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Public Engagement For Obesity

This week, the Canadian Obesity Network will host its 5th National Obesity Summit in Banff, Alberta. While the formal program begins on the evening of the 26th with the delivery of Award lectures, there are plenty of pre-conference workshops to chose from.

One such workshop is the strategy meeting of the Network’s Public Engagement Committee, which will meet in person to discuss the Network’s public engagement strategy.

As reader may know, this committee was formed two years ago at the last Canadian Obesity Summit in Toronto (image) and has been extremely active since in helping plan and provide direction for the Network’s activities to tie in and meet the interests and needs of the nearly 7,000,000 Canadians living with obesity.

It is fair to say, that their voice has been largely ignored in the policy discussions around obesity prevention and management and there is little evidence that Canadians living up with obesity are speaking up for themselves.

This is a crying shame, as who should know more about the realities and challenges that Canadians living with obesity face everyday in settings including education, workplace, and society in general? Unfortunately, the challenges also extend to health care – as will become evident from the Report Card on Access to Obesity Treatments in Canada, which will be released at the Summit later this week.

With this work, the Network is following closely in the footsteps of the Obesity Action Coalition and the EASO Patient Council to provide a voice at the table for Canadians living with this chronic disease.

I look forward to a most exciting and informative week.

@DrSharma
Banff, AB

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The Weight Of Living

weight-of-livingIn its approach to addressing weight bias and discrimination, the Canadian Obesity Network recently launched the “Weight of Living” (WoL) project on its facebook page.

Modelled on “Humans of New York”, WoL presents images and stories of Canadians living with obesity in all their diversity and variation.

After all, nothing is more effective in breaking down stereotypes and barriers than realizing that people living with obesity are no different from everyone else, in their hopes, their dreams, their challenges, their aspirations – doing their best to cope and overcome what life throws at them.

Rather than promoting a culture of fat-shaming and blaming, the Canadian Obesity Network seeks to destigmatise those living with obesity by encouraging them to share their real stories in their own words.

Thus, this project seeks to dismantle the stereotypes that surround the lives of people who live with obesity, including the notion that everyone who has overweight or obesity wants to lose weight because they are unhappy with themselves.

Many of the stories you will see in the upcoming weeks do not reflect this. The Canadian Obesity Network hopes that, by sharing these experiences, we all will realize that people who have overweight or obese have goals, dreams, and aspirations just like everyone else, and that their weight is not necessarily a barrier to achieving these, nor is it something that needs to be a source of fear and shame.

In contrast to many other “weight-loss” sites, the Canadian Obesity Network will not publish stories that glorify weight loss journeys, commercial programs or products, or extreme weight loss attempts.

“While we respect the importance and validity of each story we receive, publishing stories like these only serve to reinforce the idea that people who are overweight or obese are living unhappy, unfulfilling lives – and we know you are worth so much more than that.”

Check out the first WoL stories here, herehere, and here

For more information on how to participate in this project click here or send an e-mail to levitsky@obesitynetwork.ca.

@DrSharma
Edmonton, AB

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My Miniseries on Obesity As a Disease

NN Benefits White Paper CoverOver the past weeks, I have presented a miniseries on the pros and cons of calling obesity a chronic disease.

Clearly, I am convinced that the arguments in favour, carry far greater chances of effectively preventing and controlling obesity (defined as abnormal or excess body fat that impairs health) than continuing to describe obesity merely as a matter of ‘lifestyle’ or simply a ‘risk factor’ for other diseases.

That said, I would like to acknowledge that the term ‘disease’ is a societal construct (there is, to my knowledge no binding legal or widely accepted scientific definition of what exactly warrants the term ‘disease’).

As all societal constructs are subject to change, our definitions of disease are subject to change. Conditions that may once have been deemed a ‘normal’ feature of aging (e.g. type 2 diabetes or dementia) have long risen to the status of ‘diseases’.  This recognition has had profound impact on everything from human rights legislations to health insurance to the emphasis given to these conditions in medical education and practice.

People living with obesity deserve no less.

Thus, I come down heavily on the ‘utilitarian’ principle of calling obesity a disease.

When, calling obesity a ‘disease’ best serves the interests of those affected by the condition, then, by all means, call obesity a ‘disease’ – it is as simple as that.

First consequences of the American Medical Association declaring obesity a chronic disease are already evident (see here and here).

We can only hope for the same impact of the Canadian Medical Association declaring obesity a disease – the sooner, the better for all Canadians living with obesity.

@DrSharma
Edmonton, AB

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Arguments For Calling Obesity A Disease #9: Medical Education

sharma-obesity-medical-students1Next in my miniseries on the pros and cons of calling obesity a ‘disease’, I turn to the issue of medical education.

From the first day in medical school, I learnt about diseases – their signs and symptoms, their definitions and classifications, their biochemistry and physiology, their prognosis and treatments.

Any medical graduate will happily recite the role and function of ADH, ATP, ANP, TSH, ACTH, AST, ALT, MCV and a host of other combinations of alphabet soup related to even the most obscure physiology and function – everything, except the alphabet soup related to ingestive behaviour, energy regulation, and caloric expenditure.

Most medical students and doctors will never have heard of POMC, α-MSH, PYY, AgRP, CART, MC4R, or any of the well studied and long-known key molecules involved in appetite regulation. Many will have at best a vague understanding of RMR, TEE, TEF, or NEAT.

The point is, that even today, we are graduating medical doctors, who have at best a layman’s understanding of the complex biology of appetite and energy regulation, let alone a solid grasp of the clinical management of obesity.

Imagine a medical doctor, who has never heard of β-cells or insulin or glucagon or GLUT4-transporters trying to manage a patient with diabetes.

Or a medical doctor, who has never heard of renin or aldosterone or angiotensinogen or angiotensin 2 trying to manage your blood pressure.

How about a medical doctor, who has never heard of T3 or T4 or TSH managing your thyroid disease?

Elevating obesity to a ‘disease’ means that medical schools will no longer have an excuse to not teach students about the complex sociopsychobiology of obesity, its complications, prognosis, and treatments.

As I mentioned in a previous post, suddenly, managing obesity has become their job.

No longer will it be acceptable for doctors to simply tell their patients to control their weight, with no stake in if and how they actually did it.

Thus, if there is just one thing that calling obesity a ‘disease’ can change, it is expecting all health professionals to have as much understanding of obesity as they are currently expected to have of diabetes, heart disease, lung disease, and any other common disease they are likely to encounter in their medical practice.

Apparently, simply treating obesity as a ‘lifestyle’ problem or ‘risk factor’ was not enough – hopefully, recognising obesity as a  ‘disease’ in its own right, will change the attention given to this issue in medical training across all disciplines.

@DrSharma
Edmonton, AB

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Arguments For Calling Obesity A Disease #8: Can Reduce Stigma

sharma-obesity-hypothalamusNext, in this miniseries on arguments for and against calling obesity a disease, I turn to the issue of stigma.

One of the biggest arguments against calling obesity, is the fear that doing so can increase stigma against people living with obesity.

This is nonsense, because I do not think it is at all possible for anything to make stigma and the discrimination of people living with obesity worse than it already is.

If anything, calling obesity a disease (defined as excess or abnormal body fat that impairs your health), could well serve to reduce that stigma by changing the narrative around obesity.

The current narrative sees obesity largely as a matter of personal choice involving poor will power to control your diet and unwillingness to engage in even a modest amount of regular physical activity.

In contrast, the term ‘disease’ conjures up the notion of complex biology including genetics, epigenetics, neurohormonal dysregulation, environmental toxins, mental health issues and other factors including social determinants of health, that many will accept are beyond the simple control of the individual.

This is not to say that other diseases do not carry stigma. This has and remains the case for diseases ranging from HIV/AIDS to depression – but, the stigma surrounding these conditions has been vastly reduced by changing the narrative of these illnesses.

Today, we are more likely to think of depression (and other mental illnesses) as a problem related to “chemicals in the brain”, than something that people can pull out of with sheer motivation and will power.

Perhaps changing the public narrative around obesity, from simply a matter of motivation and will power, to one that invokes the complex sociopsychobiology that really underlies this disorder, will, over time, also help reduce the stigma of obesity.

Once we see obesity as something that can affect anyone (it can), for which we have no easy solutions (we don’t), and which often requires medical or surgical treatment (it does) best administered by trained and regulated health professionals (like for other diseases), we can perhaps start destigmatizing this condition and change the climate of shame and blame that people with this disease face everyday.

@DrSharma
Edmonton, AB

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