Some 8.4 million adult Canadians adults live with obesity and severe obesity has increased 455 per cent since 1985, according to Dr. Mary Forhan (pictured left), scientific director-elect of Obesity Canada, during a session supported by Desjardins Insurance at Benefits Canada‘s 2022 Chronic Disease at Work event in February.
Although many believe that people can control of their weight through their individual behaviours or choices such as healthy eating and exercise, this belief isn’t based on science, said Dr. Ximena Ramos Salas (pictured right), director of research and policy consultant at Obesity Canada, during same session. “In fact, weight is highly controlled by our bodies. Weight, like our height, is also highly genetic. Up to 50 to 60 per cent of our weight is determined by our genes and we have very little control of our own weight.”
Obesity has been recognized as a chronic disease by the Canadian and American medical associations, the World Health Organization and many other professional associations. The publication of Canadian clinical practice guideline for obesity management in adults in 2020, said Forhan, summarized the best evidence to provide practical recommendations for the management of obesity and demonstrated that diet and exercise programs alone aren’t enough to treat obesity.
The guidelines recommend that people living with obesity should have access to medical nutrition therapy and physical activity interventions, in combination with three adjunctive evidence-based obesity treatments, which are behavioural interventions and psychological therapies, medications and bariatric surgery – all of which should be tailored to meet the individual’s health or obesity related needs and outcomes.
“People living with obesity face pervasive weight bias and stigma throughout their lives in many different settings, including the health-care system, schools and workplaces,” said Ramos Salas. Unfortunately, she added, many people aren’t aware they have weight bias beliefs and attitudes, which are driven by misinformation and stereotypes about weight and people living with obesity.
Individuals faced with weight bias can internalize these negative attitudes and beliefs, which can have negative effects on a person’s health and be a barrier to obesity management, she added.
“This bias and stigma make it harder for us to make changes or ask for what we need,” said Dr. Ian Patton (pictured centre), a person living with obesity and Obesity Canada’s director of advocacy and public engagement.
“People living with obesity face constant struggles to find adequate resources and to achieve better health and well-being and struggle on their own to manage their disease or continue to receive advice to lose weight by going on diets or exercising more,” said Forhan.
Although there has been tremendous progress in developing obesity treatments, they aren’t accessible to all Canadians, she said, noting fewer than 20 per cent of the Canadian population with private drug benefits plans have access to the medications approved by Health Canada for obesity treatment.
People with obesity can have feelings of hopelessness and frustration, said Patton, because “there are things that we can do, but we can’t access them.” He said he can’t imagine a referral to a specialist who provides a prescription for a daily medication to manage the disease only to find out he doesn’t have access. But that’s an everyday occurrence for people living with obesity that probably wouldn’t happen to people with conditions like diabetes, he added.
About two-thirds (63 per cent) of employers believe people living with obesity could manage their weight if they just set their minds to it, said Forhan, “Many employers do not understand that obesity is a chronic disease,” she added, and may not think that people living with obesity should have access to evidence-based treatments.
“Plan sponsors can review workplace [and] benefits plan policies to see whether they are leading to unfair treatment for people living with higher weights or obesity,” said Ramos Salas.
For example, she suggested benefits plan providers ensure their policies are based on the latest scientific understanding of obesity and cover obesity treatments in the same way they cover treatments for other chronic diseases, such as diabetes or hypertension, rather than exclude them by categorizing them as a lifestyle treatment.
She also recommended that plan sponsors review workplace policies to ensure they aren’t unintentionally contributing to weight bias and stigma. She noted individuals living with obesity don’t need anything extra, simply access to the same standard of care as other chronic diseases. “Obesity is a very complex disease and weight is not solely controllable through individual behaviours. We must change this fundamental misconception and build policies based on science and patient experiences.”
Read more coverage of the 2022 Chronic Disease at Work conference.