Endorsing Change: Obesity Canada's Take on the 2025 Lancet Commission on Clinical Obesity

By Dr. Sanjeev Sockalingam , Scientific Director of Obesity Canada

Ten years ago, the Canadian Medical Association recognized obesity as a chronic disease. Yet, for many Canadians and healthcare providers, understanding what this means for patients and the care of people living with obesity remains a challenge.?

In 2020, Obesity Canada (in collaboration with CABPS) published the Canadian Obesity Clinical Practice Guideline to help address this critical gap in evidence-informed knowledge, treatment, and care for patients living with obesity.?

The Canadian guideline defines obesity as a “complex chronic disease in which abnormal or excess body fat (adiposity) impairs health, increases the risk of long-term medical complications, and reduces lifespan.”

The? 2025 Lancet Commission on Clinical Obesity further classifies obesity as either “pre-clinical” or “clinical” and offers five key takeaways that reinforce much of the science and knowledge that Obesity Canada has championed over the past decade. As endorsers to this report, we’re proud to see many of our established principles and priorities reflected.?

While the Lancet Commission is an important step in recognizing and addressing obesity as a chronic disease, this article will explore the progress it represents and the gaps that, if filled, could further help improve care and support for people living with obesity.

A paradigm shift: Understanding the complexity and nuance of obesity as a chronic disease

One of the most important insights from the Lancet Commission is the distinction between "clinical obesity" and "pre-clinical obesity."

Clinical obesity is defined as a chronic disease where excess fat (adiposity) directly causes specific signs or symptoms of organ dysfunction. This differentiation challenges the common misconception that all obesity is the same and aligns closely with Obesity Canada’s Canadian Obesity Guidelines. While not everyone living with obesity experiences clinical illness, for those who do, timely and evidence-based care is necessary.

By reframing obesity as a distinct chronic disease—rather than simply a risk factor—we can provide clarity for healthcare providers and ensure that people living with obesity receive the same access to care and support as those with other chronic conditions. This shift is essential to improve outcomes and reduce stigma.

Beyond BMI: Moving toward patient-centered measures

Body mass index (BMI) is widely used, but it is a screening tool and not enough to diagnose obesity as a disease. BMI doesn’t measure fat distribution, organ health, or how excess adiposity affects a person’s daily life.

The Lancet Commission, like Obesity Canada’s Guideline, emphasizes the need for more nuanced diagnostic tools, such as waist-to-hip ratio, body fat percentage, and imaging to assess fat distribution, to provide a more complete picture for diagnosis.

Clinicians must collaborate with individuals living with obesity to fully understand how the condition impacts their health and daily functioning. This approach ensures that diagnosing clinical obesity isn’t overlooked by relying solely on oversimplified measures like BMI.

Personalized care: Tailoring support to individual needs

Personalized care is essential for effective obesity management. The Lancet Commission highlights the importance of different strategies for clinical and pre-clinical obesity.

Obesity Canada has long emphasized the need for healthcare providers to collaborate with patients living with obesity to set shared goals. For those with pre-clinical obesity, this means focusing on prevention through lifestyle counselling and monitoring, as recommended by the Lancet Commission.

Obesity care in Canada should include timely access, shared decision-making, and treatment aligned with a patient’s values. These may include behavioural therapy, medication, or surgery that can support patients living with clinical obesity.

This individualized, patient-centered approach ensures that care is both effective and equitable, addressing the unique needs of each patient.

Combating stigma: Eliminating blame, fostering compassion

Weight-based stigma remains one of the greatest barriers to effective obesity care. Misconceptions that obesity is solely due to willpower or lifestyle choices perpetuate blame and shame, creating barriers to compassionate, evidence-based care.

The Lancet Commission calls for stigma-free care rooted in compassion and evidence. Training healthcare professionals to address weight stigma and prioritize shared decision-making is essential to creating supportive and inclusive environments for patients.

Reducing stigma and bias have been a core part of Obesity Canada’s mission for 20 years, and will continue to be for 2025 and beyond, aligning with the Commission’s call to action.?

As a society—and especially in healthcare—we must provide inclusive environments for people living with obesity. That includes providing clinic environments with appropriate furniture, equipment and staff training, addressing language and images that are stigmatizing in the media, and collective advocacy to change policies, improve training, and remove barriers to care.?

Addressing the gaps: Mental health is integral to comprehensive obesity care

While the Lancet Commission offers a strong framework for defining and diagnosing obesity, it omits a crucial element: the bidirectional relationship between mental health and obesity.

Mental health disorders, such as depression and anxiety, are both causes and consequences of obesity. People living with obesity face higher risks of mental health challenges due to stigma, low self-esteem, and the physiological effects of excess adiposity on brain function. At the same time, mental health conditions can contribute to obesity by influencing disordered eating, physical activity, and stress-related effects.?

The Canadian Obesity Clinical Practice Guideline recognizes this connection and recommends integrating mental health support into comprehensive obesity care. Effective approaches should include mental health screening, access to psychological support, and team-based care that addresses both physical and mental well-being.

To dismantle stigma and deliver truly compassionate care, mental health must be a central part of comprehensive clinical obesity treatment.

Building a future of hope and systemic change

Healthcare systems can address obesity as a complex chronic disease through education and training. The Lancet Commission emphasizes the importance of retraining healthcare professionals using structured frameworks.

Obesity Canada has developed comprehensive education competencies for health professionals, spanning undergraduate, postgraduate, and continuing education. These competencies focus on defining obesity as a chronic disease, addressing stigma, and implementing evidence-based treatments. By aligning clinical practice with the latest science through education, we can improve outcomes for people living with obesity and prepare future healthcare providers for the challenges ahead.

The insights from the Lancet Commission complement Obesity Canada’s ongoing efforts to advance obesity care. By reframing obesity as a chronic disease, adopting patient-centered measures, personalizing care, eliminating stigma, and investing in education, we can create a future where every person living with obesity receives the care they need and deserve.?

Now is the time for collective action?

The cost of inaction in treating obesity in Canada is far too great—impacting not only individuals but also the healthcare system and economy as a whole. To learn more about the urgent need for systemic change, visit Obesity Canada’s Cost of Inaction report. If you’re ready to help advocate for improved access to care for people living with obesity, join our movement by taking action here. Let’s create meaningful change together.