Developing A Research Agenda In Weight Bias
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. @DrSharma Edmonton, AB
Senate Report on Obesity: Here’s What’s MIssing
Yesterday, 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… Read More »
Senate Report: Bold Policies To Reduce the Number of Demented Canadians
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. 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… Read More »
Leading The Charge In Addressing Weight-Bias in Canada
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… Read More »
Majority Support For Laws to Require Coverage of Obesity Treatments
One 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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