The last time I checked, my TEDx talk “How To Lose 50 Pounds And Keep Them Off“, had over 3,500 views on its first day!
While that is far from going “viral”, I do admit that it’s a lot more than I expected.
Although the overwhelming response and comments were positive, some viewers appeared frankly disappointed, not to say frustrated by the notion that obesity, once established, behaves like a chronic disease.
This may in part be due to the fact that, despite all evidence to the contrary, many people continue to believe (as suggested by the diet, fitness and weight-loss industry) that “permanent” weight loss is within anyone’s reach (it isn’t) and reaching your “dream weight” means winning the battle (it doesn’t).
But, I also believe that some of the frustration that comes with seeing obesity as a chronic disease for which we have no cure (which happens to be the definition of “chronic disease”), stems from the notion that living with a “disease” is terrifying and hopeless (it isn’t!).
In fact, most of what we deal with in our health care systems are “chronic diseases” – the exceptions being largely limited to accidents, acute infections and some cancers – these we can “cure”, by which I mean that we treat them for a given period of time after which they ceases to exist and the patient can be considered “cured”.
Unfortunately, as important as these “cures” may be, they constitute a rather small proportion of what goes on in the health care system. It is fair to say that for the vast majority of medical conditions, we may have treatments, but most certainly no “cures”.
However, this is not as depressing as it may seem. Indeed, it is one of the great achievements of modern medicine that we have turned diseases that would have been fatal in the not too-distant past (e.g. type 1 diabetes, coronary artery disease, HIV/AIDs, breast cancer), into conditions where, with proper treatments, most patients can enjoy decades of meaningful and productive life, despite living with their “chronic” disease.
Not that the treatments are always easy or cheap or well tolerated – but, when applied and adhered to properly, they generally do their job of allowing patients to go about their lives in a fairly acceptable manner.
So the idea that living with a chronic disease is all doom and gloom is certainly not true – ask anyone living with well-controlled diabetes, hypertension, coronary artery disease or even cancer.
Compared to a lot of these conditions, people living with obesity may well be a lot better off.
For one, while even with the best treatment many chronic diseases tend to get worse over time (take for e.g. chronic kidney disease with progressive loss of kidney function), stopping obesity form progressing (i.e. stopping further weight gain) is actually very achievable. In fact, as shown by the “placebo” groups in most obesity trials, even minimal intervention can help stabilize weight and prevent further weight gain – thus, while you may continue living with obesity, at least we can do a fairly good job of preventing it from getting worse.
Secondly, we have ample evidence that many of the health consequences associated with excess weight will improve with very little or even no weight loss through appropriate interventions that focus on improving mood, self-esteem, sleep, diet and physical activity. We know that with these interventions many people living with obesity will feel a lot healthier and better about themselves – which in the end should really be the principal goal of treating obesity in the first place.
Thirdly, there is hope on the horizon as both medical and surgical treatments for obesity are steadily getting better. Take for example bariatric surgery, which has gone from not too long being a highly invasive procedure ridden with often catastrophic complications in the days of open surgery, to a minimally invasive procedure with surprisingly minor risks and complications (in appropriate hands) with well-documented and often remarkable long-term benefits for health and well-being (not to say that there isn’t further room for improvement).
On the medical front, the last few years have seen the approval of several new obesity drugs, which have been rigorously tested for safety and efficacy in thousands of volunteers in randomised controlled trials. While these drugs may not be for everyone and come with a price tag (that varies from drug-to-drug and country-to-country), they do raise optimism that one day, medical treatment of obesity will be no more (or less) routine than treating diabetes, hypertension or any of the other many chronic diseases where long-term medical treatment is well established.
So, the notion that just because obesity is a chronic disease somehow means that all hope is lost, is simply nonsense.
Yes, the idea of thinking of of obesity as a “disease” may not sit well with everyone, especially with the minority of people, who happen to meet the BMI criteria for obesity but appear in perfect health – I do understand that for this minority, we do need a better definition of obesity that is not based on BMI and the Edmonton Obesity Staging System is certainly a start.
But for the vast majority of people with obesity (Stage 1-4), who do experience (or will experience) the health consequences of obesity, we can certainly do a better job of serving them, by looking at their obesity as a chronic disease rather than a “problem” that can be easily “fixed” by simply telling them to “eat less and move more”.
We know a lot about managing chronic diseases – we do this all the time.
It is now time to apply that knowledge to the benefit our patients living with obesity.
They deserve no less.
Last year, the Canadian Obesity Network and the Werklund School of Education and departments of Psychology and Community Health Sciences at the University of Calgary co-hosted the 2nd Canadian Summit on Weight Bias and Discrimination in Calgary, AB.
The proceedings of this two-day summit, which was attended by 40 invitees representing education, healthcare, and public policy sectors in Alberta, British Columbia, and Ontario are now published in OBESITY.
The 40 attendees included 14 researchers, 11 practitioners, and 15 policy makers, although some participants represented multiple perspectives.
On the first day, speakers from across Canada presented their research on the prevalence and consequences of weight bias, as well as on interventions to reduce weight bias in the education, healthcare, and public policy arenas.
These daytime sessions concluded with an evening public outreach event in the form of an expert round table titled “Fear of Fat: Promoting health in a fat phobic culture” at a local community center with 100 attendees.
The second day consisted of a round table of facilitated discussions to identify what research question(s), if answered, would make the greatest impact on weight bias reduction efforts in Canada.
The key outcome from these deliberations include the identification of six research areas that warrant further investigation in weight bias: costs, causes, measurement, qualitative research and lived experience, interventions, and learning from other models of discrimination.
It also became evident that progress in this field requires attention to three key issues: language matters, the voices of people living with obesity should be incorporated, and interdisciplinary stakeholders should be included.
A 3rd Summit on Weight Bias and Discrimination that will build on the learning form the previous workshop will be held in Edmonton, May 26-27, 2016.
It will be interesting to see what progress has been made in field since the last meeting in 2015.
Of the 21 recommendations, 12 essentially fall under the category “Eat-Less” (2,3,4,6,7,8,9,10,11,12,13,20) and 6 under the category “Move-More” (5,14,15,16,17,18).
Of the remaining 3, two deal with surveillance and consultations (1,19) while recommendation 21 deals with comprehensive public awareness campaign on healthy active lifestyles.
So there you have it.
The Senate’s solution to obesity is pretty much “Eat-Less Move-More”, which, as someone who responded to me on yesterday’s blog post describes as,
“…little more than a backhanded insult, a polite rephrasing of “Put down the fork, Fatty and move.”
Now, in all fairness, the report does talk about social determinants of health.
It does also vaguely mention genetics, epigenetics and pregnancies (but not antibiotics or environmental toxins or endocrine disrupters) – but none of this is deemed relevant enough to prompt any recommendations (not even, “we need more research”).
Nothing about reigning in the commercial weight-loss industry with their false claims and promises – no mention of the fashion industry and media that promote unrealistic and harmful body images.
However, what I find most alarming about the entire report is that it essentially writes off the 7,000,000 Canadians living with obesity as being beyond help.
In view of the liberal use of the terms “lifestyle” and “choice” scattered throughout the report, one can truly sense that many involved in the report are likely of the opinion that 7,000,000 Canadians have simply “chosen their cake and should now eat it”.
I simply cannot imagine another health “epidemic” where there would not be at least some call for providing better access to treatment.
No mention of weight-bias or discrimination.
No mention of encouraging provincial governments to reduce wait times for bariatric surgery.
No mention of urging Health Canada to expedite reviews for novel obesity medications (an unmet medical need if there ever was one).
No mention of legislation to ensure that benefit plans cover all evidence-based treatments for obesity.
No mention of ensuring access to adequate equipment and professional services within Canada’s health system.
Nothing, in fact, that would actually help improve the lives of the 7,000,000 Canadians living with obesity.
And let me clear. I am not against the recommendations or policies in the report – all of these can, if implemented, potentially improve the health of Canadians – everyone can benefit from eating better and being more active – everyone!
But framing all of this as a bold and far-reaching solution to the obesity “crisis” is not only overly optimistic but also simply reinforces the nonsense that all it takes to “conquer” obesity is for people to push away from the table and walk the dog.
If only things were that simple.
According to a report just released by the Canadian Senate,
“In the past three to four decades there has been a drastic increase in the proportion of demented Canadians. Statistics Canada data reveals that almost two thirds of Canadian adults are now demented. Sadly, the increase in dementia rates among children is also dangerously high. About 13% of children between the ages of five and 17 are demented while another 20% are somewhat dull. These numbers reflect at least a two-fold increase in the proportion of demented adults and three-fold increase in the proportion of demented children since 1980.”
Just replace the word “demented”with the word “obese” in the above paragraph and you will instantly see what is wrong with this report, which happens to in fact be about obesity, and not about Canadians at risk of or living with dementia.
Only when speaking about “obesity crisis”, would an official report composed by professional writers on an important medical condition still use the name of the condition as an adjective.
Indeed, the use of “people-first language” to describe someone living with a condition rather than being defined by that condition has long been accepted in the case of virtually every other condition.
Thus, we speak of people living with addictions rather than of addicts, of people living with diabetes rather than of diabetics, of people living with psychosis rather than of psychotics, of people with arthritis rather than of arthritics, of people living with cancer rather than of the cancerous, you get my drift.
A report that wants to be taken seriously as addressing the concerns and struggles of Canadian adults and children living with overweight or obesity could perhaps begin by ensuring that it uses the proper language.
This is not to say that the report does not indeed make bold and important policy recommendations – it does, from taxing sugar-sweetened beverages to limiting advertising to children, to rewriting Canada’a Food Guide to food labeling to tax benefits to promote physical activity (and more). It even addresses (although in passing) the need to provide better treatments to people living with overweight or obesity.
Just which of these policy recommendations will actually find their way into legislation and how much difference they’ll actually make remains to be seen especially as the recommendations come with no actual funding for their implementation.
More on some of the “bolder” recommendation in future posts.
In the meantime for anyone interested, the full report is available here
In 2008, the Canadian Obesity Network’s Board of Directors identified weight bias and stigma as one of the Network’s top strategic priority.
The board firmly believes that everyone deserves to be treated with respect and dignity independent of size.
To this end, the Network is working hard towards reducing weight bias and stigma through research, education and action.
The following are just some of the examples resulting from the Network’s many collaborates with researchers, patients, knowledge users and partners to develop education initiatives and practitioner resources to address weight bias in health care settings, the media and public policies:
- Incorporated weight bias and stigma in all CON-RCO education and knowledge exchange programs such as the Canadian Obesity Summits (2009, 2011, 2013, 2015 and biennially thereafter); Dietitian Learning Retreats (2010-present); Canadian Obesity Student Meetings (2010, 2012, 2014); Obesity Research Summer School (formerly known as Obesity Research Boot Camp); Obesity Management Certificate for Post-Graduates (2013-2015).
- In collaboration with health services and primary care experts, CON-RCO has developed the 5As of Obesity Management framework to support primary care practitioners in their interactions with patients with obesity. This was a two-year initiative supported by the Canadian Institutes of Health Research (Knowledge Translation Supplement Grant) and the Public Health Agency of Canada (Innovation Strategy Grant). The resources incorporate weight bias sensitivity training and have now been adapted for pediatric and pregnancy populations.
- CON-RCO under the leadership of Dr. Mary Forhan, associate professor, University of Alberta, Faculty of Rehabilitation Medicine, Department of Occupational Therapy, coordinated the first Canadian Weight Bias and Discrimination Summit in Toronto, Ontario (January 2011). The purpose of the summit was to raise awareness about weight bias and discrimination as it relates to obesity and its association to the health and well being of Canadians. The event drew a capacity crowd of 150 health professionals, students, policy makers, industry representatives, and educators who heard from an expert panel of eight speakers from Canada and the United States.
- CON-RCO partnered with the Canadian Institutes of Health Research to inform a Canadian Bariatric Research Agenda, which included a priority on weight bias and discrimination.
- CON-RCO and the Public Health Agency of Canada collaborated to poll CON-RCO members to identify and counteract some of the most common obesity myths. Results of this study were published and disseminated to CON members and partners.
- CON-RCO partnered with the Rudd Centre for Food Policy and Obesity to develop an image bank to combat stigmatizing images of people with obesity in the media.
- In 2012, CON-RCO partnered with the World Obesity Federation (formerly known as International Association for the Study on Obesity) to host the first International Hot Topic Conference on Obesity and Mental Health. The outcome of this conference was a Charter calling for action for health system funders, researchers and health practitioners to deal with the stigma associated with both obesity and mental illness.
- In 2015, CON-RCO partnered with the University of Calgary research leaders Drs. Angela Alberga, Shelly Russell-Mayhew, Kristin Von Ranson and Lindsay McLaren to participate in a two-day Weight Bias Summit (March 12-13, 2015). The objective of the summit was to bring together stakeholders (researchers, practitioners and policy makers) to discuss and facilitate the design of research projects aimed to reduce weight bias in three sectors (education, health care & public policy) in the province of Alberta.
- In May 2015, CON-RCO established its first Public Engagement Committee (PEC) comprised of people living with obesity from across the country. The mandate of the PES Committee is to be the voice of individuals affected by obesity within CON-RCO and to elevate the conversation of obesity and its impact on health in the community.
- In August 2015, CON-RCO established a collaborative called EveryBODY Matters. This group is composed of CON-RCO members working in research, healthcare, education, public engagement and policy. The mandate of this collaborative is to exchange knowledge, identify opportunities for collaboration across research and practice/policy sectors, and support CON-RCO’s efforts to reduce weight bias and obesity stigma in Canada.
Not least as a result of these many activities, the Network has seen an impressive increase in weight bias and obesity stigma research in Canada.
Thus, while the first Canadian Obesity Summit (2009) only received a handful of abstracts focused on obesity stigma. CON-RCO began to see a shift at the second (2011) and third (2013) Canadian Obesity Summits with more inclusion of weight bias research in the program.
In 2015, the summit included four plenary presentations on weight bias, three workshops, and ten oral and poster abstract presentations on this topic.
This remarkable shift in research interest in better understanding and addressing weight-bias is reflective of the Network’s considerable efforts to increase awareness of weight bias as well as the growing body of literature focused in this area.
Clearly, all of this should be of interest to anyone living with obesity, who, unfortunately, continue to suffer the emotional, physical, social, and financial consequences of weight-bias and discrimination.
To learn more about the Network’s continuing efforts to foster greater respect and a better understanding of people living with obesity click here.
New York, NYC