New Weight Management Group - Fall 2023
A new version of my Intensive Group Intervention for Weight Management/ Weight Loss is being offered this October 2023.
If you or someone you know is interested, please contact me , or you can print or share the link to my one sheet summary HERE .
If interested, you could read the post below that provides some background.
Dr.O
It has been over 10 years since I created Version 1.0 ! Some things have happened since then…
Obesity has come a long way
Obesity has gained almost universal recognition as a Chronic Disease - an important first step for patients living in larger bodies to get the resources and care they deserve.
Diabetes medications like Semaglutide (Ozempic, Wegovy) have transitioned to become effective, “game changing” Obesity medications, and there are more obesity medications to come, such as Tirzepatide (Mounjaro) or Retatrutide which has achieved levels of weight loss in phase 2 trials previously only ever achieved through bariatric surgery.
The success of Obesity medications has sent a destigmatizing message to the world - look at that, Obesity IS driven by biology, and it’s NOT an individual’s fault.
In 2020, the Canadian Adult Obesity Clinical Practice Guidelines (CPGs), were published - this 19 chapter living document, which is free for anyone to access, has become a game changer not only in Canada but around the world. The guidelines were an authoritative, scientific voice calling out the negative attitudes and beliefs that health care professionals hold towards people in larger bodies. Old habits die hard, but I feel we are slowly getting there.
The diagnosis of Obesity has continued to becoming more nuanced, with the success of the Edmonton Obesity Staging System, and the emergence of other models that look beyond BMI and emphasize that adipose tissue can become dysfunctional just like any other organ, and that body size or amount of adipose tissue does not determine obesity. Not only do these ensure the right approach for the right person, but they also emphasize that the diagnosis of obesity is a private matter that happens between a qualified professional and a patient, not an assumption you should make by looking at someone.
Obesity science is fast evolving, becoming a slightly less chaotic system - since the discovery of Leptin in the 1990’s, we have been learning more and more about the genetic underpinnings of obesity, how the body adapts metabolically to weight loss, as well as “what works” and what doesn’t, but we still have lot to learn. This recent article by Kevin Hall and others provides insight into some of the unanswered questions.
My practice has come a long way
When I offered my first weight management program, my brain was full of great information, I had already been to my first CON course, I had met Dr. Sharma who inspired me a great deal, I had attended a week long conference in the US and studied for the American Board of Obesity Medicine (ABOM) board exam (only to find out Naturopathic Doctors were not allowed to write it), and I had picked the brains of some older physician ‘gurus’ who taught me the ropes. What I was lacking was a deeper understanding of the psychology of behaviour change, to direct me on “when and how” to introduce information and effective strategies to patients.
Recently, I completed my Diploma in Counselling for Obesity Management (DCOM) , a program created by Dr. Michael Vallis, co-author of the Pyschological and Behavioural Interventions chapter of Obesity Canada’s guidelines. By far, the most influential course that I have taken in the last 10 years, this course gave me a better understanding of the science and psychological principles that underlie health behaviour and how those principles fit together.
It’s not about the Modules - A common way that Obesity management is practised is through the methodical introduction of information in modular format - Introduction module, followed by Calorie Counting module, followed by Meal Planning module, followed by CBT module, etc. This is somewhat how I did things at first, and unfortunately is how things need to go if you are providing a course in group format. The downside to this approach is that it can be somewhat didactic, which stands the risk of damaging the therapeutic power dynamic and fails to meet the patient “where they are at” in order to make the concept relevant to them. The other major problem with a modular approach is that it tends to focus on the relationship as a simple passing on of information, which typically does not empower change.
It’s all about YOU - While I still might present a module or handout from time to time, my primary focus is for you to learn about and become confident in the use of the various skills and knowledge of weight management, in a way that is relevant and timely to you. So, less “teaching and telling” and more patient-led discovery toward skill development. If you imagine that leading a healthy lifestyle is like building and maintaining a house over time, instead of just handing you a picture of the house and a list of materials, I slowly help you put together your own “tool belt” of science-informed strategies and then empower you on how to use those tools in a step by step fashion.
So that is the largest difference between Dr.O program 1.0 vs 2.0 - timely and patient centred inquiry that leads to the acquisition of and confidence to use certain skills and knowledge effectively and on your own. This means less of an emphasis on “here is an eating plan for you to follow” and more of an emphasis on “let’s talk about what will help you achieve that eating plan”. I learned one thing very quickly - patients with obesity are usually experts in healthy eating, it’s not more information that was missing.
Other improvements to my weight management practice include:
Improvement in Motivational Interviewing skills.
Development of more skills and strategies to prevent weight gain over time.
Greater understanding of and more skilled use of the powerful standard behaviour therapies, such as Goal Setting, Self Monitoring and Stimulus Control.
Better appreciation of the role of the therapeutic relationship itself as an effective treatment.
Understanding that the therapeutic relationship itself is powerful stimulus control.
Improved use of empathy and validation of lived experiences.
Greater understanding of and skill managing self-efficacy.
Increased confidence in recognizing weight bias and acting as an ally.
More skilled use of Acceptance and Commitment as well as Cognitive Behavioural approaches to behaviour change - both of which may support more sustained behaviour change.
Summary
Version 2.0 continues to have a strong emphasis on effective behavioural therapy elements like goal setting, self monitoring and stimulus control, but now has a much more sophisticated approach to assessing readiness, managing motivation, and instituting behaviour modification techniques. The end result is a program that seems less “clunky”, with one session transitioning to the next based more on your own experiences and wisdom rather than being told what to do by an “expert”.
Dr. Ryan Oughtred, ND, CBE, DCOM
Naturopathic Doctor, Certified Bariatric Educator, Counselling for Obesity Management, Vancouver, Whistler, Online.