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Canada Needs a National Strategy to Tackle Obesities



Faithful readers may recall previous posts in which I described obesity as a complex heterogeneous disorder of multiple etiologies and called for a far more sophisticated classification of obesity in terms of its diagnosis, its complications, and perhaps most importantly, its diverse etiologies.

The fact that obesity is not a single syndrome or homogeneous entity is indirectly reflected in the language that Health Canada uses to describe the determinants of “healthy weight”:

“Healthy weight is influenced by a number of things, including your lifestyle, environment, metabolism (how quickly you transform food into energy), height, age, and family history/genetics.”

An even clearer recognition that obesity is simply a term used to describe a wide range of heterogeneous conditions (all of which result in excess weight) was perhaps evident in the recent UK Foresight Report, which preferred to use the term “obesities” rather than “obesity”.

The potential implications of speaking of “obesities” rather than “obesity” are profound and are vital to a meaningful public discourse on this issue.

Indeed, the term “obesities” not only implies that there are many causes and forms of obesity but also that no single prevention strategy or treatment will ever eradicate all forms of excess weight.

Some obesities may well be tackled with “social engineering” while other obesities may require highly specialised psychological, medical, or even surgical treatments.

People with some obesities may better manage their weight with education on healthy eating and activity, people with other obesities, who may already be eating healthy and physically active, will require completely different lines of treatment.

This is not unlike the situation with cancer, which most experts often refer to as “cancers”, because although all cancers are characterized by malignancy, there are countless types of cancers, each requiring its own specialised diagnosis and treatment.

Thus, when we speak of cancer prevention – we are actually speaking about preventing cancers. Some prevention strategies may well prevent some forms of cancer (e.g. smoking cessation for lung cancer), while the same strategy may have little or no impact on other cancers.

So let us make the national dialogue on obesity a national dialogue on obesities – what we need is a national strategy to address obesities – not just obesity.

Of course we are not about to rename the “Canadian Obesity Network” the “Canadian Obesities Network” or rename these pages “Dr. Sharma’s Obesities Notes” but perhaps, over time, we can all learn to automatically interpret the word “obesity” as really meaning “obesities”.

AMS
Lake Louise, Alberta

10 Comments

  1. Hmmmm. Why not rename these pages? You toss it off as though it’s ridiculous, but it’s not. The three-in-a-row “s” suffixes are a bit of a mouthful, so you might want to rethink that. Some thoughts: Dr. Sharma’s Obesities Dialog (paying homage to the “community” you invite to participate here). Dr. Sharma’s Obesities Network. Dr. Sharma’s Obesities Spotlight.

    The first step toward changing the one-dimensional, bigotted cultural mythology that obesity is a single condition caused by a character flaw (the crux of your post yesterday) will be to do something tangible to portray it differently. And what better, simpler, more elegant way than to make it plural? I don’t think you can count on the general public “to automatically interpret the word “obesity” as really meaning “obesities”.” Our minds are not so flexible.

    If the women’s movement taught us anything, “man” is not generic for “man and woman.” Be honest, to this day, when you read the sentence “Now is the time for all good men to . . .” you picture men, not women and men. When one hears the word “obesity” most people picture a “morbidly obese” person (maybe headless, thanks to our popular media). They don’t picture a person with a BMI of 31. They don’t picture a group of people of different BMIs. This is nonscientific, but I would guess that if you were to ask people to think about a roomful of 20 obese people, they wouldn’t picture them working out in a gym. They’d picture a bunch of very large people sitting around, displaying their laziness. If you told the study participants that the 20 obese people were engaged in an activity and asked what that might be? You’d get a stereotypical response: eating fast food, at a potluck, etc. This is my hypothesis. I give anyone permission to study it. Now, if you were to change the language, “Picture a roomful of people with various obesities . . .” You’d first get a “Huh?” But then, after you answered, they’d have to think. . . multi-dimensionally. Over time, “obesities” would flip naturally off of their tongues. The truth always feels better. “Now is the time for all good people to come to the aid of their country.” Ahhh. It’s not historic, but I feel included, and that feels good. And my inclusion doesn’t exclude you. It simply empowers me to join you. When we start talking about “obesities,” then not only will trim people be forced to see fat people in multi-dimensions, but fat people will be allowed to see themselves as multi-dimensional too. It will feel good.

    Dr. Sharma, if there’s anything you’re doing right, it’s not simply treating patients with compassion, but opening the minds of all people on this topic (in Canada, south of the border and beyond). What better way to broaden thinking than to change the language. Make others who quote you (and we are legion) use that language (at least when we are quoting you). How you could make others think!! Oh, it boggles my mind.

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  2. Bravo Dr. Sharma!

    Each overweight person needs his/her own path to manage their obesity, as you point out so well.

    There are no magic pills, and the one size fits all approach (eat less, exercise more) just doesn’t address the diversity of weight management.

    Thanks so much for your dedication to help us all!

    Rosemary Dinsdale
    Edmonton, AB

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  3. If someone is already eating a healthy diet and is physically active and healthy, then why would they require any treatment at all?

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  4. I am a RN and have worked in health education & wellness for the past 12 years. I completely agree that there are many issues at play with regards to obesity. This is a much more complex situation than simply monitoring food intake and increasing physical activity. Mood and depressive symptoms also play a large role in this major health issue. For instance, a recent meta-analysis found that depression increases the risk for being overweight by 58% (http://www.medscape.com/viewarticle/718012). So, even if a person is physically active and eating a healthy diet, they may still need some sort of strategy or intervention to assist in managing the symptoms associated with depression in order to affect true change. I work with a company that provides physician-directed weight loss & healthy behavior education via the web & text messaging. One of the components of the program is monitoring mood to assist people in living an overall healthier life, in addition to their weight loss. I truly believe obesity is a multifaceted problem!

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  5. “If someone is already eating a healthy diet and is physically active and healthy, then why would they require any treatment at all?”

    Because, despite eating healthy and exercising, someone may have health problems that can require obesity treatment (e.g. sleep apnea, osteoarthritis, urinary incontinence, infertility, etc.)

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  6. “If someone is already eating a healthy diet and is physically active and healthy, then why would they require any treatment at all?”

    Sorry, Dr. Sharma, but the question refers to a “physically active and healthy” person. Your answer refers to someone who has health problems. Two different people, methinks.

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  7. “Sorry, Dr. Sharma, but the question refers to a “physically active and healthy” person. Your answer refers to someone who has health problems. Two different people, methinks”

    Oops, apologies, missed that part – of course, if you have closely followed my blog, you’ll have seen the many posts on Health at Every Size and my recommendation that weight management strategies should be based on how “sick” you are and not how “big” you are.

    For many, successful weight management simply means prevention of weight gain – I do not advise my patients to lose weight unless there is a good medical reason to do so.

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  8. NewMe made an excellent point. The way that you misread my post implies that you believe that fat people always have health problems. Not so.

    Your short remark also makes me wonder why you think “obesity treatment” is required to treat issues like sleep apnea, osteoarthritis, urinary incontinence, and infertility. It seems to me that when it comes to those health issues – and frankly almost all others as well – obesity is at most a contributing factor. All of those problems are also experienced by thin people. All of them have effective treatments other than weight loss. Weight loss may indeed not have any kind of beneficial effect in treating them.

    As a fat person, I can tell you that one of the most frustrating things about dealing with doctors is that they tend to blame everything on your weight and see weight loss as a primary treatment for any health problem. However as you know there’s no dependable- and certainly no healthy – way to permanently lose weight. Therefore, it is best to approach these health concerns in the same way you’d approach them in a thin person. Treat them directly.

    Frankly, treating weight loss is a health panacea for anyone with a BMI over 25 is lazy and irresponsible.

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  9. “…someone may have health problems that can require obesity treatment …”

    True – and if someone has NO health problems that REQUIRE obesity treatment, they should not be seeing doctors or public health programs to get help to lose weight for cosmetic reasons, unless they are paying for this treatment themselves.

    If obesity in itself is not a medical problem, the public health system in Canada should not be expected to deal with obesity unless it is to treat a specific medical condition.
    Our health care system is hard pressed to take care of people who do have medical problems.
    It is not right to take public health care money for what is essentially a cosmetic problem.

    We already have to pay doctors for some services (eg a medical for employment purposes, eg removal of a facial growth that is unsightly but not cancerous or dangerous).
    Drs should bill patients directly for weight control not required for a real medical problem.
    I’m sure this will be open to scamming as patients press doctors for medical excuses to get their cosmetic treatments covered, for example claiming it’s “preventative”.

    The emphasis on obesity as it is related to sickness, not just weight or BMI, is a very important improvement . People who actually need medical treatment will be the ones who get it.

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