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Toronto Charter on Obesity and Mental Health

Yesterday, the Canadian Obesity Network in partnership with the International Association for the Study of Obesity (IASO) and the Centre for Mental Health and Addiction (CAMH) officially released the 2012 Toronto Charter on Obesity and Mental Health, which reads as follows:


1. Both people with obesity and mental illness experience bias and stigmatization.

2. People with enduring mental health problems are two to three times more likely to develop obesity and related disorders like diabetes and heart disease than the general population.

3. Conversely, obesity can negatively affect mental health.

4. Shared societal, environmental and/or biological drivers are implicated in this frequent association of mental illness and obesity.

5. This frequent association has a large impact on the length and quality of peoples’ lives and leads to enormous costs for society.

Call to Action

The organizers and attendees of the Hot Topic Conference on Obesity and Mental Health, Toronto, June 26-28, 2012 declare and support this Charter and call on all stakeholders, including policy makers, health care professionals, service users and their families and caregivers, to join in the effort to reduce the negative consequences associated with obesity and mental illness by:

Enabling Change through Policy

1. Prevention of mental illness and weight-related disorders should be an important component of public health goals and measures.

2. Policies must recognize the links of both conditions to socioeconomic, cultural, gender and other determinants of health.

3. Public health policies and interventions must reflect the complex interplay between mental health and obesity without marginalizing and stigmatizing persons with obesity and/or mental illness.

4. Policy makers must ensure that individuals with mental health problems have equitable access to evidence-based obesity prevention and treatment. They should also ensure that individuals with obesity have equitable access to appropriate mental health services to address drivers and consequences of obesity.

5. Health systems need to ensure adequate capacity, infrastructure and program support, including education for health care professionals, caregivers, families and service users, to empower them to address these issues.

6. Policy makers should establish and ensure standards for responsible media coverage of obesity prevention and management and the promotion of healthy body image, including establishing standards for advertising and promotion of weight loss practices.

The Role of Health Professionals

7. A cultural shift is needed to foster respect, understanding and a non-judgmental attitude towards persons with mental health problems and/or obesity.

8. All health practitioners, particularly those involved in mental health care, must be trained and resourced to recognize and address the bidirectional association between mental health and body weight and to prevent excessive weight gain, including that associated with the use of psychiatric medications.

9. All health practitioners, particularly those involved in weight management and its consequences must monitor and consider mental health, as well potential unintended adverse consequences of interventions.

10. The primary care setting is ideally positioned to provide a holistic and family orientated approach to address these associated health problems.

11. All health professionals should collaborate across disciplines, services and sectors to ensure that the close links between obesity and mental health are recognized and addressed.

Expanding and Disseminating Knowledge

12. Greater investments must be made in research to understand the causes, consequences and costs of combined mental illness and obesity, and on the most effective ways to prevent and manage them.

13. Researchers must recognize and address the potential confounding role of mental illness in obesity research and of obesity in mental health research.

14. Existing knowledge on the links between mental health and obesity must be synthesized and developed into practical resources, accessible to the medical community, educators, patients, their families, and other caregivers.

I sincerely hope that this Charter will receive wide attention and consideration by policy and decision makers and be taken to heart by all involved in the care of individuals with obesity and/or mental illness.

Please indicate your support for this Charter by distributing this post and/or the actual Charter (available here) to as wide an audience as possible.

All comments appreciated.

Edmonton, Alberta


  1. Hi Thanks for posting this, I especially appreciate #7 for Health Professionals, “there needs to be a cultural shift”, my eyes were very opened to this over the month of June when I became the target of “discrimination” I operate a fitness and adventure company exclusive to obese clients. Recently we received international media attention; however it was not about our much needed concept, the headlines turned into a “skinny ban”. I thought it was quite interesting that our concept was created to support the needs of obese people trying to work on their health. I understand, from a personal level, how intimidating it can be to get started. The comments, emails and phone calls we received in response to this media was overwhelmingly positive from obese people around North American; however, those who did not fit our demographic were angry and seem uninformed to the needs of our growing epidemic. Our program is designed specifically to serve the physical, emotional, mental needs of the obese clients. It was intended to include, not exclude. I think people need to understand that if you are obese you feel sidelined in many arenas of life and further support and inclusion is needed to help obesity in Canada. It baffles me why this is offensive to some. Love all your posts, I find it very fascinating. Louise Green

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  2. I am encouraged by this charter, particularly in that it looks at the interplay of obesity and mental illness and also emphasizes that those who have either or both should not be subject to stigma. Both obesity and MI are often seen as weakness.

    Too often, people with mental illness get very simplistic admonitions to exercise without anyone recognizing the full picture of what they’re up against. When you have a day where you are so depressed that simply getting dressed and brushing your teeth is a victory, it can seem overwhelming to go for a run. When you are on sedating medication, common in bipolar treatment, where you have to sleep 10-11 hours a day just to function and are holding down a full-time job, there are not many hours left to hit the gym. Does exercise help? Yes, certainly. But you have to recognize the very real barriers before you can help someone work around them.

    In some ways, obesity carries stigma because it’s visible, while mental illness carries stigma because its invisible. You get sympathy when you get cancer. There’s a test for that. There’s no blood test for mental illness. Someone looking from the outside doesn’t realize how bad it is.

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  3. Thanks, Dr. Sharma, for your report on this charter. The following quote from your summary provides a much needed critical perspective: “Policies must recognize the links of both conditions to socioeconomic, cultural, gender and other determinants of health.” In addition, it is useful to recognize the ways in which both concepts, “mental health” and “obesity” are socially constructed by various discourses within social structures of power. These constructs, therefore, are not ethically neutral, or value free categories (and ways to understand.) These constructs are thus like rhetorical lenses, which may help us to better understand struggles that people experience, but which may also limit or distort our perspectives on human experience and may even prevent us from recognizing ways that these social constructs (as they are currently constructed and legitimized as appropriate ways to categorize individuals) serve to hide and/or normalize widespread practices of domination, oppression and social control. Ironically, even apparently noble-sounding efforts to acknowledge the social/cultural “determinants” of health legitimizes (lends power to) the continuing focus on “individuals” as the primary unit (level) of analysis (in “health care”, for example). Hence, we are able to continue locating “health” and “illness” as manageable outcomes within individuals rather than (in addition) understanding “health” and “illness” constructs as systemic ways of reproducing (and legitimizing) current power structures (professional “providers” of health care, for instance).

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  4. Hi Doctor sharma:
    Thanks for the insightful posting of an obesity treatment charter–I wonder why an announcement like this does not get the publicity it deserves, versus those head in the sand weight bias ostriches announcement is not surprising. The mainstream media is the most weight bias in society. There has been very little care-giver weight bias through my mental health treatment. The clubhouse for MI consumers has not displayed weight bias either, which is very nice. Few organizations are present in the world promote the members to develop and use the skills thay have with mental illness like the clubhouse structure does. It may be nice and beneficial to have a simaular group for those who are obese–I do not think that if an obese individual came into the clubhouse here in Wetaskiwin would be turned away if they were only obese there is an associate member status that he/she would qualify for.

    It is most important that those who have limitations are not incapable but he/she does require a little more physical and emotional support than the average non-obese/MI person does. Thanks againfor the insight

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  5. The socioeconomic aspect is not due to “the man” “oppressing” people with mental illness and obesity; it is because when you are carrying a mountain in your head you are unable or less able to function effectively in a society that is set up to robust competition at its best, and to (in the U.S.) needing to fight governmental regulations set up to block the competition. Therefore, in the U.S., and probably Canada, adding in societal intolerance for overweight and “strange” behaviors, people with mental illness sink to the bottom.

    And those who cannot see the invisible burden then blame them, and the spiral downwards continues.

    The irony, of course, is that every judgmental, arrogant contributor to the problem is one illness away from joining those whom they scorn.

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  6. I am so pleased to see this. It’s an extremely important topic. Physical health care for people who receive mental health care is getting cut back rather than expanded. At my hospital the full time outpatient dietitian position was cut completely and the other inpatient dietitian was cut. The healthy eating/cooking groups have been cut way back and there are fewer OTs to work with clients on all the different aspects of taking care of yourself.

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