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Who Helps Canadians Manage Their Weight?



The short answer, for the vast majority of Canadians, would simply be, “no one”.

Last year, the Canadian Obesity Network undertook a representative survey to examine how Canadians manage their weight.

It turns out that over 65% of overweight Canadians have never talked to a licensed health professional (family doctor, dietitian, pharmacist, etc.) about losing weight. The same is true for over 40% of Canadians, who meet the clinical definition of obesity, i.e. have a BMI greater than 30.

This may probably be as well, because most health professionals are in fact ill-equipped to support individuals struggling with excess weight. Although, health professionals often cite lack of time and resources as the main reason for not broaching the topic, I suspect that the key problem is simply a lack of knowledge and training in weight management.

As I have said before, most health professionals have little more than a layman’s understanding of the complex socio-psycho-biology of energy homeostasis and have virtually no formal training in even the basics of behavioural, medical or surgical management of excess weight.

Add to this an (un)healthy dose of anti-weight prejudice and discrimination and it is probably no surprise why anyone who has ever solicited weight management advice from their health professional is more likely to receive simplistic slogans along the lines of “eat less and move more”, than a meaningful analysis of the problem with a personalized evidence-based management plan.

Indeed, weight management plans too often follow along the lines of well-meant but often ineffective diet or exercise recommendations, that virtually always fail to address the actual root of the problem (see my post – overeating is a symptom).

It should hardly come as a surprise when simply providing an impulsive overeater with a diet plan proves to be about as effective as providing a drinking plan to an alcoholic.

In contrast, teaching time-management skills to people who regularly fall back on fast food for lack of time or offering stress management classes to people who use food as a coping strategy may well be far more effective than simply educating them on healthy choices or handing them recipe books.

Of course patients can always turn to the billion-dollar weight-loss industry, that peddles everything from magical weight loss supplements to crash diets. While some of these program may well be better than others, there is no way a consumer can tell which of these many products and services are likely to be effective or just a waste of money.

Even if patients “successfully” lose weight with any of these products or services, this is rarely more than temporary “symptomatic” relief with a nineteen-in-twenty chance of weight regain within weeks or months of stopping the program.

Rarely do these products or services truly diagnose and address the root cause of the problem – that would require far more than a cursory “one-size-fits-all” business model and is unlikely to deliver the same lucrative profits.

Perhaps, it is time to promote a better public understanding of the many societal and individual level drivers of excess weight and it certainly appears high time health professionals and health care systems seriously took on the challenge of addressing the greatest health problem of our times.

When the problem is excess weight, not helping patients deal with this issue is simply palliative care.

AMS
Edmonton, Alberta

8 Comments

  1. Hi AMS,
    Thanks for this post. Just to go in the same direction of your discussion. Yesterday, September 2 a researcher of the radio interview I got a request … I said why not…! I begin to explain the basis of my research … my scientific development … but most of all my findings and my inability to be able to provide a scientific explanation of peculiar results ….
    She listened with a “certain” warning to finish by saying …. You know what … we will not interview … IT’S TOO COMPLICATED!!
    I burst out laughing [?!?!?] too complicated???? I did not even begin to show you the complexity of the problem of overweight [Obese/pre-obese-Men-Wonen-Kids Etc…] in Canada!!
    What people are looking for is the “miracle” and the “easy”solution … But …. life is complicated!
    Thank you for contributing to the explanation and demonstration of this complex problematic
    Sincerely,
    N 😀

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  2. I agree with you 100 %. I have found as a member of the Weight Wise program – that to get my doctor on board I had to tell him what I wanted – he did not offer. I did the research. People need to realize that you have to be a self-advocate for your own health a lot of the times. You cannot just expect the doctor to handle and know everything. They are very busy and there is such a shortage. In Edmonton, any cliinc you go to says the doctors are not accepting new patients – you have to come in on a walk in basis only. This makes it very difficult to get consistency and have a personal relationship with your MD. One doctor told me to not bother with the program and not have surgery because I would “feel better if I did it all on my own” Obviously, he has never been in the position that many of us in the WW program have/are in!

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  3. Dr. Sharma,
    Thank you for telling it like it is. The only person I know in Canada that provides the kind of leadership this country needs in order to get the handle on Obesity is you.
    Your explanations about health care professionals is right on.
    People need to take the most precious thing they have (Their own lives) and read, research, ask questions and stay in touch with Dr.Sharma for all the guidance and help possible.
    We at Thee Quest For Perfect Health understand and are willing to take a bigger role in the explanations and teachings people need to know.
    Thanks Doc for being there.
    Pierre Trudel
    Thee Quest For Perfect health

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  4. Yes!! Go for it!!

    I’ve been there – no pressure from my Dr to loose, despite BMI in bariatric surgery range – I asked (begged) for help & got ELMM plan (eat less move more)

    I think dr’s are driven by the need to deal with immediate severe problems – he has no time for chats about my lifestyle when he’s overloaded with cases that are crises right now.

    I got fatter and fatter, figuring one of these days I’ll loose the weight, after all it didn’t seem to be much of a concern to my dr. My dr should have raised hell about me being overweight, told me that fat does permanent damage, told me fat isn’t just something you can put on and later take off. He should have raised hell when I was overweight before I got to be obese, much less morbidly obese.

    ( I know my dr – for another patient-dr situation “raising hell” !! might not be the proper bedside manner, but the patient still needs the clear warning BEFORE obesity sets in)

    Drs around here are too busy, so I’m going with a do-it-yourself plan – patients do loose weight with non-medical programs, and if there’s a 1 in 20 failure rate, there’s a 19 in 20 chance of successfully keeping weight off for weeks and months after a program. That’s a start.

    While I’m on my DIY plan I’ll be eagerly checking in for innovations in the medical community.

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  5. Very well said Dr Sharma! I wonder what would be the role that CON-RCO can play in advocating for more education on obesity to be included in medical school’s curriculum.

    Wouldn’t partnering with Colleague of physician and surgeon’s of Canada, government (health Canada) to develop more educational tools and plans on obesity be part of the solution?

    Educating patients, healthcare professional and increase their awareness is one thing implementing a multidisciplinary approach in management of obesity is another thing. It is a huge responsibility for only one institution (CON-RCO) to deal with, specially as you say on a shoe string budget!

    We will need more Dr Sharma to fight the Obesity Octopus and cut its long troubled legs here and there…

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  6. Eat right.

    Amazing that medical science finds eating right too complicated when ordinary housewives, cooking ordinary food, used to keep most people at a decent weight.

    The culture that got rid of housewives “don’t know what you’ve got ’til it’s gone.”

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  7. good ideas in post … except for:

    “To minimize competition with other courses, integrate home ec into math, science, etc etc.” (paraphrase)

    Superficially that seems simple. actually it creates more work and upset of other cirriculumm subjects.

    Just teach the home ec. Make it simple and practical. Make it skills oriented, and as soon as a student masters a skill s/he should move on to the next skill. (That way it isn’t boring).

    If you want to integrate the school experience have the kids invite their calculus teacher for a home-cooked lunch.

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