Celebrating Canadian Excellence: A Conversation with Dr. Angela Alberga

– Welcome to “Scale Up Your Practice” the podcast, brought to you by Obesity Canada. I’m Dr. Roshan Abraham, a family physician and Associate Professor at the University of Alberta. Each day in clinic, I see how deeply the chronic disease of obesity affects individuals and families, and how critical it is that we evolve our understanding and our care.

– And I’m Michelle McMillan, a lived experienced advocate. Together, we bring you thoughtful conversations that centers on both evidence and empathy. On this podcast, you’ll hear from researchers, clinicians, and people with lived experience, all working to reframe how we understand and manage obesity.

– Today’s episode is supported by an unrestricted educational grant from Eli Lilly Canada. We’re continuing our celebrating Canadian Excellence series, spotlighting leaders shaping the future of obesity care.

– And we are thrilled to welcome Dr. Angela Alberga, global voice in weight bias research and equity informed care.

– Thank you both. It’s a pleasure to be here.

– Angela, so let’s start at the beginning. Tell us a little bit about your background. What sparked your interest in this field?

– Sure. So I guess when I was a child, teenager, I’ve always kind of been interested in sports, and health sciences, and working with kids. I was one of those, you know, loving to be working as a camp counselor, as a daycare educator. I worked as an afterschool care supervisor. So I always loved working with children. I love sports. I loved playing sports. I was a field hockey coach for young kids. So I just kind of had an interest in that. But I guess I didn’t really know what I was going to do with all those passions and interests. And I guess I thought, “Well, you know what, as a first step, I’ll start with an undergraduate degree in kinesiology.” And I thought it was a pretty good move considering that I totally fell in love with research from one of my professors. So she completely inspired me, Dr. Joanna Komorowski. In one of my classes, I took pediatric exercise science in one of my undergrad courses, and she was just so passionate. She was an awesome teacher, an incredible mentor, very inspiring. One of the best professors I’ve ever had. And she introduced me to pediatric obesity and research. I never thought I was going to be interested in research. I never thought I was going to pursue that at all. But she really provided me my first kind of opportunity to get involved in research. Offered me my first research position. And I guess she believed in me and provided me something that I never had an opportunity to do before. And so I started my research position with her, and then that kinda just started my love for research on this topic area. And I was doing a research project related to looking at how exercise improves cardiometabolic health and strength in kids living with overweight and obesity. So I worked a lot with kids and families, and that kind of started off my whole track for being interested in this topic area. And after that, I went to the University of Ottawa. I did my master’s and PhD there. I learned from an incredible multidisciplinary team of researchers in pediatric obesity, who I actually still work with today. And I guess some of those experiences that I worked with in Ottawa, and working with kids and teens, I always kind of knew that I’d be interested in pursuing more research. So I did a postdoctoral fellowship in weight bias and stigma at the University of Calgary with tri-faculty mentorship from incredible mentors there too. And then here I am, I’m starting… Well, I’m not starting, I guess. I’ve been involved as a professor at Concordia University in the Department of Health and Kinesiology and Applied Physiology since 2017. And I lead an interdisciplinary research program now on all kinds of topics related to obesity, pediatric obesity specifically, and weight bias and stigma.

– Wow, that is amazing. All from one mentor who kind of pushed you in that direction. That’s amazing.

– Yeah.

– I’d be curious, you know, you had a mentor that did that for you, try to fill that role for your students now being a mentor and keeping them interested in the field of pediatric obesity and living with overweight?

– I really try to. And you know what’s the crazy part about this whole story is that I’ve come full circle. So I started my undergrad at Concordia, and now I am having my own lab at Concordia. And I actually have the same lab that my professor had when she inspired me to do her work when she was a professor here. So I’ve kind of come full circle and I hope that I could, you know, be as impactful and influential as she was to not just me but so many students that have followed her path.

– That’s actually incredible. And I don’t think we’ve talked nearly enough about the importance of mentorship, especially in the health professions education or research fields. And I think this is truly an essential part of moving the field forward. Not to mention ways of addressing weight bias and stigma in all aspects of education and research showing that, “Hey, this is something that I can craft an entire career around, and that can be defining for me,” right? I think that’s incredible, to be able to have that type of mentorship. So we’re always a little bit curious. Was there any particular turning point that drew you to the research itself?

– I guess there… When I was inspired by my professor like Joanna Komorowski who really inspired me to do research, I kind of just followed her path, and I was interested in the research that she was doing. And then when I really got involved in reading a lot, and as a graduate student, you fall into those PubMed holes where you start reading one article, and then you start looking at the other related articles, you end up reading a ton more. And I guess I was just reading a lot during my master’s PhD, and I had stumbled across a lot of research from Rebecca Poe, and she was really the pioneer, the internationally renowned researcher who understood weight stigma and research and really started putting it out there into literature. And I came across her articles and I really feel like that was really a turning point for me in terms of like what I want to do next and what kind of training I want to do next. Because finally, I felt like reading some of these articles, I thought finally there’s evidence and scientific data to showcase examples of weight bias and stigma that I’ve seen, heard about, talked about with my friends, family, you know, and the kids and teens that I was working with who are living with obesity in my research. So I heard about all these weight-based teasing stories and anecdotes from families, friends. And these kinds of experiences, when I started reading them, and research articles made me really figure out, “Okay, this is something I really want to do more research on and I wanna be able to have an impact on, because it’s really affecting so many people.” And that’s what kind of, I think, was a turning point for me in terms of, like, next steps. That’s where I really knew I want to get more research expertise, and that’s why I sought after a postdoctoral fellowship. Get more research training on weight bias and stigma. And that’s what led me to the University of Calgary to be mentored by three incredible women at the university who really gave me a lot more training on weight bias and stigma, and that’s why I became like an interdisciplinary researcher. I really do lots of different types of research, but mainly because of that mentorship and those turning points of research, understanding the impacts of weight bias and stigma, how pervasive it is, and that fit a lot of those anecdotes and stories that a lot of these kids and teens were telling me about throughout their lives.

– I have a couple of questions, but one thing I’d be curious of, you know, you have so much experience in the field, is there one specific thing that you’re particularly proud of that you’ve done over your career so far?

– I feel like I have to think about this one. One thing I’m particularly proud of? I guess my first reaction is probably just seeing my students succeed. I think I’m like a notorious for like crying at every time my students defend their thesis or, you know, present their kind of work. I get really emotional by just seeing them succeed and go off and do these awesome presentations and owning their research and seeing their self-confidence grow throughout their research experience. I think I would say that’s probably something I’m most proud of, is seeing how they’ve kind of succeeded and how they move on to next steps in their work. And I guess professionally too, in terms of, like, what we’ve created in Canada, I feel like I’m really proud of some of the work we’ve done together with a lot of Canadians. So in 2016, I think it was Ximena Ramos Salas from Obesity Canada and formerly Canadian Obesity Network. She started the Everybody Matters collaborative with a lot of researchers in Canada and I was one of them, but amongst several others in Canada, and we did a lot of like awesome things together. We, like, applied for tons of grants together. We organized weight bias summits together. We did a lot of really great things, I feel like as a team. So I feel like that’s also something I’m quite proud of with the work that we were able to do as a team in Canada.

– So shifting our focus a little bit to our audience, what’s one insight you wish every clinician understood about managing obesity?

– Yeah, I guess, you know, keeping in light of weight bias and stigma too, I think one insight maybe that we can all try to have more of, is more curiosity. Because I think one of the first things that we make assumptions on, is we make assumptions based on someone living in a larger body. We make assumptions that people living in a larger body don’t exercise, they don’t have healthy habits, they may be living with mental illness, they may have had a parent or a sibling with obesity. Like there’s a lot of kinds of assumptions that we make just upon looking at someone who lives in a larger body. And we can’t even say “making assumptions based on someone who’s living with obesity,” because even that we can’t even see visually. We can see a person lives in a larger body, but we can’t assume that that person’s also living with a chronic condition. So, maybe just the insight I would try to make all of us reflect on, is trying to be a little bit more curious so that we’re not making assumptions upon our first reactions. Because these automatic assumptions are like automatic. They happen subconsciously. They make these quick little reactions in our mind about what we associate people with. But if we were to just, you know, maintain curiosity, ask more questions, be curious about what is bringing this person here today with me and my clinical encounter, what are some things I could help with through a non-judgmental, open-minded kind of curious way, I feel like that can go a long way.

– I love that you use the word curious. I mean, a lot of time we talk about being empathetic or trying to be non-biased, but if you reframe it as just being curious about another human being, that opens the window so much. That’s a fantastic tip, a fantastic idea. Thank you so much.

– I think Ted Lasso popularized that “Be curious, not judgmental,” even though I think it comes from Walt Whitman or quite a famous American poet. And that’s something that I hope we can instill in future generations as well as I’ve tried with my students every year, is actually, I tell them that quote when we talk about bias in healthcare. So let’s actually get into weight bias specifically. We know that children with obesity face disproportionate levels of bullying and stigma, often from adults and peers alike. Can you share an example of how weight bias shows up in pediatric settings?

– Yeah, sure. So Roshan, you’re absolutely right. Like there’s been some research that shows that the number one reason for bullying is because of weight. And kids and teens who have obesity have like a 60 to 70% chance of being bullied just because of their weight. And we see this, I mean, everywhere. And in pediatrics, like you mentioned, it can be through weight-based teasing. So making fat jokes, derogatory humor, you know, placing examples about being in a larger body and not being able to do certain things. So weight-based teasing can be done through like fat jokes, derogatory comments, it’s all over the media. So it’s not even just like in the education system, but in the healthcare system, and even the family environments. Like, how you talk about weight, or food, or exercise, or physical activity, or mental health. Like somehow it’s always tied to weight or it’s often tied to weight, and making like oversimplifications about weight being so simple and it’s just like, you know, exercise more and eat less, and it should be as simple as that to manage your weight, to manage your obesity. But in kids, you know, it’s even found in like children’s stories. Like, we see this in, like-

– Oh, right.

– children’s literature. And not just like, you know, literature from like 20, 30, 40 years ago, but even in children’s books today. I’m a parent too, so like I’m very conscious of this stuff too that I’m reading to my kids. And I always try to be careful of what kinds of stories we’re telling, what kinds of, like, automatic quick assumptions that are made in storybooks and in the media, like kids and Disney, and like all these episodes on Netflix, and associating thinness with beauty, and thinness with success, and thinness with more romantic partner, the more successful one, the more beautiful one. Or the evil person or the person living in a larger body is the person who is evil to be feared, like Ursula, for example, from “The Little Mermaid.” You know, I think there’s like more positive examples that are coming up with Disney and some media that are coming out that are portraying larger body characters with more positive attributes. But I don’t think it’s necessarily the case for all, like the history of media and children’s stories, and books and movies. So it’s so ingrained everywhere. There’s so many examples of these. But it’s no wonder, you know, kids as young as 3 years old already have some negative attitudes towards people in larger bodies because it’s literally everywhere. It’s not just in conversations in our families and our friends in schools, but it’s in the stuff that we see, people talking about this in the changing rooms at a shopping center. People talking about this over the dinner table over Christmas and other holidays. It’s really just ingrained everywhere. So there’s lots of examples of this unfortunately.

– I mean, given that it’s so pervasive, and we’ve talked about that before in the podcast here, you know, what do you think clinicians can do, particularly if we focus around schools or primary care dealing with, you know, children and younger generation, what do you think clinicians can do to disrupt this bias and become allies for kids who are living in larger bodies?

– Yeah, so there’s so many things we can do. And I think one of the things we have to try to do is just be advocates. You know, even if it’s like small little conversations with your colleagues. If you notice in, like, medical notes that you’re taking about patients where the language-

– Yeah.

– or the wording that’s written about a patient or a family living with overweight and obesity speaking about that openly, not in a shaming way though, because you don’t want to fight shame with shame, you know, you want to be able to speak about things openly and honestly, and just be curious about, you know, why certain things are written, why certain assumptions are made with colleagues, for example. So asking a lot of questions, trying to challenge some of the assumptions we make. But advocating to it like higher levels, because that’s what’s really gonna make a difference too. Is like speaking up to higher administration, you know, implementing policies, anti weight discrimination policies, making incentives for including, you know, that body diverse policies, or having healthcare environments that are more body inclusive and diverse. You know, providing incentives for encouraging positive body diversity, but also having repercussions and consequences too to have policies in place that protect people from being discriminated, whether that’s in the workplace, in schools, in healthcare environments, everywhere. So there’s a way to speak up about this, but I think going higher up, even if you’re not able to at the local level, but maybe speaking higher up in administration, could really be impactful. Whether that’s higher up in a school too with leadership or other peers in a school or primary care, I think that could be really impactful to try to make a difference to speak up.

– Dr. Alberga, thank you for sharing your journey and expertise. You’ve given us a lot to think about from the roots of bias to the ripple effects of respectful care.

– Thanks, Roshan and Michelle.

– To our listeners, if this episode sparked a new insight or reminded you of your purpose, share it, send it to a colleague, send it to a friend, or drop us a review on your favourite podcast platform.

– We’re here to help you scale up your practice with compassion, curiosity, and evidence. Until next time, stay tuned, stay kind. 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.