Close Concerns: Changing Attitudes to Obesity

Yesterday, the influential diabetes consulting group Close Concerns published a rather lengthy interview regarding my take on a wide range of issues related to the future of obesity management. The interviews were conducted by Joseph Shivers, Vincent Wu, Lisa Vance, and Kelly Close, who certainly challenged and stimulated my thinking with their well-informed questions.

The following is a brief excerpt from this interview published in their newsletter Closer Look:

JOSEPH: One of the big themes in your own work, and in particular in your presentation at the Qnexa AdCom, is that obesity is a chronic medical condition like hypertension or hypercholesterolemia, even though it’s not often seen this way. What do you think will be required to change cultural and medical attitudes toward obesity?

DR. SHARMA: I think a lot of it comes from the public understanding of obesity. As an aside, I’m the Scientific Director and founder of the Canadian Obesity Network, which, interestingly, is the largest professional national obesity NGO in the world. We have over 7,000 members, most of whom are health professionals, researchers, etc. One of the primary strategic objectives of the Canadian Obesity Network is to address weight bias and discrimination. The reason we’ve put weight bias and discrimination as our primary goal is because most decisions made around obesity – whether it’s management, access to care, public health measures, drug reimbursement, physicians or health professionals wanting to treat obesity, and perhaps even drug approvals, are held back by weight bias and discrimination.

Nobody likes fat people, and everybody thinks it’s their fault. Most people don’t understand the science and the biology behind obesity. They think this is really a matter of personal responsibility, and if you would eat better and get your butt off that couch, then you would be fine. As long as the public and government and everybody believes that to be true, you are not going to have the same kind of level playing field that you’ll have for hypertension or depression or any of those other conditions.

That’s going to have to change. It’s not a question of having better data. Organizations like the Canadian Obesity Network, or in the US, the Obesity Action Coalition or The Obesity Society, have to step up and educate the public and the decision-makers. Obesity is not merely an issue of self-responsibility, there’s actually a very complex biology here. Even if you were highly motivated to lose weight, your chances of keeping it off are actually pretty slim. Those are the messages that actually need to get out in order for decision-makers who decide about these things, whether it’s licensing the drugs, access to care, or paying for reimbursement, etc.

KELLY CLOSE: That’s really instructive. How optimistic are you that messages like this can be conveyed to the governments and payors? Can you tell us more about your goals for the Canadian Obesity Network and how you are (or would like to be) working with the OAC?

DR. SHARMA: In 2011, the Canadian Obesity Network hosted the first National Council on Weight Bias and Discrimination in Toronto. We had every major news channel reporting on this Summit – I had calls from international media asking me if we were saying that it was now ‘OK to be fat’. I explained why reducing weight bias and discrimination was a very real problem that not only affects the emotional, physical and monetary health of people with excess weight but that it is also a major barrier in having a constructive discussion about prevention and access to treatments, research funding, policies and regulations.

Other organizations are also catching on – only recently the OAC has begun paying more attention to this issue. I believe that anyone who is concerned about obesity prevention and management or has a product or service in this area has a vested interest in seeing organizations like CON or the OAC tackle this problem. It will certainly be high on the agenda of our National Obesity Summit in Vancouver in May of next year. (Editors’ note: For information on the National Obesity Summit in 2013 and to see videos of plenary sessions from the 2011 meeting, see

More excerpts from this interview to follow…

Edmonton, Alberta