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 »
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 »
Redefining Obesity Beyond Numbers
As I pointed out in yesterday’s post, there appeared to be broad acceptance for the notion that obesity is a chronic medical disease at the recent 5th Canadian Obesity Summit. In my opening address to the delegates, however, I emphasised that acceptance of obesity as a chronic medical diagnosis requires modification of the definition of obesity to ensure that people diagnosed with this condition do in fact have significant health impairments that warrant them being considered ‘sick’. This is where, the current commonly used ‘definition’ of obesity based on BMI breaks down, as it would ‘misdiagnose’ a significant proportion of Canadians with having a ‘disease’, when in fact they may be perfectly healthy. Moreover, the current BMI-based ‘definition’ of obesity would exclude an even larger group of individuals, who may stand to benefit from anti-obesity treatments as having a BMI that is too low. Let us recall that BMI is really just a measure of size and not a direct measure of actual health. As discussed in a recent editorial published in OBESITY, we have suggested that it would only take a minor (but important) modification of the current WHO definition of obesity to ensure that this label is only applied to people whose health is in fact affected by their body fat. Thus, we have suggested that the current WHO definition, “The presence of abnormal or excess body fat that may impair health.” be modified to “The presence of abnormal or excess body fat that impairs health.” This simple change to the wording would have significant implications in that obesity would move from simply being a term used to describe a risk factor (“may impair health“) to being an actual disease (“impairs health“), with all of its consequences for policy, regulators, healthcare systems, research, and clinical practice. Before anyone thinks that this would be far too cumbersome or impractical, let us remind ourselves that such diagnostic approaches are standard practice for a wide range of other diseases that require a clinical encounter, laboratory testing, and/or diagnostic imaging for their diagnosis. In fact, there are very few diseases that can be reliably diagnosed with just a single measure or test. Thus, “…in clinical practice, assessing whether or not abnormal or excess weight is impairing someone’s health should not pose a major diagnostic dilemma. In the vast majority of patients, a few interview questions, a brief physical exam, and a short panel of routine lab tests should readily establish (or… Read More »
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
The Weight Of Living
In 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, here, here, 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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