Obesity is prevalent among working-age people in Canada, with 24.6 per cent of people age 18 to 34; 33.2 per cent of people age 35 to 49; and 33.9 per cent of people age 50 to 64 self-reporting it.1 A chronic and often progressive disease, obesity is linked to poorer quality of life, worse mental health and serious health conditions, such as cancer, diabetes and cardiovascular disease.2 Sandra Elia experienced her darkest moments with obesity in her late 20s, but has since found sustainable ways to manage her weight and build a thriving career as a certified food addiction counselor, author and public speaker. She’s also board chair and director of education and patient advocacy with Obesity Matters.

Can you describe how obesity has affected you throughout the years?

Obesity cast a dark shadow over most of my life. It dramatically affected my self-esteem growing up. It’s been a daily battle against intrusive food thoughts. Even when it comes to just getting dressed in the morning, I can never wear exactly what I want. Everything from office chairs to airplane seats weren’t built for my size. And it’s impossible not to internalize the narrative of fat shamers.

As a teen in the 1980s—an era of diet culture and the glorification of thinness—I was desperate to lose weight and got on the rollercoaster ride of restrictive dieting, followed by overeating and gaining back all the weight and then some. I had dieted my way into obesity by the time I was in my 20s. I went to my doctor for help, but she oversimplified it to “calories in versus calories out” and made me feel inadequate and ashamed. I stopped going to the doctor because I couldn’t face her.

During one of the times, I managed to stick to a restrictive diet, lost 50 pounds and landed a job at a prestigious global consulting firm. Then at 29, I found myself in a perfect storm of family stress and within a year and a half, I gained 100 pounds. My physical and mental health plummeted, and my career stopped. I became less client-facing, my office was moved to a different floor and in the end, I had to take an extended sick leave. But I didn’t want to go back to the doctor and have her say, “I thought I told you to eat less and move more.”

What aspects of this disease have been most difficult for you?

It’s always been complex—and it’s always involved physical, emotional and social challenges. Physically and socially, at my heaviest, my mobility was significantly impacted; I had lower back pain and I couldn’t keep up with my peers. Emotionally, it takes so much mental real estate to turn away from food cravings, compulsions and urges to overeat; and the more I weighed, the less I thought I was worth. It was also tough facing preconceived notions that people living with obesity are lazy, lack willpower and aren’t as intelligent.

What other misconceptions do people have about obesity?

One is that it’s a lifestyle choice. This is a real medical condition that’s complex, chronic, relapsing and deserves treatment—and treatment is not “eat less and move more.” As patients, we shouldn’t accept that as a treatment plan. Also, there are a lot of contributing factors, including genetic, environmental, psychological and societal factors, and many of these are outside my control. No one chooses obesity.

Another misconception is that diets work. They don’t. There’s research to prove that almost all diets work in the short term, but we have even more research to show that more than 95 per cent of all diets ultimately fail. Yet the finger of blame is always pointed at the person living with obesity.

What have you done to address the physical and mental-health impacts of obesity?

I’ve taken an intentional approach and have found that the more interventions I have, the better the outcome. This is because obesity is complex, with many contributing factors, so there isn’t one single answer.

My No. 1 priority is sleep. It’s the first line of defence in maintaining good health and managing chronic illnesses like obesity. I’ve also had to figure out a sustainable meal plan, tailored to me and my health needs, activity needs and cultural preferences. I need movement, of course, but I’ve let go of the myth of “no pain, no gain” because I can’t do stuff that’s painful for a long time. I’ve found things I love to do that ensure consistency. It’s also important to be part of a supportive community to reduce the loneliness often experienced alongside obesity.

Counselling and mindfulness have played a considerable role for me, too. The biggest shift was understanding that the number on the scale is not the prize. Instead, I focus on mobility, flexibility, strength, better sleep, better self-esteem, better presence and better blood work. I got rid of the scale and I always say, “My weight is none of my business.” My business is to eat whole, fresh foods, move my body, as well as love and enjoy the body I have today because I’m never getting this day back.

We’re lucky to live in a time where there are safe anti-obesity medications. They’re another important tool to help quiet the food noise, so you can build a village of interventions and set yourself up for success.

What can employers do to better support employees with obesity?

The employer I had when I was in my late 20s wasn’t supportive. At my heaviest, I asked for a modified work week to take time off to manage obesity and was denied; however, the sick leave I took ultimately cost them more. When I returned to work, my manager mentioned they could see I was struggling and getting sicker by the month. Why did they just watch an employee suffer when it was so evident?

Employers need to take care of their employees, especially if they’re in an environment that may contribute to obesity—for example, jobs that require shift work, have little autonomy or are very stressful. They can offer resources specifically focused on elevated weight and obesity, perhaps by tapping into organizations like Obesity Matters and Obesity Canada. Another way is to increase the variety of mental-health services available to employees to address the psychological aspects of eating and weight management. Also, employers should emphasize inclusivity and diversity related to body size; simple things like providing chairs that accommodate different bodies, being sensitive to team-building events that require a certain level of physical activity, and doing regular check-ins on accommodations can make a big difference.

What changes would you like to see in attitudes towards obesity?

I’d like to see broader recognition that obesity is a complex medical condition that has little to do with will power and lifestyle choices. When we drop the judgement, we can look for solutions. Focusing on health and not just weight, as well as having a lens of compassion, empathy and support for people who are living with obesity are great places to start. Health-care professionals need to create a safe environment for patients to come forward and talk about obesity-related issues and they need to help people with internalized bias and stigma. Meanwhile, public policies should educate and support people, improve access to nutritious foods, encourage environments that are conducive to physical activity and offer coverage for anti-obesity medications.

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