Discomfort with Obesity Care Standards for the Masses

Obesity care is in the midst of an awkward but critical transition. Standards of care for obesity are leaking out from specialists in obesity medicine through a process of translation to the setting of primary care for the masses. Primary care for obesity will draw upon the authoritative work of organizations like Obesity Canada, The Obesity Society, and the European Association for the Study of Obesity.

But it will not be the same.

Discomfort with this is evident as the American Diabetes Association begins rolling out its 2025 Standards of Care in Overweight and Obesity.

Me-Too Guidelines?

Last week, ADA published two chapters of its standards in BMJ Open Diabetes Research & Care. Those chapters were the “Introduction & Methodology” and “Weight Stigma and Bias.”

On LinkedIn, Arya Sharma dismissed the work as offering “absolutely nothing new.” He wrote:

“While one may congratulate the ADA, after having in the past largely ignored the importance of obesity and compassionate obesity care in diabetes management, it is also little more than a blatantly obvious attempt to stay relevant by scrambling aboard the obesity train that is fast leaving the station.”

Pride of Authorship

Sharma has good reason for pride of authorship in the outstanding work of Obesity Canada in publishing the landmark 2020 Canadian Clinical Practice Guidelines for Obesity. They made a mark and set a standard for care with a firm focus on advancing health without over-emphasizing weight. They also made it clear that weight bias and stigma are perhaps the biggest obstacles to good care.

The core principles and technical standards in these guidelines might evolve over time, but their quality will be hard to surpass.

The Challenge of Care at Scale

But the biggest challenge we face has become one of delivering care at scale. For this challenge, standards for care must not only set the bar for quality of care. They must also reach a much larger audience than specialty groups and academic centers will ever reach.

Obesity care needs to move into primary care. It is already moving into telemedicine settings. And yet, only a fraction of the people who need it are currently receiving it.

If clinical practice guidelines or standards of care are to mean anything, they must reach a much larger audience of healthcare professionals than the Canadian Clinical Practice Guidelines have reached.

So Sharma and others in the elite context of clinical obesity science may well be right. ADA may have nothing new to offer in the science and art of obesity medicine. But standards of care for obesity reaching the broad audience that needs it will be a vital service to people living with obesity.

It remains to be seen if the ADA can deliver on that.

Click here and here for the new ADA publications on standards of care in overweight and obesity. For the 2020 Canadian Clinical Practice Guidelines, click here.

Eye of Providence at the Gate of Aachen Cathedral, photograph by Trexer, licensed under CC BY-SA 3.0

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May 19, 2025