Disclaimer: Obesity Canada receives unrestricted educational grants from companies who research, manufacture and/or market obesity treatments in Canada and other jurisdictions.
Obesity is a chronic disease (defined as when excess weight or fat impairs health). Just like diabetes and other chronic diseases, obesity results from a number of contributing factors. Some of these contributors can be influenced by behavioral modifications such as diet and movement, but that is hardly the entire story. Just like diabetes, there are hormonal, physiological, environmental and genetic factors that are not under an individual’s control. We also know that the body resists weight loss as a survival mechanism.
If obesity is a chronic disease, then it is reasonable and appropriate to expect that people living with it would receive comparable care and support as do those who live with other diseases. Sadly, if we look at Obesity Canada’s 2019 Report Card on Access to Obesity Treatment for Adults in Canada, this is not the case. No province or territory recognize obesity as a disease, nor do any treat it within a chronic disease framework. Only 67 out of more than 86,000 physicians in Canada are certified in obesity medicine (note that physicians receive little to no formal training in weight management, obesity, diet or exercise in medical school).
If Canada is going to make significant strides in improving access to obesity care, we need to have as many evidence-based treatments and trained professionals as possible.
Just like for other chronic diseases (e.g. diabetes, hypertension, cancer, etc), therapeutic interventions for obesity can include behavioural therapies, nutritional and physical activity programs, medications and surgery. Health professionals and patients can work together to try different therapeutic interventions based on the person’s values, preferences, and goals. Oftentimes, like with any other disease, a person may end up using several different therapeutic interventions.
Anti-obesity medications are one of a number of possible interventions. Despite what the perception of the general public might be, medications are not the “easy way out.” They are not “cheating,” and they are not a “cure”.
Have you wondered why this perception is so common when it comes to obesity? Would we think that a patient with hypertension is taking the easy way out because they take hypertensive medications? One of the many drivers of this perception is weight bias and obesity stigma. The lack of recognition of obesity as a chronic disease fuels assumptions that people should be able to manage their disease on their own by just eating less and moving more. It seems like obesity treatments are stigmatized since they are seen as the easy way out. We need to move beyond obesity stigma and consider the science and the realities that people face in managing this chronic disease.
In the right patients, obesity medications can be an effective tool, and Canadians therefore need to be open to having them in the obesity treatment tool chest along with other obesity treatments such as bariatric surgery, behavioural interventions and peer support and more.
In Canada, three medications have been approved for obesity management. None are covered under provincial or territorial public formularies or pharmacare programs. Contrast that figure with the fact that as many as 31 medications for diabetes are covered under various public plans. When it comes to access to these medications for those who have private health benefit plans, the situation is also bad. Less than 10% of Canadians with private coverage have access to anti-obesity medications.
Canadians need a diverse and comprehensive set of treatments that match the diversity and complexity of the disease itself. Anti-obesity medications are not for everyone who needs treatment for obesity — no single type of treatment is a one-size-fits-all solution.
In order to improve access to treatments, one of the first steps is to have provincial and territorial governments (as well as employers and private health plans) to recognize that obesity is a chronic disease and to include medications and other treatments in their coverage programs. In Canada, for a treatment to be considered for the public formularies it must go through a very comprehensive review that assesses effectiveness, cost-benefit ratio and potential impact through the Canadian Agency for Drugs and Technology in Health (CADTH).
Currently only one of the three medications approved for treating obesity in Canada has been submitted for such a review (that application is in progress). Should the application be approved, many Canadians will experience improved access (through the public health care system) to one potential treatment option. This will hopefully spark further interest in and focus on improving access to a diverse set of treatments.
This first CADTH submission is a positive step in addressing the abysmal findings of the Report Card on Access to Obesity Treatment for Adults in Canada. You can help demand better by speaking up to elected officials, policy makers and your employer.
Start here by joining our advocacy campaign; simply scroll down to the campaign, add your postal code and click send, and an email will be sent to your elected officials to raise awareness of issues surrounding access to care.
Not getting the support you need from your private benefits? Click here for tools to help you self-advocate for treatment coverage.
Photo: “What” by Véronique Debord-Lazaro/Flickr/CC-by-SA-2.0
