Obesity is increasingly considered a chronic health condition in its own right, but in public policy, we continue to treat it merely as a risk factor for other conditions such as diabetes, cardiovascular disease and cancer.
A new report from Obesity Canada shows that disconnect has a real impact on the millions of Canadians with obesity who are looking for help. They have trouble accessing care, from weight-loss management through to bariatric surgery, because interventions, if they are available at all, are rarely covered by insurance.
Yet, the health effects of obesity are devastating, individually and collectively: Excess weight is a leading cause of Type 2 diabetes, high blood pressure, cardiovascular disease and sleep apnea, and can be a factor in a number of types of cancer, osteoarthritis, infertility, incontinence, depression and more.
An estimated one in 10 premature deaths among Canadians between the ages of 20 to 64 is directly attributable to obesity.
Obesity Canada defines obesity as a “progressive chronic condition, similar to diabetes or high blood pressure, which is characterized by abnormal or excessive fat accumulation that impairs health.”
Because of the social stigma and “widespread negative stereotypes that persons living with obesity are lazy, unmotivated and lacking self-discipline,” the condition can also have significant social and economic impact, the report notes.
While there is a genetic component, the rise in obesity has been fuelled by the shifting socio-economic environment: Food – especially high-fat, high-sugar processed food – is readily available, and activity has been engineered out of daily life.
According to Statistics Canada, only 40 per cent of adults maintain a healthy weight; 34 per cent are overweight and 27 per cent are obese, based on body mass index (BMI). The fastest growing category is the “morbidly obese” (a BMI of more than 40 per cent), those who have the most health problems.
Obesity rates also vary considerably by geography – a low of 22 per cent in B.C. and a high of 38 per cent in Newfoundland and Labrador – and by levels of education and income.
The problem is not unique to Canada. A large global study published in The Lancet showed that excess weight affects the health of more than two billion people worldwide, and accounts for four million deaths each year. The report estimated that, over all, obesity costs the global economy $2-trillion per annum, similar to the impact of smoking.
In its new publication, Obesity Canada includes a report card on access to obesity treatment, and it makes for grim reading.
Like most chronic illnesses, obesity can be treated and the symptoms mitigated, but what most people get is simplistic and often condescending advice to eat less and exercise more.
What patients with obesity need – especially those with the most excess weight – are not only medically supervised lifestyle interventions such as dietary and exercise therapy, but mental-health support such as cognitive behaviour therapy, pharmacotherapy and even bariatric surgery.
But all those are hard to come by in Canada.
One of the most common approaches to medically supervised weight loss is meal replacement therapy, bolstered by group support meetings, sometimes for as long as a year or two.
The clinical aspects of the treatment (physician care and diagnostic tests) are covered, but meal replacement products are not, and they cost in the range of $250 weekly. Psychological care, which focuses on breaking destructive eating patterns, is not covered either.
Three drugs have been approved for obesity treatment in Canada, but none are covered by public drug benefit plans. By contrast, up to 32 diabetes drugs are covered.
Those with the most severe forms of obesity – meaning, generally, that their BMI exceeds 40 and they have other medical conditions – benefit most from bariatric surgery.
While 10,276 bariatric operations were performed in Canada last year, that’s only a fraction of the number of patients who could benefit, and the waits are mind-boggling – up to eight years to see a specialist who determines eligibility and then up to a year more before actual surgery.
In the meantime, all the other health problems that come along with obesity worsen and require treatment, at enormous cost to the individual and the health system.
Tackling the roots of this epidemic – malnutrition and inactivity – is long overdue. But so, too, is a more organized approach to treating the sick.
But we can’t afford to wait any longer to tackle our collective weight problem.
André Picard