Benefits plans tend to cover care for common chronic conditions such as diabetes, hypertension and chronic obstructive lung disease. But the one they often don’t support is obesity, said Arya Sharma, scientific director at Obesity Canada and clinical co-chair of Alberta Health Services’ obesity program, during Benefits Canada’s 2021 Chronic Disease at Work conference in late February.
The organization’s 2019 report card on access to care for obesity treatments found in a sample 9.6 million Canadians with private drug benefits plans, only about 10.4 per cent have plans that include coverage for anti-obesity medications. Meanwhile, private plans provide “extensive” coverage for other chronic disease medications.
“When you manage someone with obesity, you’re managing chronic disease. And so we have to apply all the known principles of chronic disease management, self-monitoring, patient education [and] self-management,” Sharma said. “We also have to consider of course [that] in order for patients to be able to do this, they need to have access to those treatment options.”
Obesity, defined as the presence of abnormal or excess body fat that impairs health, is a complex condition that involves genetic factors as well as psychosocial and environmental determinants of health. It’s also, Sharma stressed, a chronic health issue.
“Weight is actually something that is very tightly controlled by a very complex biological system . . . [with] one purpose and one purpose only, and that is to protect you from weight loss,” he said. “It doesn’t matter how you manage to lose weight, you are essentially always going to be fighting your own biology that wants to put your weight back to where you started. . . . So we’re talking about a chronic, lifelong condition.”
Sharma said obesity should be treated as a chronic disease in workplace health and well-being programs, rather than with more generalized lifestyle interventions. “If everybody [in the workplace is] going to benefit from them, then these are not specific treatments for obesity,” he said.
During the session, Ximena Ramos Salas, director of research and policy at Obesity Canada, emphasized the importance of employers understanding their own beliefs and attitudes about weight when developing workplace wellness programs for obesity and how they impact employees living with obesity.
“Weight bias is pervasive in our culture, and most of us will have some level of weight bias,” she said. “Unless we’re aware . . . of [these] attitudes and beliefs, we can’t really change them.”
Studies have shown people with obesity will avoid health-promoting behaviours for fear of being judged, shamed and blamed for their weight, and feeling shamed can also trigger disordered eating, she said. “In other words, shaming people does not change their behaviours. In fact, the opposite is true. . . . We must also understand the science so that we can develop evidence-based solutions that go beyond telling people to eat less and move more, which could unintentionally contribute to more weight-biased attitudes and beliefs in the workplace.”
According to a recent study by the UK-based Institute for Employment Studies, 54 per cent of employees with obesity reported experiencing weight bias and stigma from their co-workers, and 43 per cent reported experiencing it from their employers or supervisors. The authors concluded employers’ lack of understanding of obesity “may be leading to stigmatizing recruitment and selection decisions,” Ramos Salas said.
The study also found employers don’t understand the causes of obesity, leading to stereotypical beliefs that people with obesity are lazy, less conscientious and incompetent. “Studies show that employees with obesity are not regarded as able leaders or to have career potential, and they have less success in getting jobs and receive lower starting pay. They’re also more likely to experience bullying and harassment in the workplace.”
Ian Patton, director of advocacy and public engagement at Obesity Canada, said if employers concentrated their focus on rooting out weight bias in the workplace, it could have multiple positive outcomes.
“What would have a huge impact is actually working to eliminate some of the bias. Some of the bias that we’ve talked about is actually internalized bias, so people not wanting to or [being] fearful of asking for help or seeking those treatments [out of fear they’re] going to be judged or stigmatized,” he said. “Something that workplaces could do is to normalize those sorts of treatments and [access to] those treatments . . . so it’s a comfortable thing that people feel they have the right to do.”