By Ian Patton, PhD, Director of Advocacy & Public Engagement, Obesity Canada
Historically, people living with obesity have faced a contradiction in Canada.
In science and clinical practice, obesity is recognized as a progressive, relapsing chronic disease in which excess or abnormal body fat negatively impacts health. Effective treatments exist. Yet access to those treatments has remained limited, and recommendations from Canada’s Drug Agency have been conditional on whether an obesity-related health condition has already developed.
On August 28, Canada’s Drug Agency has issued a positive recommendation to reimburse tirzepatide (Zepbound™) with conditions for individuals with a BMI of 27 or higher with prediabetes. This recommendation does, however, put growing recognition of the need for earlier obesity treatment on the record.
Now, the recommendation goes to Provincial and Territorial governments, who will make their own coverage decisions with public drug plans based on price negotiations with the manufacturer.
Obesity Canada contributed patient input to this review and participated in a joint clinician submission with other Canadian health organizations, bringing both lived experience and clinical expertise into the reimbursement review process. We are grateful to everyone who shared their experiences and expertise to help inform the submission.
Treating obesity before complications develop
One of the clearest signals in the recommendation is the recognition that obesity should be treated earlier.
Clinical experts consulted by CDA said there is a need for more treatment options before complications and other health conditions develop. They also noted that limiting access until prediabetes develops can delay appropriate care and reduce opportunities to prevent future complications.
This reflects what obesity science has told us for years: obesity is a chronic disease that deserves appropriate treatment in its own right.
There is a broader cost to delayed care. Obesity Canada research estimates that the cost of inaction in treating obesity in Canada reached $27.6 billion in 2023, including $5.9 billion in direct healthcare costs and $21.7 billion in lost productivity and other indirect costs.
The review also acknowledges that health behaviour interventions alone do not lead to sustained weight loss, and that tirzepatide could be used as a first-line medication option alongside health behaviour interventions. Experts did not support requiring people to try and fail multiple treatments before starting it.
These recommendations bring reimbursement policy closer to evidence-informed obesity care outlined in the Canadian Adult Obesity Clinical Practice Guidelines, which we have been advocating for since they were published in 2020.
Recognizing weight maintenance as a treatment outcome
The renewal criteria are an encouraging development.
After the first year, the recommendation requires evidence of a beneficial clinical effect: at least a 5% reduction in body weight from baseline. For subsequent renewals, people would not be expected to continue losing weight indefinitely. CDA’s clinical experts recognized that weight loss typically plateaus even when treatment is effective and that maintaining the weight already lost is an appropriate outcome for continued treatment.
That reflects the realities of chronic disease management more closely than a model built around continual weight loss.
Obesity care should support health, function, quality of life and long-term management. It should not be reduced to an endless pursuit of a lower number on the scale.
What happens next for public drug coverage
A positive CDA recommendation does not automatically create public coverage.
Provincial, territorial and participating federal drug plans will still decide whether and how Zepbound™ is reimbursed based on price negotiations with the manufacturer. In other words, it is not automatically publicly covered in Canada because of this recommendation.
So while this recommendation signals progress, access remains the next step.
People living with obesity should not have to wait until their health deteriorates before treatment becomes accessible. Nor should access depend on whether someone has private insurance or can afford to pay out of pocket.
For a long time, obesity policy has lagged behind obesity science. This recommendation begins to narrow that distance.
Now governments have an opportunity to build on it and make evidence-informed obesity treatment more accessible to the people who need it.
