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Report Card on Access to Obesity Treatment for Adults in Canada 2017: Recommendations

Based on the failing access to obesity care for the overwhelming majority of the 6,000,000 Canadians living with obesity in our publicly funded healthcare systems, the   2017 Report Card on Access To Obesity Treatment For Adults, released the 5th Canadian Obesity Summit, has the following 7 recommendations for Canadian policy makers: Provincial and territorial governments, employers and the health insurance industry should officially adopt the position of the Canadian Medical Association that obesity is a chronic disease and orient their approach/resources accordingly. Provincial and territorial governments should recognize that weight bias and stigma are barriers to helping people with obesity and enshrine rights in provincial/territorial human rights codes, workplace regulations, healthcare systems and education. Employers should recognize and treat obesity as a chronic disease and provide coverage for evidence-based obesity programs and products for their employees through health benefit plans. Provincial and territorial governments should increase training for health professionals on obesity management. Provincial and territorial governments and health authorities should increase the availability of interdisciplinary teams and increase their capacity to provide evidence- based obesity management. Provincial and territorial governments should include anti-obesity medications, weight-management programs with meal replacement and other evidence-based products and programs in their provincial drug benefit plans. Existing Canadian Clinical practice Guidelines for the management and treatment of obesity in adults should be updated to reflect advances in obesity management and treatment in order to support the development of programs and policies of federal, provincial and territorial governments, employers and the health insurance industry. If and when any of the stakeholders adopt these recommendations is anyone’s guess. However, I am certain that since the release of the Report Cards, the relevant governments and other stakeholders are probably taking a closer look at what obesity management resources are currently being provided within their jurisdictions. Given that things can’t really get any worse, there is hope that eventually Canadians living with obesity will have the same access to healthcare for their chronic disease as Canadians living with any other illness. @DrSharma Edmonton, AB

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Bariatric Surgery: More Is Still Not Enough

Bariatric surgery is now widely considered by far the best effective long-term treatment for severe obesity – the long-term benefits on morbidity and mortality are well-documented (not to say that there cannot be problems in individual patients, but overall, the average outcomes are pretty remarkable). That said, bariatric surgery is still not as widely available in Canada as surgical treatments for other health issues. Nevertheless, over the past decade, yearly bariatric surgery rates in the Canadian public healthcare system have increased from around 3,000 a year in 2009 to over 8,500 in 2016. However,  as pointed out in the  2017 Report Card on Access To Obesity Treatment For Adults, released last week at the 5th Canadian Obesity Summit, despite this increase, only about 1 in 200 Canadians with Obesity Class II or III would have access to surgery per year (at this rate it would take 200 years to do everyone eligible today). What is also the remarkable is the variation in access to surgery from one province to the next. For e.g. while 1 in 90 eligible patients have access in Quebec, the corresponding number for Canadians living in Nova Scotia is 1 in 1,300, an almost 15-fold difference in access! I can think of no other disease or treatments that would have a 15-fold difference in access between provinces. Not quite as dramatic are the differences between Alberta (1 in 300) and its direct neighbour Saskatchewan (1 in 800). Even Newfoundland and Labrador does better with (1 in 390). With these low rates, every province (except Quebec) gets an “F” for access and waiting times that range from 18 months (Alberta) to 60 months (Nova Scotia). So, yes, while access to bariatric surgery has certainly improved in Canada in the last decade, getting it remains a rather long haul – a significant number of years of life lost, if you’re facing serious health problems from your obesity. @DrSharma Edmonton, AB      

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Why Would Anyone Want Access to Prescription Medications For Obesity?

Just imagine if the question in the title of this post was, “Why would anyone want access to prescription medications for diabetes?” (or heart disease? or lung disease? or arthritis? or, for that matter, cancer?) Why would anyone even ask that question? If there is one thing we know for sure about obesity, it is that it behaves just like every other chronic disease. Once you have it (no matter how or why you got it) – it pretty much becomes a life-long problem. Our bodies are so efficient in defending our body fat, that no matter what diet or exercise program you go on, ultimately, the body wins out and puts the weight back on. In those few instances where people claim to have “conquered” obesity, you can virtually bet on it, that they are still dealing with keeping the lost weight off every single day of their life – they are not cured, they are just treated! Their risk of putting the weight back on (recidivism) is virtually 100% – it’s usually just a matter of time. Funnily enough, this is no different from people trying to control any other chronic disease with diet and exercise alone. Take for e.g. diabetes. It is not that diet and exercise don’t work for diabetes, but the idea that most people can somehow control their diabetes with diet and exercise alone is simply not true. No matter what diet they go on or what exercise program they follow, sooner or later, their blood sugar levels go back up and the problems come back. You could pretty much say the same for high blood pressure or cholesterol, or pretty much any other chronic health problem (that, in fact, is the very definition of “chronic”). So why medications for obesity? Because, like every other chronic disease, medications can help patients achieve long-term treatment goals (of course only as long as they stay on treatment). Simply put, if the reason people virtually always regain their lost weight (no matter how hard they try to lose it) is simply because of their body’s ability to resist weight loss and promote weight regain, then medications that interfere with the body’s ability to resist weight loss and promote weight regain, will surely make it far more likely for them to not only lose the weight but also keep it off. Now that we increasingly understand many of the body’s mechanisms to defend… Read More »

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Canadians Have Virtually No Access To Interdisciplinary Obesity Care

Every single guideline on obesity management emphasises the importance of interdisciplinary obesity management by a team that not only consists of a physician and a dietitian but also includes psychologists, exercise specialists, social workers, and other health professionals as deemed necessary. As is evident from the evident from the 2017 Report Card on Access To Obesity Treatment For Adults, released last week at the 5th Canadian Obesity Summit, the overwhelming majority of Canadians living with obesity have no access to anything that even comes close. Thus, the report finds that Among the health services provided at the primary care level for obesity management, dietitian services are most commonly available. Access to exercise professionals, such as exercise physiologists and kinesiologists, at the primary care level is limited throughout Canada. Access to mental health support and cognitive behavioural therapy for obesity management at the primary care level is also limited throughout Canada. bariatric surgery programs often have a psychologist or a social worker that offers mental health support and cognitive behavioural therapy to patients on the bariatric surgery route, but the availability of these supports outside of these programs is scarce. Centres where bariatric surgery is conducted also have inter- disciplinary teams that work within the bariatric surgical programs and provide support for patients on the surgical route. Alberta and ontario have provincial programs with dedicated bariatric specialty clinics that offer physician-supervised medical programs with interdisciplinary teams for obesity management. Interdisciplinary teams for obesity management outside of the bariatric surgical programs are available in one out of five regional health authorities (RHa) in british Columbia, one out of 18 RHas in Québec, one out of two RHas in new brunswick and one out of four RHas in newfoundland and labrador. Among the territories, only yukon has a program with an interdisciplinary team focusing on obesity management in adults. I hardly need to remind readers, that this is in stark contrast to the resources and teams available to patients with diabetes, heart disease, lung disease, or any other common chronic disease, that are regularly available in virtually every health jurisdiction across the country (not to say that they are perfect or sufficient – but at least there is some level of service available). I understand that our current obesity treatments are extremely limited (at least when effectiveness is measured in terms of weight loss). But even if access to these resources could simply help stabilise and… Read More »

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High Time For Canadian Governments To Recognise Obesity As A Chronic Disease

It has now been almost two years since the Canadian Medical Association declared obesity to be a chronic medical disease. This declaration was widely praised by people living with obesity as well as healthcare and academic professionals (not least myself), who supported the notion that recognition of obesity as a disease would help precipitate a shift in thinking of obesity as just a lifestyle choice to a medical disease with an obligation to prevent and treat it as other chronic diseases. Not much has happened since then – at least not as far as Canadian policy makers are concerned. Thus, it is evident from the 2017 Report Card on Access To Obesity Treatment For Adults, released last week at the 5th Canadian Obesity Summit, that so far, neither the federal government nor any of the provincial/territorial governments in Canada have recognized obesity as a chronic disease. As discussed in the report, this has a significant negative trickle-down effect on access to obesity treatment for the over 6,000,000 Canadians living with this chronic disease, not to mention the millions of Canadians at high risk of developing this disease in the near future. As a reminder, in preparing the Report Card, the Canadian Obesity Network extensively reviewed all publicly accessible resources and documents for evidence of policies, guidelines and services for obesity treatment and management in each province and territory. In addition, the Canadian Obesity Network tried to identify and speak directly to government officials in each province and territory regarding their take on obesity as a chronic disease. This was by no means an easy task, “The search for information on the recognition of obesity as a chronic disease and treatment guidelines or recommendations by provincial/territorial governments and identifying appropriate policy makers in each province/ territory required significant effort. many provinces and territories do not have a person or department dedicated to the bariatric or obesity-treatment portfolio.”  As the Report Card highlights, “Since the declaration, none of the provincial or territorial governments have officially recognized obesity as a chronic disease.” “Health Canada has also not officially recognized obesity as a chronic disease and has continued to consider obesity as a lifestyle risk factor. There is no directive from Health Canada on the treatment and management of obesity in adults.” It also notes that the 2016 report of the senate standing Committee on social affairs, science and technology titled Obesity in Canada, referred to obesity as a… Read More »

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