Introduction to Obesity Canada with Lisa Schaffer

– Hello and welcome to the “Scale Up Your Practice” podcast, brought to you by Obesity Canada. I’m Roshan Abraham, an associate professor in the Department of Family Medicine at the University of Alberta. Besides educating medical learners, I’m deeply involved in the Obesity Canada Education Action Team. As a family physician, I witness daily the complex challenges of obesity, both at individual and system levels.

 

– And I’m Michelle McMillan. I am a lived experience collaborator with Obesity Canada and your co-host. We’re here to help you navigate the ever-changing landscape of obesity management from multiple perspectives. Myself as a patient, Roshan as a medical professional, as well as the insights of all our guests, all of whom have worked in the field of obesity. This podcast is an important information source for healthcare professionals looking to enhance their understanding and skills in managing obesity.

 

– We want to remind our listeners and viewers that today’s episode is not sponsored. So let’s get started. In today’s episode, we’re thrilled to chat with Lisa Schaffer, executive director of Obesity Canada. Lisa, welcome. Could you share with us a bit about Obesity Canada’s vision and mission?

 

– Absolutely. Thank you for having me. I’m so excited that we have this new endeavor of our podcast and excited to be here as one of the first guests. So I wanna introduce everybody to Obesity Canada and that really is gonna be a through-line for us. Across 2025, we’re really committed to improving and enhancing our visibility and impact across Canada and making sure that the everyday Canadian really knows about Obesity Canada. We have been around for 20 years. This year will be our 20th anniversary, so we can talk about that more in a little bit as well. But we’re deeply rooted in education, research, and advocacy. Our mission and vision is about improving the lives of people living with obesity. And we really have a vision for a day when all of us who live with obesity can show up as our best selves and have vibrant and exciting lives. And so much has changed in this space over the last few years. It feels like one of those, like, slowly then suddenly moments where now this really is an exciting topic and an interesting space to be in. And at the same time, that noise is causing a lot of friction in some places and confusion, quite frankly, as well, which I’m not 100% against. So Obesity Canada, we’re really here to improve the lives of all Canadians living with obesity. And what we now know is some more research that we’ve recently published, one in three Canadians is living with overweight or obesity. So in a lot of ways, we need to make sense to every Canadian, and that’s really what our mission in 2025 is gonna be, is to show up differently, louder, and be more helpful than ever before so that people really understand that we are the trusted resource for all things related to understanding obesity.

 

– That’s amazing, Lisa. As we know each other from our work at Obesity Canada, you know, I come from kind of the patient perspective of things and as someone living with obesity, but that’s only one perspective. Maybe you could talk a little bit about how, you know, Obesity Canada supports health professionals in addition to people living with obesity.

 

– Absolutely. And that’s really core to everything that we do as well. And that’s our through-line in all touchpoints. And a place that we’re incredibly proud of as well is how much we are able to try and help healthcare practitioners in this moment. I like to remind everybody as well, no offense, Roshan, I know you’re a doc, doctors are just people too, and you guys are raised and steeped in the same kind of diet culture and chaos that all of your patients are as well. So we need to help really elevate the right evidence-based information, the most recent and most right information to share, and be a trusted resource for healthcare practitioners so that it can get down to the patient level as well. So that’s something that we’re incredibly proud of and our large anchor point, and I often call them the crown jewels for Obesity Canada, are the clinical practice guidelines that were released in 2020. And Obesity Canada was really foundational in putting together these clinical practice guidelines. So the guidelines, as they exist, they’re a 300-page document, they are lit reviewed, they have all the expert voices, but they have the most relevant and up-to-date information for everybody to understand. And then as an organization, we took it a step further as well, a couple steps further, really, we really tried to make it possible for people to disseminate this information, to make it tangible and useful. So we have summary chapters available and we are committed to maintaining these clinical practice guidelines and making them relevant, up-to-date, and current. So that’s a big way that we support healthcare practitioners, not just in Canada but around the world because what has been established with our clinical practice guidelines has now become the gold standard in how to understand care and treat and think about obesity, quite frankly. And what makes me incredibly proud, and to bring it back to both our hearts, Michelle, you and I, you know, the patient voice has always been core to how Obesity Canada has approached everything. And that was a foundational moment for me when I first met the organization. And those come through in the clinical practice guidelines as well. The patient voice is center in those clinical practice guidelines and the clinical practice guidelines are rooted in the patient experience. So what’s different about our guidelines than maybe some other guidelines? And Roshan, you probably have seen more guidelines than I have, but ours really starts with just let’s ask for permission to have the conversation. Let’s make it easier to have these conversations. That’s what we really hope to happen and help healthcare practitioners with, because let’s be honest, again, as I used to say, when I first started doing advocacy or volunteering before I even worked here saying the word obesity felt verboten almost, or it feels like knees and elbows, it’s not a conversation that, you know, people are terribly comfortable having. So we wanna empower healthcare practitioners to get it right and also empower them to have the right kinds of conversations. How do you even approach this with somebody? Or how do I answer somebody when I don’t even know the answers 100%? Or even further, science doesn’t know all the answers yet and it’s an emerging and evolving science space. So it’s not easy. But what I keep saying on repeat and what we as an organization want everybody to understand is that curiosity is actually a really great thing. It means you’re not stuck, it means you’re not fixed in believing that it’s just a diet and exercise conversation or that you have the right to assess somebody’s health just based on the way that they look. And our clinical practice guidelines are really designed to help support those conversations. And we take it even further with our amazing education platform and our learning pathways that we’ve developed for healthcare practitioners as well. If you take our Calibre courses, if you take our Introduction to obesity courses, if you take our bias and stigma courses, you’re going to be that much more empowered to have the right conversations because you really cannot talk about obesity without talking about bias and stigma. So that’s a lot to add into a GP’s day. And then I know when I go see my GP, I love her to bits, but she’s got stacks of paper everywhere. It’s not the most tech savvy, advanced place. So we want to do anything we can to make life easier for GPs so that patients are getting the right experiences, whether that’s they want to navigate care itself or if they just want to exist in this world and feel like they’re being treated and respected with kindness while they’re living with obesity. So those are ways that we really try and help healthcare practitioners. We also are known for our obesity summits and in 2025, we’ll be having a national obesity clinic update conference where we really get in the room with people, we really mean this. I’ve never met a community that is so passionate and so giving. We want people to have the information. We wanna create conversation wherever we can. And that’s another big point for me is, you know, again, it’s not always easy. You gotta have the courage to have these conversations and the courage to hold the line and help people understand that this is a chronic disease, obesity is a disease, not a decision. And if we can start there and give everybody space and grace to catch up to that moment, I think we can have such a big impact. I can keep going if you want me to. Do I need a breath?

 

– I might ask you to, but I am actually curious. There’s lots of opportunities. So for myself, I’m a family doctor, for those tuning in for the first time and hadn’t heard our intro episode. I mean, I’ve been in practice for about seven years now. It’s going to be eight years in July. I mean, what you describe minus the paperwork, but let’s say a computer filled with stacks of paper because that’s the equivalent for us. The amount of administrative work that we do as family physicians in this country and many countries around the world seems almost unending. And with how complex obesity is, we do find that it’s almost easier for the bias and stigma to actually come in because then it’s easier to treat people if you are just making shortcuts in the way that you’re thinking about their care. And so I think my experience has really been that if there’s an organization that can advocate for some better learning opportunities and really enhancing those practical skills, I think that’s something that is going to benefit all practitioners, not just family physicians, but all practitioners as well. Are there any particular sort of learning opportunities or options that you really think enhance the practical skills of healthcare providers? You mentioned those bias courses. I think they are, I mean, essential for I think all healthcare professionals, not just ones interested in obesity management.

 

– No, for sure.

 

– Are there any ones that you would say that are particularly important for maybe our listeners to be aware of?

 

– I would love for more people to know and understand about our Calibre course. Our Calibre course is really, again, that bridge moment from having the clinical practice guidelines as this slightly overwhelming document to going, “Okay, but how do I do this for real in my practice today? Or how do I implement this?” And Calibre is a great resource, it is an investment in time and money, but it really is going to give you everything you need to bring things forward in your practice. And it might not, you might not be able to do everything all at once. But I truly believe the more people and more practitioners that we can get to go through Calibre, and that doesn’t also just have to be GPs. That could be chiros, that could be pharmacists, that could be so many different touchpoints just to give you the right information because we need people to start there. Let’s start with the right information. We know not everybody is necessarily gonna get there quickly or might not get there at all to truly, truly, at their core, believe this is a chronic disease. That’s a kind of a big hill that we’re still asking people to climb. But at a minimum, what we need people to understand is you are entitled to your own opinion but not your own facts. And the facts exist, the evidence exists, and we can supply you with the right evidence so you can at least have the right conversations. And my dream is, across ’25, we’re gonna enhance our obesity care finder on our relaunched website as well. So if you can’t handle it, let’s at least give people resources where they can go and then find somebody who might be able to help at the moment. Science has moved faster than our systems can support today. We know that. And we also do a lot of advocacy work. And while that might feel like we’re advocating for humans, the patient experience, we’re equally advocating for our healthcare practitioners. We need billing codes to exist so that you can give proper care. We need to understand that this is a complex and chronic disease, that if we treat it first and correctly, we can actually remove impacts of over 200 other diseases. So by getting out of our pejorative feelings that this is just about you making some bad decisions, patient X, Y, or Z, and move to how can I actually help this person get some functional health back in their world, you can avoid having conversations with that same person about hypertension, about diabetes, pre-diabetes, osteoarthritis. There’s so many things and really what’s stopping us is is the bias and stigma and shame that we have put around living in a bigger body because we know how people treat people who live in a bigger body. We don’t want to be that. The world isn’t designed for us. It’s incredibly hard to navigate. So let’s start with kindness and the right information and the correct facts and check our opinions. So we’re leading with science and non-stigma.

 

– Wow, Lisa’s a soundbite machine.

 

– I know. She’s amazing.

 

– Wow. And I mean, that segues perfectly into one of our recurring, probably our only recurring segment as of now, the bias break, where we reflect on weight bias and its impact on care because it has such a profound impact on the care of patients in multiple levels of care. Michelle, I think you had something in mind, I believe, this week.

 

– Yeah, so this week, I thought, last week we talked a little bit about weight bias and stigma and what it is. Today, I thought we’d start kind of back from the beginning of evaluating some of our biases here. And where this comes from for me is that I’ve had the absolute privilege and honor of being able to speak to some medical students throughout the years and speak about living in a larger body and having obesity and just having them have some understanding around it. And one of the things I always start with is directing them towards the Harvard Implicit Bias Test. Now today I’m going to talk about the test in relationship to weight bias. But if you go there, you will see there is a long list of biases that you can take the test around, you know, around ethnicity and gender and a whole bunch of things. But today we’re gonna talk about weight. So you can either Google Harvard Implicit Bias Test on whatever, or whatever search platform you wish to use, or you can go to implicit.harvard.edu and the test takes about 10 minutes. In essence, what you’ll be doing is clicking left or right, basically what it’s looking at is associations. So between the concept, in this case. of thin people and fat people, and evaluations, whether you give good words, bad words associated with that. And basically the idea, and I am not a psychologist or a psychiatrist, but basically the quicker you respond to an item, the more closely related they are in your mind. So for example, you know, if you see a thin image on the screen and a good word, you probably will click that faster than if you see a larger person on the screen and a positive word. And as I said, you can go through this test and I highly recommend it for everyone. And here is why, because I pop into this test every few months and I just did it this morning. And so as I spoke about in the first podcast, you know, I’ve lived in a larger body my whole life. Genetically the people that I’m related to, most of them live in larger bodies. Many of my friends live in larger bodies. My colleagues live in larger bodies. I, of all people, know that living in a larger body does not make you dumb, stupid, less intelligent, all of those things. But this is what I’m gonna tell you. So I took the test this morning, guess what my result was? It says I have an moderate automatic preference for thin people over fat people.

 

– Wow.

 

– So, you know, I’d be interested in, you know, just as Lisa said earlier, we all live in this same diet culture.

 

– Yes.

 

– So even when you know this, like I do have a frontal lobe, I can move past these, I mean, but just acknowledging to yourself that, you have these is important ’cause if you can’t get to that step, you’re going to have a harder time getting to the next step in engaging things. So I’d be curious, you know, what are your guys’ thoughts around, you know, just these automatic responses and biases that you have?

 

– Lisa, have you done this test before?

 

– I have. It’s been a hot minute since I’ve done it, but I do find it so interesting and I mean I, we do, we all have this implicit bias or these implicit or these these baked in paths in our head, right, as well that just are true. And I think one of the best examples is anytime somebody’s having a baby and they’re talking about what they might name the baby, you’re like, “Oh, you can’t name them Stacy. I sat next to a girl in the second grade named Stacy and you don’t want to do that.” Right? Like, that’s bias, implicit bias as well. It seems like we all have little quirks in our head and I think the more we can give that space to kind of check ourselves, the better off we would all be. But it is fascinating, the Harvard test.

 

– I’ve experienced it now twice, but only in the context of being an interviewer for admission to medical school. So in my role as a faculty member, I have lots of participation in a lot of different committees. And one of them is as part of the admissions committee and actually being an interviewer and even a lead for some of the interview groups that are there for the MD program. And I remember now doing this twice. And what I find interesting is sort of the change from year to year for me and how a lot of these biases sort of evolve over time and even some of the blocks that we have in our own mind and some of the ways that we sort of compensate for these biases, especially in clinical care. And it’s all swirling through my head while I’m going through this. I think, Michelle, what you have highlighted, which is really important is to actually revisit this on a regular basis. So I would say as clinicians, it’s really important for us not just to do it because we’re told to do it in order to select better people as our future colleagues. We need to be doing this as part of our entry into the clinical world. We need to be, before we start residency, like, after medical school and then through our clinical rotations, we need to actually be revisiting bias. And that is something that, as an educator, especially in undergraduate education, I found that that’s been extremely lacking. Not just with weight bias and stigma, although that appears to be still one of the few types of bias and stigma, at least in health professions education, that seems to be allowed. And then that’s just from my experiences and we’ll talk about that at another bias break down the road because I’ve got lots of examples and it’s not just our medical school, lots of medical schools where that bias seems to be okay to talk about out loud.

 

– Yeah.

 

– And it is wild. And people don’t think it happens. It definitely happens. And it’s not just in medical school programs, it’s in health professions, educations programs across the country, across the world. When it’s part of the system, right, when it’s baked in, right, as you said Lisa, when it’s baked in, you really have to get past that. And I think that’s what’s going to be important for us, not just in this podcast, but a lot of the other education work that we do is to just recognize that. And I think, Michelle, you just hit it on the head there is recognizing and then being able to reflect on it and reflect on it consistently. So Lisa, I think it’s going to be great for us to see a lot of the changes moving forward with Obesity Canada. I’m curious, for our listeners as well, what do you think Obesity Canada’s role is and how will it evolve in the future?

 

– Absolutely. So thank you for framing it that way as well because I really am so fortunate and proud. I’ve only been in my role for just under six months now, but I’ve been in and around the organization for seven years and as I said earlier, the organization itself has existed for 20 years. And what that really is a testament to is the fact that we are the pioneers, we are the people that literally have blazed this trail and started these conversations and literally had like a scientific director in Arya Sharma who would pull people aside at a conference and be like, “We need to talk about this, we need to think about this, we need to have this conversation.” And I’m so proud of that. So I want to make sure everybody else understands that is going to stay true. We want to be network people, we want to build community, we want to build shared resources, and we don’t want to sit beside each other making the same thing either. All boats rise, let’s be an amazing collective. We’ve already shown ourselves to be, as I said, pioneers and innovators. Let’s go full bore with this. Let’s be innovative in how we apply our clinical practice guidelines and be innovative in as a country in how we treat and recognize obesity systemically, as you said as well because it is, it’s baked into all of our systems, healthcare systems being one of them, but a lot of other systems as well. And when you were talking about that bias, I promise I really will get back to the future, but oh, that’s back to the future. But I want to go to the bias for one second as well because you know, we’ve seen, again, in our most recent research paper that when employment rates are high and we need people, people living with obesity get hired at the right rate. The minute it’s low and people have that minute to be a bit more judicious, automatically people living with obesity go to the bottom of the pile and our rate of employment goes down. We know that people living with obesity do require comprehensive care and so they might have more time away from work. So we’ve got a bit more absenteeism. But what we really have that’s heartbreaking is presenteeism with people living with obesity who are employed ’cause we don’t feel like we can show up as ourselves because our systems and our tools for how we do our job are not even set up correctly necessarily. That goes to furniture things. But it also goes to things like policies. If I’m a professional and I look at my new employment handbook and there’s already a person of size policy so that I know when I need to do business travel, I’m not gonna have to have a really awkward conversation or like that they’ve even considered that that might be something that somebody might need. My shoulders go down, I feel seen, I feel heard, I want to give back. When we don’t have those mechanisms, that’s when we all feel a little bit more, like a little more cagey, a little more we gotta hold ourselves back because I can’t show up. My whole self isn’t really invited to be here. So that’s a big part of it. And we know that that is coming at a cost of about $21 billion to the economy right now by not recognizing what people living with obesity can really bring to society. And I’ve often said, I think if we could get out of this diet culture belief with just women alone, the amount of goodwill that could be put back into society and the amount that could come back to the workforce would be phenomenal. So I’d love to see that happen. For Obesity Canada, we’re going to stay that through-line. We want to create this network, we want to share the information, we want to tell others. That’s why we are so proud that our clinical practice guidelines have been endorsed and adapted globally. We’re reaching other parts of the world by just going, “This is the right way to do it and it makes sense.” And there’s hope. There’s treatment now. There are conversations worth having. It’s not one cause and not one cure, it’s still complicated, but there’s hope in a way that there hasn’t been hope before. And everybody deserves to understand that. So our goal is to make sense to the everyday Canadian, to show up louder, prouder, and easier to engage with so people can understand what do they need and how can Obesity Canada support that. So we’re looking at putting together toolkits and resources for the patient community, enhancing our education offerings so that we can serve more of workplaces, those other parts of society as well and just help them understand this moment. And then continuing to expand our educational resources as well and staying on top of the most right and relevant information so those clinical practice guidelines can be the through-line and that north star for everybody. And so that Canada can get back to what Tommy Douglas had in mind and be a place that we can really be proud of where we take care of each other in a way that makes sense. No small ask. You guys are still in?

 

– Yeah.

 

– Absolutely.

 

– Oh, definitely.

 

– Absolutely.

 

– I love it. So that’s what we really want to be in the future. We want to remain true in being those leaders who are changing the face of what this looks like through advocacy, through education, and through research. And I think research is a really interesting place for us as well to start looking at obesity in the law and really tucking into some of those human rights moments. But also research in as much as, like, how do we navigate this? How can we get more weight bias and stigma research done when there isn’t even a qualifier to do that kind of research?

 

– Correct.

 

– How can we get good evidence and research when our own Canadian Institutes of Health research don’t have qualifications that say that you need to work outside of the BMI when we know the BMI is the fundamentally flawed through-line. So there’s a lot of Christmas lights to untangle, but we have to start by having the courage to have the conversation. So let’s get to work.

 

– I’m excited. I was always excited to be part of Obesity Canada. Now I am so much more excited after this episode.

 

– I’m so excited.

 

– We need an army. We need everybody’s.

 

– We do.

 

– We do. So like, the more people that can join us and have the same through-line, I think the more impact that we’re gonna be able to make. I still get goosies. I’m so excited. I’m such a nerd.

 

– Lisa, it’s been incredibly enlightening learning about the critical work that Obesity Canada does. I wanted to thank you so much for sharing with us today. You know, even working within the organization, I have learned so much today, so I know our audience has learned much and your enthusiasm, as always, is amazing and I’m sure that that is going to encourage our audience to also investigate Obesity Canada and how it can assist their practice.

 

– Thank you so much for giving me this opportunity to join and for both of you for all that you’re bringing to the podcast. And yeah, I wanna reiterate to everybody, we are in the process. We are gonna show up very differently next year, so sign up for our newsletters ’cause you’re gonna wanna keep in touch with us and find out all the good things that are going on. We’ve got the, as I said, updates to the clinical practice guidelines for adults. We also have pediatric guidelines that will be coming out in early ’25, meaning we’re going to be able to provide care for the entire lifespan of somebody living with obesity. And the little Lisa that lives inside of me that knows what those doctor’s appointments feels like is very optimistic about this next generation and how we’re setting people up for success. We’re also gonna be celebrating our 20th anniversary and we’ve got a few other things planned throughout the year that are gonna be pretty interesting and exciting. So I’m excited to see where it goes. Hopefully I’ll be back for more conversations here in the podcast as well. But let’s make a difference. Let’s put a ding in the world.

 

– Wow, yeah, we should definitely have you back. Thank you again for joining us. We hope our discussion has been enlightening for all our listeners and viewers and that you’re leaving with enhanced knowledge on Obesity Canada. For more information and resources, please visit the Obesity Canada website at obesitycanada.ca.

 

– And also if you could help us spread the word by sharing this podcast with your colleagues and your friends. And don’t forget to subscribe on your favorite podcast platform to stay up to date with the latest episodes.

 

– And until next time, keep scaling up your practice. This podcast is intended for informational and educational purposes only and does not constitute medical advice. The content shared in this podcast should never be used as a substitute for professional medical advice, diagnosis, or treatment. Always seek the guidance of a qualified healthcare professional with any questions you may have regarding your health or a medical condition. The information and treatments discussed in this podcast are based on Canadian guidelines and approved practices as of the time of recording. If you’re listening from outside of Canada, please consult your local healthcare professional to ensure compliance with your region’s medical standards, guidelines, and recommendations. The creators of this podcast disclaim all liability for any decisions or actions taken based on the content discussed. Listening to this podcast does not establish a professional or patient-client relationship.