Fixing the Canadian Health Care System

Readers may recall that last week I spoke on obesity at the Conference Board of Canada’s Summit on Sustainable Health Care.

The key learnings from this Conference are now elegantly summarized by Glen Hodgson, Senior VP and Chief Economist at the Conference Board on his blog

Five key priorities for reform emerged from the Summit.

  • Fix the gateway to the health care system. Primary care is the first contact point with the health care system. There was a strong consensus that interdisciplinary family care teams should be the standard model for primary care, and these teams should be expanded and strengthened in all provinces and territories.
  • Invest in and use technology more intensively in the health care system, particularly information technology. More intensive and standardized use of information technology would allow patient information to be collected and shared seamlessly, making treatment much more efficient and thereby boost productivity in the health care system.
  • Change health professional compensation. The compensation model for physicians and other health professionals should be linked to more patient outcomes, not to activities like treatment or consultation, within a clear accountability structure.
  • Build an appropriate support system to care for the elderly. Few older Canadians want to be hospitalized for chronic conditions. They want to be cared for and healed where they live: in their homes and communities.
  • Improve the state of Canadians’ overall health and wellness. A healthier population would slow the growth in chronic diseases and in health care demand—so Canada needs a “wellness system” as well as a health care system. Employers have an important role to play in supporting the wellness of their employees and their families.

One aspect that is missing in this discussion, is the realisation that the obesity epidemic will lead to an unprecedented epidemic of ‘chronic disease of the young’. This will require taking chronic disease management directly to the workplace, an effort that goes well beyond current workplace ‘wellness’ activities.

Rather, we should be looking at creating an infrastructure which (in collaboration with the primary care provider) takes chronic disease management directly to the workplace.

The rationale for this is the simple fact, that contrary to the problem of chronic diseases in the elderly, younger people, who are likely to bear the brunt of the obesity epidemic, can ill afford to sit around in doctor’s waiting rooms during normal office hours.

Even expecting them to show up in doctor’s offices or community clinics after a busy work day may prove an important deterrent.

Thus, I believe that we will need to explore ways in which to bring chronic disease management resources and expertise into the workplace in a fashion that goes well beyond simply providing a treadmill for employees or changing food options in the cafeteria.

Edmonton, Alberta


Obesity May Cost US Boomer Babies $1 Trillion in Lifetime Earnings

Born between 1982 and 1993, the kids of the Baby Boomers are sometimes also referred to as the Millennial generation, Generation Y, Net Generation, or Echo-Boomers.

This generation has fully embraced social networking (e.g. Facebook) and file sharing (e.g. Napster) and spends an average of 3.5 hours a day online. They have also been noted to live longer with and be more dependent on their parents while at the same time valuing flexibility and independence.

Importantly perhaps, up to one in three members of this generation in one third of the US States is now clinically obese.

As this generation enters the workforce, how will the obesity epidemic impact their economic health and expected earnings?

It may be reasonable to ask this question, as obesity will likely negatively impact their productivity and, as a result, their economic prosperity. Not only do obese individuals tend to miss more days at work but especially obese women have been shown to earn substantially lower wages (around 12% less) than their normal-weight counterparts.

This question of lifetime earning was now addressed by Shari Barkin and colleagues from Vanderbilt University, Nashville, TN, in a paper just published in the Journal of Business Psychology.

Utilizing evidence in the existing literature, the researchers created an economic model to predict the impact of obesity on the aggregate lifetime earnings for the Millennial generation and the consequences for employers and employees.

If the assumptions for this model hold true, Millennial US women will earn an average of $956 billion less due to obesity during their lifetime, whereas Millennial men will earn an average of $43 billion less. The overall impact of obesity on the aggregate lifetime earnings of Millennial men and women is close to one trillion dollars.

The enormous disparity of this impact on lifetime earnings between men and women is largely due to the much larger wage penalties payed by obese women compared to obese men and exist despite the fact that women’s labour participation rates and earnings tend to be less than men’s.

The article highlights the urgent need for employers to address the issue of obesity in the workplace and cites positive examples where employers (IBM, General Mills, Medtronic) have launched major initiatives aimed at improving the health of their workforce.

The authors also suggest that these interventions should perhaps be tailored to the characteristics of the Millenium generation by making full use of social networking and online strategies based on chronic disease management models.

Whether or not the assumptions underlying the model are completely true or not, the study does highlight the potential impact of obesity on this generation and the substantial fallout that this can have on the economic future of the US.

Similar impacts of obesity on the economics of other countries are only to be expected.

Edmonton, Alberta

p.s. Join my new Facebook page for more posts and links on obesity prevention and management

Barkin SL, Heerman WJ, Warren MD, & Rennhoff C (2010). Millennials and the World of Work: The Impact of Obesity on Health and Productivity. Journal of business and psychology, 25 (2), 239-245 PMID: 20502510


Will the Public Accept Laws that Prohibit Weight Discrimination?

Regular readers of these pages will be well aware of the very real problems caused by weight-bias and discrimination.

As noted previously, anti-fat prejudice has direct implications for the health of those struggling with excess weight as it can increase vulnerability for depression, low self-esteem, anxiety, suicidality, maladaptive eating behaviors, avoidance of physical activity, poorer outcomes in behavioral weight loss programs, and hesitation to seeking preventive health-care services.

In most countries (including Canada), it is within the legal rights of most employers to discriminate against their employees on the basis of weight, and those who experience weight discrimination have no means for legal recourse.

But is the public ready to accept laws that will prohibit weight-based discrimination?

This question was addressed by Rebecca Puhl and Chelsea Heuer from the Rudd Center for Food Policy and Obesity, Yale University, New Haven, CT, in a paper just published online in OBESITY.

The study was conducted online in a national sample of 1,001 adults to examine public support for six potential legislative measures to prohibit weight discrimination in the United States:

Surprisingly, the researchers found substantial support (65% of men, 81% of women) for laws to prohibit weight discrimination in the workplace, especially for legal measures that would prohibit employers from refusing to hire, terminate, or deny promotion based on a person’s body weight.

Perhaps not so surprisingly, the likelihood of agreement with antidiscrimination laws was higher among individuals who were obese, 35–49 years of age, with a political ideology identified as Liberal or Moderate (or who identified themselves as Democrats), and those with lower education (high school vs. college or graduate degrees) and lower annual income (<$25,000).

In addition, although only 9% of the sample reported having experienced weight-based discrimination in the workplace, these individuals were 2–4 times more likely to endorse agreement with laws than individuals who had not reported workplace discrimination.

Similarly, participants who reported that their family members had been targets of weight-based victimization were more likely to express agreement for laws compared to participants who did not report victimization toward family members.

On the other hand, there did not appear to be much support for laws that proposed extending the same protections to obese persons as people with physical disabilities.

Thus, while it appears that there may be some acceptance and room for legislation against weight-based discrimination (especially in the workplace), there may also be important limitations to both the extent and acceptance of such legislation amongst the US population.

While this is a US study, I am not convinced that public opinion in favor of legislation against weight-based discrimination would be very different in Canada. Although, there have been legal precedents in Canada for rulings in favor of obese individuals (e.g. the airline seat ruling), there remains a strong public bias against people with excess weight.

Have you or someone you know been affected by weight-bias? I’d love to hear your story.

Edmonton, Alberta

p.s. Join my new Facebook page for more posts and links on obesity prevention and management

Puhl RM, & Heuer CA (2010). Public Opinion About Laws to Prohibit Weight Discrimination in the United States. Obesity (Silver Spring, Md.) PMID: 20508626


Will CDC Employer Obesity Toolkit Promote Weight Bias?

No doubt, the obesity epidemic is costing employers billions!

No doubt, sedentary jobs, unhealthy cafeteria food, and high job-related stress are all important contributors to the obesity epidemic.

So what would make more sense than to try to address obesity in the workplace?

To meet this need, the CDC yesterday launched a new website LEAN Works, which provides employers with extensive step-by-step recommendations, resources, and other features to address obesity in their employees.

Some of the features include:

– An obesity cost-calculator

– Information and resources to help employers set up and assess interventions to combat obesity.

– Information on how employers can estimate return on investment

While I have no doubt that the intentions are admirable and that the information provided is based on the best available evidence, the focus (as you may already guess) is sadly only on improving eating and activity behaviours.

Thus, I did not see much talk about depression and weight gain, emotional eating, dealing with past abuse, addressing food addiction, managing pain, coping with obesogenic medications, improving body image and self-esteem, managing peer pressure, or seeking competent medical advise on obesity medications and surgery (if I have missed any of this, please feel free to point this out).

What I did see was the usual recommendation to improve cafeteria diet, exercise prescriptions and opportunities, as well as the ubiquitous “weight-loss” competitions. Regular readers will appreciate my previous concern with all of the above, especially the nonsensical “competitions”, about which I have blogged before.

Regular readers will also perhaps recall my previous concerns on how targeting obesity with well-meant but simplistic “eat less – move more” messages can potentially do more harm than good, by simply reinforcing the “obese people are lazy gluttons” stereotype. I have previously blogged about the potential of workplace wellness programs to promote bias and discrimination. 

Given the accumulating evidence that weight-bias and discrimination actually prevents people from adopting healthy lifestyles and may simply make the problem worse, I wonder what impact this program will have on people, who actually suffer from this condition?

Remember, overeating and undermoving are symptoms and not the root causes of obesity. Addressing the root causes of obesity requires truly identifying and understanding the actual determinants of overeating and undermoving: stressors, food insecurity, peer pressure, mental health, abuse, medications, self-esteem, long commutes, urban sprawl, absentee parents, and countless other factors that I can think of, which truly underly the causes of the obesity epidemic.

Edmonton, Alberta