Patients’ Voices at the European Congress on Obesity
Attendees at the recent 5th Canadian Obesity Summit, hosted by the Canadian Obesity Network, will hardly have missed the important role that patient champions played at this meeting. Thus, for e.g. every plenary session was opened by a brief presentation from a representative of the Canadian Obesity Network’s Public Engagement Committee, which not only illustrated the remarkable diversity of individual “obesity stories” but also set the stage for the scientific and clinical presentations that followed. Indeed, one of the recurring themes at the Canadian Obesity Summit was, “nothing about us, without us”. Thus, I was happy to see that the “patient voice” is also gaining increasing attention at the European Congress on Obesity, currently taking place in Porto, Portugal. In fact, the conference was kicked off by a workshop on weight bias, discrimination, and other issues relevant to people living with obesity, organised by representatives of the EASO patient council, with representatives from across Europe. How much impact these presentations and role of people living with obesity will have on the overall conference will remain to be seen, but clearly, as in other areas of medicine, the patient voice is certainly become more important as a driver of knowledge and policy – as it should. @DrSharma Porto, Portugal
Preventing and Managing Childhood Obesity
This morning, I am presenting a plenary talk in Berlin to about 200 colleagues involved in childhood obesity prevention. The 1-day symposium is hosted by Plattform Ernährung und Bewegung e.V. (Platform for Nutrition and Physical Activity), a German consortium of health professionals as well as public and private stakeholders in public health. Although, as readers are well aware, I am by no means an expert on childhood obesity, I do believe that what we have learnt about the complex socio-psycho-biology of adult obesity in many ways has important relevance for the prevention and management of childhood obesity. Not only do important biological factors (e.g. genetics and epigenetics) act on the infant, but, infants and young children are exposed to the very same societal, emotional, and biological factors that promote and sustain adult obesity. Thus, children do not grow up in isolation from their parents (or the adult environment), nor do other biological rules apply to their physiology. It should thus be obvious, that any approach focussing on children without impacting or changing the adult environment will have little impact on over all obesity. This has now been well appreciated in the management of childhood obesity, where most programs now take a “whole-family” approach to addressing the determinants of excess weight gain. In fact, some programs go as far as to focus exclusively on helping parents manage their own weights in the expectation (and there is some data to support this) that this will be the most effective way to prevent obesity in their offspring. As important as the focus on childhood obesity may be, I would be amiss in not reminding the audience that the overwhelming proportion of adults living with obesity, were normal weight (even skinny!) kids and did not begin gaining excess weight till much later in life. Thus, even if we were somehow (magically?) to completely prevent and abolish childhood obesity, it is not at all clear that this would have a significant impact on reducing the number of adults living with obesity, at least not in the foreseeable future. Let us also remember that treating childhood obesity is by no means any easier than managing obesity in adults – indeed, one may argue that effectively treating obesity in kids may be even more difficult, given the the most effective tools to managing this chronic disease (e.g. medications, surgery) are not available to those of us involved in… Read More »
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
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
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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