By Dr. Ximena Ramos Salas
On January 14th, 2019, Dr. Arya M. Sharma (Obesity Canada’s Scientific Director) and I participated in the UK All Parliamentary Group (APPG) on Obesity International Conference, where we shared Canada’s approach to obesity.
This international conference also brought together US, European and UK experts, as well as policy makers and people with obesity to examine whether obesity should be recognized as a chronic disease. Discussion focussed on the effects this might have on the UK healthcare system in terms of funding and services, while making comparisons to other countries that have already made this step.
The conference was well attended, and discussions were informative and passionate. What struck me during the event was that the debate about whether obesity is a chronic disease or not has officially ended – at least within the scientific and clinical communities. International scientists and clinicians agreed that obesity is a chronic disease.
The debate about whether obesity should be recognized rages on within government and public sectors, however. Some government officials that attended the conference expressed their opinions about why obesity is not a chronic disease. Their opinions remained even after hearing from international scientists and clinicians who presented compelling evidence on why obesity is a chronic disease.
Their opinions also remained despite the UK Royal College of Physicians (RCP) declaring publicly that they believe obesity should be recognized as a disease, in the days prior to this conference.
From the media coverage about the UK Royal College of Physicians (RCP) declaration, it is clear that the public also has diverse opinions about whether obesity is a chronic disease or not.
Among Canadian scientists and clinicians, we don’t see debates about obesity as a chronic disease anymore. Obesity Canada, the Canadian Association of Bariatric Surgeons and Physicians and the Canadian Medical Association have recognized obesity as a chronic disease for several years. However, neither federal, provincial or territorial governments have recognized obesity as a chronic disease and continue to use the narrative that obesity is a lifestyle risk factor. So, Canada and the UK are experiencing similar barriers to getting obesity recognized as a chronic disease by governments and the public.
One of the biggest misconceptions that is preventing the recognition of obesity as a chronic disease is that people with obesity will lose the ability to make decisions for themselves. However, as international experts and persons affected by obesity explained at this conference, clinical practice and patients’ lived experience demonstrate the opposite is true. People with obesity find it is helpful to finally receive a medical diagnosis because this can help them receive evidence-based support. It is also entirely possible for people with chronic diseases to take individual responsibility and receive evidence-based treatments simultaneously. Individual responsibility for health is part of any chronic disease management intervention. But, putting all the responsibility on the individual is neither helpful nor evidence-based. Unfortunately, based on the current narrative of obesity, governments and the public believe that obesity is a matter of individual responsibility only.
Unless we address this misconception, individuals with obesity will not be able to receive respectful, evidence-based treatments and supports.
Another misconception is that obesity prevention and management will devastate healthcare budgets. The reality is that Governments are spending on obesity related conditions already. And let’s not forget that people with obesity deserve to be treated with dignity and respect as all other Canadians living with chronic diseases. From a public health perspective, treating individuals with obesity differently will inevitably create health disparities. Our goal should always be to reduce health disparities and improve the health of all citizens.
The second part of the conference focused on the policy implications of recognizing obesity as a disease. The answer is both simple and complex. Recognizing obesity as a chronic disease means that governments need to offer both prevention and treatment interventions. The good news is that health care systems are already set up to manage chronic diseases, so in principle we already know what the broad policy implications are. Obesity is not unlike other diseases requiring comprehensive approaches at the individual, community and policy levels.
There will be specific interventions needed as in other chronic diseases. Although we do not have interventions that may help all individuals living with this complex chronic disease, there are evidence-based interventions that work for a lot of people. Engaging persons affected by obesity in future obesity policies will be key to ensuring that policies reflect their realities and needs. In my opinion, not providing these interventions to those who need it and could benefit from them is a matter of lack of understanding of obesity combined with pervasive weight bias and ideological views.
Obesity Canada , our colleagues from the UK and from around the world will continue to work together to influence policy chance. Ultimately, our hope is that all governments will recognize obesity as a chronic disease and that people affected by obesity will have access to dignified, respectful and evidence-based care.
Ximena Ramos Salas is the Managing Director of Obesity Canada.