REPORT CARD ON ACCESS TO OBESITY TREATMENT FOR ADULTS IN CANADA
2017

Obesity is a chronic disease that impacts the lives of millions of Canadians. But how well are we doing at treating obesity in Canada?
The Canadian Obesity Network has now examined access to publicly provided medical care for adults with obesity, including interventions covered by private health benefit plans.
Click here to open a summary of the study methodology.

What is Obesity?
Obesity is a progressive chronic condition characterized by abnormal or excessive fat accumulation that impairs health. It should be diagnosed by a qualified health professional using clinical tests and measures that assess health, not size.

Obesity is a leading cause of type 2 diabetes, high blood pressure, heart disease, stroke, arthritis, cancer and other health problems. It also affects peoples’ social and economic well-being due to the pervasive social stigma around it. Weight bias can increase morbidity and mortality, and is associated with significant employment, healthcare and education inequities.
Click here to learn more about obesity.

Treating Obesity
Recent research has shown that treating obesity can control and even improve osteoarthritis, diabetes, sleep apnea, hypertension, urinary incontinence and even infertility.
The Canadian Clinical Practice Guidelines suggest that health professionals utilize the treatment approaches on the right. The guidelines stress that the diagnosis and treatment of obesity must be delivered in a supportive, non-judgemental and interdisciplinary environment.

What is the Current Level of Care?
The Canadian Medical Association, the American Medical Association, the World Health Organization and others agree that obesity is a chronic disease.
Fact: Neither the federal government nor any of the provincial/territorial governments in Canada have recognized obesity as a chronic disease.

Access to Trained Health Professionals
Fact: A very limited number of Canadian physicians are pursuing formal training in obesity management, and medical schools do not routinely include obesity in their curriculum.
Only 40 Canadian doctors (out of 80,544) have completed certification through the American Board of Obesity Management (ABOM). ABOM administers a comprehensive exam that Canadian physicians can take to demonstrate their understanding of the diagnosis and treatment of obesity.

Access to Medically Supervised Weight- Management Programs with Meal Replacements
The OPTIFAST® weight-management program is a medically supervised program that uses a 900-calorie meal replacement, and is delivered by an interdisciplinary healthcare team.
  • Provincial health plans cover costs associated with medical supervision (e.g. diagnostic tests and clinicians’ time) only.
  • The cost of meal replacements is not covered by any provincial drug benefit program or private drug benefit plan.

Access to Prescription Anti-Obesity Medications
The Canadian Clinical Practice Guidelines recommend the addition of a pharmacologic agent to assist in reducing obesity related symptoms for adults who are not attaining or who are unable to maintain clinically significant weight loss with dietary and exercise therapy alone.

Access to Prescription Anti-Obesity Medications
Public Coverage Conclusions:
Those who rely on public (provincial, territorial or federal) coverage for prescription drug costs have no access to these medications.
In contrast, the Canadian Diabetes Association reports that public drug benefit programs cover at least two medications for diabetes in every province and territory and in Ontario, six diabetes medications are covered.

Access to Prescription Anti-Obesity Medications
Private Coverage Conclusions:
In a sample of 45% of Canadians who have private drug benefit plans, only 8.8% had access to the medications through their plans.

Access to Prescription Anti-Obesity Medications
We also surveyed leading insurance companies on coverage for anti-obesity medications in the private drug benefit plans they provide.
Conclusions:

  • Only four of the 11 recognize obesity as a chronic disease.
  • A majority said less than 10% of their plans covered anti-obesity medications.
  • Most reported that less than 10% of plans offered health spending accounts that could cover the cost of the medications.
  • Nine out of 11 indicated that plan sponsors (i.e., employers) can opt out of covering anti-obesity medications in the drug benefit plans they offer to their employees.

Access to Bariatric Surgery
The Canadian Clinical Practice Guidelines recommend that adults with clinically severe obesity (BMI ≥ 40 kg/m2, or ≥ 35 kg/m2 with severe comorbid disease) may be considered for bariatric surgery when behavioural intervention is inadequate to achieve healthy weight goals.
Bariatric surgery is associated with reduced onset of diabetes, remission of existing diabetes and lower mortality, among other benefits.

Access to Bariatric Surgery
Facts:

  • Bariatric surgery is conducted by 113 surgeons in 33 centres in 9 provinces.
  • Many centres do not accept out-ofprovince patients.
  • The number of centres has not changed since 2012.
  • Gastric bypass and sleeve gastrectomy are the most commonly conducted procedures.

Access to Bariatric Surgery
Conclusions:

  • There is significant inequality in access to bariatric surgery in Canada.
  • Bariatric surgery is available to only one in 183 (or 0.54% of) adult Canadians per year who may be eligible for it, i.e., adults with Class II or Class III obesity.
  • Access ranges from one in 90 adults in Québec who have Class II or Class III obesity to one in 1,312 adults in Nova Scotia.

Access to Bariatric Surgery
Grading criteria for wait times between referral and consultation, and between consultation and bariatric surgery were based on benchmarks developed by the Wait Time Alliance for similar conditions.
Conclusions:

  • Wait times for bariatric surgery in Canada are among the longest of any surgically treatable condition.
  • There is a significant risk of patients dying while waiting for bariatric surgery.
  • Current access to and wait times for bariatric surgeries in Canada are unacceptable.

Recommendations
The Report Card on Access to Obesity Treatment for Adults in Canada 2017 authors make seven recommendations based on the outcomes of this research.
Click here to see what health systems, employers and health professionals can do to improve access to obesity treatment for adults in Canada.

Acknowledgements
The Canadian Obesity Network-Réseau canadien en obésité was responsible for the design, data collection, analysis and interpretation of the report and assumes full responsibility for its content and conclusions.
We are grateful to the individuals who participated on the Scientific Working Group and Knowledge Translation Working Group for this project. A full list of participants is available in the full report.
Report Card on Access to Obesity Treatment for Adults in Canada 2017 was made possible with financial support from Novo Nordisk Canada Inc.
The Canadian Obesity Network-Réseau canadien en obésité is also grateful for the support of Johnson & Johnson Medical Products, a Division of Johnson & Johnson Inc., as well as Nestlé Health Science Canada for financial support toward dissemination and promotion of this report.