Changing the way society thinks about obesity could improve efforts to combat weight problems and the health issues associated with them, according to an expert in the field.
Dr. Yoni Freedhoff, medical director of Ottawa’s Bariatric Medical Institute, told delegates at Benefits Canada’s Chronic Disease at Work conference in May that no country in the world has seen its population lose weight in modern times.
“We tend to see it as a disease of willpower: that people aren’t trying hard enough, they don’t want it badly enough. They just need to push away from the table. But I find it hard to rationalize the idea that this is a global epidemic loss-of-willpower disease. I don’t think that’s what’s happening,” said Freedhoff.
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Instead, Freedhoff said it’s better to characterize obesity as a “disease of the environment,” brought on by changing eating habits and attitudes to food. He said consumption of junk and processed foods have become so mainstream that even health charities use them in their fundraising efforts. For example, Freedhoff showed an ad for a juvenile diabetes campaign that raised money by selling chocolate bars.
“I’m not suggesting that the people who come up with these ideas are trying to do harm. . . . This is our new normal, and people don’t question normal. But it’s normal behaviour that we ought to stop.”
In recent years, a number of medical groups, including the Canadian Medical Association, have recognized obesity as a chronic disease, a move Freedhoff hopes will signal a shift in the way employers think about treatment and coverage options.
“Basically, the treatment is similar to what we see with other diseases. You start with lifestyle changes, but we only moralize about obesity. It’s the only condition where we blame people and say, because you could theoretically do it on your own, we can’t help you,” he said. “I don’t have to ask the question about which health plans cover drugs for hypertension. But if I ask who covers drugs for obesity, I’d be surprised if I see a whole bunch of hands.”
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Freedhoff says employers could support their employees by pointing them to reputable obesity management professionals.
“Unfortunately, we don’t regulate weight loss in Ontario, so there are a whole bunch of quacks out there just waiting to meet your workforce,” he said. “Having ethical places to send people is crucial.”
Anti-obesity medications can also prove beneficial in some cases, although Freedhoff says few plans cover them. He pointed to a recent report from the Canadian Obesity Network as evidence of the significant gap Canadians face in accessing obesity-related treatments.
In a sample of Canadians with private drug insurance, just 8.8 per cent had access to anti-obesity medications through their plans, the report found. Those who rely on public coverage for prescription drug costs don’t have access to the two prescription anti-obesity medications in Canada.
“Even if you could get your workforce to stop gaining, that would have some benefits,” Freedhoff added, noting that even small weight gains in patients with high body mass index scores can significantly increase the cost of their care.