🎙️This episode is sponsored by an unrestricted education grant from Eli Lilly Canada

What happens when obesity assessment stops at BMI?

In this episode of Scale Up Your Practice, we speak with Dr. Kristin Terenzi, family physician based in Ontario, about what it really means to assess obesity well in primary care.

Drawing on both clinical experience and lived experience, Dr. Terenzi discusses how the 4Ms framework can help clinicians move beyond weight alone to better understand the mental, mechanical, metabolic, and social factors affecting a person’s health.

The conversation explores how stigma and self-blame can shape the care experience, why trust matters, and how thoughtful, realistic assessment can open the door to care that feels more supportive, more practical, and more effective over time.

In this episode

• Why obesity assessment needs to go beyond BMI to explore the mental, mechanical, metabolic, and social factors shaping a person’s health.
• How the 4Ms framework can help clinicians uncover root causes, understand barriers, and build more realistic care plans.
• What internalized weight bias and self-blame can sound like in practice, and how clinicians can respond in ways that build trust and reduce shame.
• Why follow-up, shared decision-making, and focusing on function rather than weight can help patients stay engaged in long-term care.

Additional resources

• Free course: Obesity Assessment Essentials https://utm.guru/upqGa 
• Assessment of People Living with Obesity chapter of the Canadian Adult Obesity Clinical Practice Guidelines https://utm.guru/upqGv 
• PDF download: 5As Framework for Obesity Management in Adults https://utm.guru/upqGQ  
• PDF download: The Edmonton Obesity Staging System https://utm.guru/upqHa 

Learning objectives

• Apply the 4Ms framework (Mental, Mechanical, Metabolic, Monetary/Milieu) to obtain a comprehensive, obesity-focused patient history that identifies the root causes of weight gain.
• Analyze the biological and psychosocial drivers of obesity—including life transitions like menopause and mechanical barriers like osteoarthritis—to co-construct individualized, evidence-based management plans.
• Evaluate how systemic weight bias and internalized shame prevent patients from seeking care, and implement stigma-free communication to build therapeutic trust.

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Disclosures

This episode script was developed using NotebookLM to synthesize complex source materials into a structured educational format. The tool was used to analyze the Canadian Obesity Education Competencies (COECs), the Obesity Canada Strategic Plan, and guest-specific research. Specific prompts were utilized to extract relevant learning objectives, map them to CanMEDS roles, and generate competency-based interview questions.

While NotebookLM assisted in drafting the narrative arc and educational framework, all content has been reviewed, fact-checked, and refined by the podcast hosts and Obesity Canada's clinical experts. This ensures the script aligns with current Clinical Practice Guidelines and authentically represents the lived experience perspective.