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Senate Report on Obesity: Here’s What’s MIssing

sharma-obesity-policy1Yesterday, I listed the 21 recommendations of the Canadian Senate Report on Obesity in Canada.

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.

@DrSharma
Edmonton, AB

 

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Senate Report: Bold Policies To Reduce the Number of Demented Canadians

languagemattersAccording 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.

Enough has been written on this issue here, here, here, here, here and here.

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

@DrSharma
Edmonton, AB

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Leading The Charge In Addressing Weight-Bias in Canada

sharma-obesity-accuracyIn 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:

  1. Incorporated weight bias and stigma in all CON-RCO education and knowledge exchange programs such as the Canadian Obesity Summits (2009, 201120132015 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).
  1. 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.
  1. 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.
  1. 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.
  1. 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.
  1. 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.
  1. 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.
  1. 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.
  1. 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.
  1. 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.

@DrSharma
New York, NYC

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Majority Support For Laws to Require Coverage of Obesity Treatments

sharma-obesity-treatment-pyramidOne of the key barriers to accessing obesity treatments in many countries (besides lack of training and common weight-bias of health professionals) is the lack of coverage for obesity treatments in public and private plans.

Thus, for example in the US, under the Medicare Modernization Act of 2003, Medicare is in fact prohibited from covering prescription obesity medicines.

Now, a US survey conducted by the Gerontology Society of America among 1,000 US Adults using online interviews shows a strong majority in favour of Medicare coverage for obesity medications.

Here is a summary of the main findings:

  • 87 percent of Americans believe obesity is a problem in their state.
  • 69 percent of Americans believe Medicare should expand coverage to include prescription obesity medicines.
  • 77 percent were unaware that federal law specifically prohibits Medicare from covering patient costs for prescription obesity medicines.
  • 69 percent of Americans were unaware that the FDA has found that current prescription obesity medicines are safe and effective in treating obesity. (In the last 5 years multiple medicines have been approved as safe and effective by the FDA)

To me these results are surprising as I would have expected that most Americans (like most everybody else) still believes that people with obesity need to overcome this by simply eating less and moving more rather than taking the “easy way out” by simply “popping a pill”.

Perhaps, the notion that obesity is a chronic disease and that people who have it deserve treatment the same as anyone else with any other chronic disease is starting to trickle through.

Then again of course, this survey (as so often with polls) may simply be completely off the mark.

@DrSharma
Edmonton, AB

 

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Why Does The Food Addiction Model of Obesity Management Lack Good Science?

obesity-questionmarkYesterday’s guest post on the issue of food addiction (as expected) garnered a lively response from readers who come down on either side of the discussion – those, who vehemently oppose the idea and those, who report success.

Fact is, that we can discuss the pros and cons of this till the cows come home, because the simple truth is that the whole notion lacks what my evidence-based colleagues would consider “strong evidence”.

Indeed, I did try to find at least one high-quality randomized controlled study on using an addictions approach to obesity vs. “usual” care (or for that matter anything else) and must admit that I came up short. The best evidence I could find comes from a few case series – no controls, one observer, nothing that would compel anyone to believe that this approach has more than anecdotal merit.

Yet, the biology (and perhaps even the psychology) of the idea is appealing. Self-proclaimed “food addicts” that I have spoken to readily identify with the addiction model and describe their relationship to “trigger foods” as an uncontrollable factor in their lives that calls for complete abstinence. Animal studies confirm that foods do indeed stimulate the same parts of the brain that are sensitive to other hedonic pleasures and substances.

So why the lack of good data? After all, the idea is hardly new – intervention programs for “food addicts” using the 12 steps or other approaches have been around for decades.

Can it be simply the lack of academic interest in this issue? I find that hard to imagine – but nothing would surprise me.

Is it perhaps because addiction researchers do not take obesity seriously and obesity researchers don’t like the addiction model?

I certainly don’t buy the argument that there is no commercial interest in such an approach – if there were strong and irrefutable evidence, I’m sure someone would figure out how to monetize it.

So again, I wonder, why the lack of good data?

Honestly, I don’t know.

I’m open to any views on this (especially if substantiated by actual evidence).

@DrSharma
Berlin, Germany

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