Thursday, September 8, 2011

Alberta’s Obesity Initiative: Not Just Diet and Exercise!

From left, Dr. Arya Sharma, Health Minister Gene Zwozdesky, patient Jim Starko and Alberta Health Services CEO Dr. Chris Eagle

From left, Dr. Arya Sharma, Health Minister Gene Zwozdesky, patient Jim Starko and Alberta Health Services CEO Dr. Chris Eagle


Yesterday, Alberta Health Services CEO, Dr. Chris Eagle, formally announced the launch of a 5-year comprehensive initiative, that will address Alberta’s obesity problem across the continuum of care – from prevention and health promotion – to primary care – to speciality services, including increased capacity for bariatric surgery.

At the launch event, Alberta’s Minister of Health and Wellness, Gene Zwozdesky, not only demonstrated the Government’s full support but also emphasized its commitment to provide stable funding for this important initiative – as he pointed out, there will be no quick fix, but not addressing obesity is simply not an option.

The following are excerpts from my brief presentation at this launch:

“Four years ago, I came to Alberta because I saw the opportunity to help do something that no health system has done before – find a way to address what many consider the greatest health problem of our times – obesity, a condition that today causes more pain, suffering, despair, frustration and cost to Albertans than any other medical condition.

If simply losing weight by eating less and moving more worked as a treatment for obesity, we would not have this problem – I have yet to meet an obese patient, who has never lost weight before – many have lost 100s of lbs over their lifetime only to put them back on.

Imagine the will power and commitment that goes into losing 100s of lbs – these are not lazy people, they are not people who are not motivated, they are not people who do not understand how their excess weight affects their health or their livelihood– they are not people who are stupid or just don’t get it.

When you hear someone say that all you need is a life style change – I have a message for you – “Changing your lifestyle is more about changing your life than your style”.

We work more hours today than ever before – many of us check our e-mails before we get out of bed – we check them again last thing before turning out the lights. We sleep fewer hours than ever before, we have longer commutes, we have fewer children, we have less time to buy and prepare healthy foods – unhealthy foods have never been cheaper – healthy foods have never been more expensive. I have often said that the so-called ‘fast-food problem’ is not really a ‘food’ problem at all – it is a ‘time’ problem – we have created a society in which we do not even have enough time to eat.

Our parents and grandparents were paid to be physically active – today you have to pay to be physically active, and I am not just talking about buying a good pair of running shoes – for many of us time IS money.

We use food for comfort, to celebrate, but also to cope with stress, depression, anxiety, trauma, addictions, lack of sleep, physical and emotional pain.

Our genes have not changed, but we know now that the genes you got from your parents and grandparents can actually be switched on or off, depending on how much weight your mother gained during pregnancy, what she ate, how much she exercised, not to mention smoking, stress, or gestational diabetes – all of which can permanently change how genes you are born with actually work – In fact, there is now good evidence that perhaps much of childhood obesity starts in the womb.

So not only are there many causes of obesity – stress, depression, lack of sleep or even medications that can make you gain weight – unfortunately, there is also no simple solution to losing weight and keeping it off – yes, losing weight is easy, but keeping it off is not. This is why commercial weight loss centres can sell you weight-loss, but cannot offer you obesity treatment.

In fact, whether you lose weight by dieting, exercising, taking pills or even having surgery – when the treatment stops the weight comes back – this is why we consider obesity a chronic disease!

In fact, rather than talking about losing weight – we would already be better off if people simply stopped gaining weight – if you are 200 lbs today and still only 200 lbs in 10 years – you will have done pretty well!

That is exactly the challenge we face – Although we now have a better understanding of the complex societal, psychological and biomedical causes of obesity – we do not have a cure.

The good news is that we can prevent obesity and for those, who already carry extra weight, we do have treatments that work – however, the same principles apply as for any chronic disease – patient education, professional guidance and using the many resources in the community to better manage this condition.

Unfortunately, despite all of this – those with severe obesity and 100s of lbs to lose may need surgery – at least till we come up with better medical treatments.

Today, I am excited about this plan to tackle obesity – rather than spending more and more money on treating diabetes, heart disease, replacing hips and knees, or buying CPAP machines, let us spend our health care dollars where they can really make a difference. I see far more value in my taxes going to preventing and treating obesity than continuing to pour endless money into treating its complications – every dollar spent on obesity prevention and treatment could be 10s of dollars saved on treating its complications.

When you treat diabetes you treat diabetes, when you treat heart disease you treat heart disease, when you treat osteoarthritis you treat osteoarthritis, but when you treat obesity you treat all of the above and more!”

For a brief video on the obesity problem in Alberta click here.

For the AHS news release on the launch of the Alberta Health Services Obesity Initiative click here.

AMS
Edmonton, Alberta

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6 Responses to “Alberta’s Obesity Initiative: Not Just Diet and Exercise!”

  1. fredt says:

    To bad the plan does not include the lifestyle changes necessary to get all forms of sugar and grain, and Omega 6 oils out of the human diet. That alone would reduce the problem to what it was before 1950. Wheat is evil. Sugar is worse.

  2. Alexie says:

    The time poor explanation is interesting. Leisure time pursuits, particularly digital ones, have actually risen over the past couple of decades, yet we are relentlessly pounded with the message that we are time poor. Food advertising, in particular, promotes this idea that we are too time poor to eat properly and need meal substitutes that we can eat on the run. What may be happening is that we are turning the idea of proper eating into a luxury, or we are kicking eating down the chain of priorities – which is subtly different from not having time to eat.

  3. Sean says:

    Hi Dr Sharma,
    Excellent and very interesting post.
    Speaking as one of the statistics in Alberta you mentioned and who has had some success keeping 40+ lbs off, I can definately confirm you are correct. It was never about the weight and always about other problems.
    People think they have a weight problem, but more likely they have a combination of other problems, Depression, Sleep Apnea, Adult ADHD and various other issues. I chuckled a little when I saw the post above me by Fredt. I too used to think it was all cause by one or another issue. Maybe it is. But my guess it is a subtle combination of many factors. The sooner people experience this and come to a realisation the sooner they will start asking for help.

    Interesting thing is, a lot of my friends and family asked me, how did I do it. As soon as I start talking about the gory details of Depression, SSRI’s, Psychotherapy, refined Carbs, Addiction and yes…ELMM (Eat Less Move More) they switch off. No quick fix means no interest.
    Anyway, please, you and your collegues keep up the great work you are doing.

  4. NewMe says:

    Although I generally enjoy and nod in agreement with a lot of what you have to say, unfortunately, a good part of your statement above left me extremely uncomfortable.

    First, there was a long comment that could easily be interpreted by laypeople as “blame the mother”. I truly believe that most women do their utmost to eat healthily and maintain a generally healthy lifestyle while pregnant. If I look at myself and the women I knew when I was pregnant, there was a huge range of weight gain but I’ll bet you dollars to donuts (lol) that the children of these women will have a weight profile that matches their parents’ profiles, no matter how little or how much weight the mothers gained during pregnancy. If there is one effect that pregnancy nutrition and weight gain has on the foetus, it would seem to be the deleterious effects of dieting intentionally or unintentionally, (i.e. starving). Studies show that the children of women who did not have enough to eat during pregnancy (in wartime Holland and more recently in the 70s in Bangladesh) seem to have more weight problems than children whose mothers were sufficiently nourished.

    My other source of discomfort with this post lies in the fact that you stress treating *obesity* rather than stressing the basics of a healthy life: eating non- or lightly processed foods, plenty of fresh fruit and veg; and being physically active to the best of one’s abilities on a regular basis (which could mean doing anything from going for a 20 minute walk daily to yoga to tai chi to biking to weight lifting to jogging to training for a marathon!). In a roundabout way, you seem to allude to this when you say that maintaining your weight at 200 lbs. for 10 years means you’re doing something right.

    I concede that as a physician, you are in a tricky situation, since you deal with the end result of genetics, mixed with disordered eating, yo-yo dieting, emotional issues, a highly sedentary lifestyle, etc. As you have said in the past, you are dealing with morbidly obese people who suffer from co-morbidities that are correlated (though perhaps not necessarily caused by) with obesity. You have to act once the horse is out of the barn.

    However, in terms of public health, I continue to believe that “fighting obesity” is a sure-fire recipe for making many people fatter and some of these people unhealthier. That is why I believe we MUST stop talking about weight and START talking about health and how each individual can find a pathway to a healthy life–no matter what their weight. If we stop stigmatizing fat people (and I know you agree with me on this) and start stressing health, especially when it comes to children and youth, in years to come, we will find ourselves living in a society with people of all sizes, but a much higher percentage of these people–be they slim, fat or in-between–will be healthy.

  5. Nathalie D says:

    Congratulations and really well done video.

  6. Sven says:

    One of the most often overlooked issues in the obesity debate is human consumption behaviour. Dr. Sharma is right to point out that our modern city lifestyles have significantly reduced physical activity levels while our eating habits haven’t changed much. Besides all the good work on fighting obesity we should spend more effort on studying reasons behind people’s consumption (eating) choices. Grocery shelves have never more diversified in their offerings of quality fresh veggies, fruits and many other “healthy food choice”. Is it that people are overwhelmed by too many product options, labels, campaigns and other efforts and therefore continue to feed on fatty, cheap carbohydrate, highly processed junk foods?

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