On June 10th, 2021 the Canadian Agency for Drugs and Technology in Health (CADTH), an independant, not-for-profit organization responsible for providing Canadian decision makers with objective evidence about the optimal usage of drugs and medical devices, released a draft of their recommendations for the coverage of the obesity medication Saxenda (Liraglutide) in public healthcare formularies.
A positive recommendation would mean that provincial and territorial governments would have a green light to include Saxenda in the publicly funded healthcare programs.
Currently there are no obesity medications that are part of the public formulary or that have been recommended by CADTH for reimbursement by provincial and territorial governments.
Obesity is a disease that could be impacting over 8 million Canadian adults and we have very few effective and evidence based treatments available. However, the accessibility to these evidence-based treatments as outlined in the 2019 Report Card on Access to Treatment for Obesity is almost non-existent.
A positive recommendation from CADTH would mean that Canadians living with obesity would have coverage for at least one medication. Compare that with Canadians living with other chronic diseases and the coverage of medications that exist for those conditions, including obesity related complications such as diabetes, hypertension, cardiovascular disease, and some cancers.
Unfortunately, CADTH’s recommendation is that Saxenda not be reimbursed as an adjunct therapy for obesity management alongside a reduced calorie diet and increased physical activity. While the clinical trials for this medication demonstrate a significant impact on weight reduction, the draft recommendation made by CADTH primarily outlined the lack of clear evidence of improvements to co-morbid conditions within the clinical trials as a reason for the decision. This is unfortunate as clinically significant improvements to health, wellbeing and co-morbid conditions have been shown with as little as 5% reduction in weight for individuals with obesity in other research, these however were not primary measures included in the specific clinical trials for this medication.
This is bad news for Canadians living with obesity, who currently have to pay out of pocket for obesity medications (unless they are among the less than 10% Canadians who have access to obesity medications through their private insurance).
Obesity Canada made a submission to CADTH in support of the public coverage of both Health Canada approved obesity medications (Saxenda and Contrave).
In our submissions to CADTH, on behalf of Canadians living with obesity, we asked that CADTH recommend the coverage of obesity medications in the publicly funded healthcare system from two main reasons: 1) obesity is a chronic disease that requires medical management, and 2) currently Canadians do not have access to any effective and evidence-based obesity medications through the public healthcare system. This is unacceptable. Canadians living with obesity are contributing members of society and deserve to have access to healthcare treatments like everyone else.
In our submission we shared the latest science of obesity which shows that obesity is a complex chronic disease that impacts the health and wellbeing of millions of Canadians. We also provided evidence about the extent to which obesity stigma is preventing Canadians from accessing evidence-based treatments and contributing to worse health outcomes. We explained that obesity has long been misunderstood and simplified to a condition of poor personal behaviours and lack of willpower. We argued that these biased beliefs are preventing governments, healthcare professionals and the public from treating obesity seriously and this is creating deeper health and social inequalities in our country.
Biased beliefs about obesity (i.e. lack of understanding of the science of obesity and deeply socially ingrained stereotypes about people living with obesity) have severe consequences for people living with obesity. A direct consequence of these biased beliefs is that people with obesity are left to manage their disease on their own, while also being targeted with weight-based stigma and discrimination across education, employment, and public policy.
People with obesity are also discriminated against in the workplace because of the negative stereotypes such that individuals with higher weight or living with obesity are lazy, unintelligent, lacking motivation and willpower, and less successful. These biased beliefs can influence the types of benefits plans that employees have access too. For example, most employers do not include obesity treatments in their benefit plans.
People with obesity are stigmatized by healthcare professionals who believe that weight can be controlled solely through individual behaviors such as healthy eating and regular exercise. These biased beliefs among healthcare professionals can influence the type and quality of care they provide for people living with obesity. For example, research shows that healthcare providers who have weight bias will spend less time with patients living with obesity and will prescribe less screening for serious illnesses.
People with obesity are stigmatized by policy makers who have biased beliefs about obesity treatments. Many policy makers believe, for example, that obesity treatments such as medications, surgery, and psychological interventions are unnecessary and ineffective. People just need to try harder and control their weight.
The CADTH recommendation is yet another barrier to reducing stigmatization and discrimination and achieving health equity for people living wiht obesity in Canada.
The Canadian Adult Obesity Clinical Practice Guidelines, which represent the most current recommendations for evidence-based obesity management, include obesity medications. The CADTH decision to not recommend obesity medications for reimbursement by public healthcare systems leaves Canadians with minimal access to effective treatment and highlights the disparities in the approach to obesity when compared to other disease states.
Obesity Canada will continue to advocate for improved access to effective, evidence-based treatments for Canadians living with obesity and we hope that as new innovative treatments become available in the future, decision makers will begin to shift their beliefs and attitudes towards obesity and people who are affected by this disease. We hope that in the future policy makers critically reflect on how their beliefs and attitudes towards obesity impact their work and the policies they develop. Our efforts are strengthened when more people are willing to speak up and demand better. You can do so by clicking here and letting policy makers know that we need to start treating obesity as a chronic disease.