment is accessible, safe and respectful to all patients regardless of their weight or size. Make efforts to improve health and quality of life rather than solely focusing on obesity management. Ask permission before weighing someone, and never weigh people in front of others; instead, place weighing scales in private areas. Health care providers should consider how their office’s physical space accommodates people of all sizes and ensure they have properly sized equipment (e.g., blood pressure cuffs, gowns, chairs, beds) ready in clinical rooms prior to patients arriving. Because weight bias impacts morbidity and mortality, advocate for and support people living with obesity. This includes action to create supportive healthcare environments and policies for people of all sizes.

“Obesity pharmacotherapy is a safe and effective option to support long-term obesity care,” added Pedersen. “It is one of three pillars of treatment outlined in the full Canadian Adult Obesity Clinical Practice Guideline, with other pillars being behavioural and psychological and surgical approaches. Obesity treatment should always be tailored to each person’s specific health needs, values, and preferences. Recommendations also support sustained use of obesity pharmacotherapy as part of a long-term strategy to maintain improvements in health and quality of life.”

The full guideline and related tools can be found on the Obesity Canada website here. The recommendations were featured in the paper, ‘Pharmacotherapy for obesity management in adults: 2025 clinical practice guideline update, published in the Canadian Medical Association Journal.