Obesity is a treatable chronic medical condition that affects over 25% of Canadian adults. But how well are we doing at treating obesity in Canada?
Today, the Canadian Obesity Network has released the Report Card On Access To Obesity Treatment For Adults In Canada. This is the first rigorous assessment of the degree to which Canadians with obesity can access publicly funded treatments such as dieticians, psychological counselling/support, medically supervised weight management programs, medications for obesity, and bariatric surgery.
The Report, not unexpectedly, showed that access to care for obesity in Canada is extremely limited.
- There is very little publicly funded access to dietary counselling, mental health support, cognitive behavioural therapy, or exercise professionals.
- There is no public coverage for anti-obesity medication, and only about 20% of private medical plans offer coverage.
- Bariatric surgery is available to only 1 out of every 183 adult Canadians per year who may be eligible for it (this varies widely by province, with the best availability of 1/90 in Ontario, and the lowest availability of 1/1,312 in Nova Scotia).
So why is access to obesity care in Canada so poor?
1. Despite the Canadian Medical Association declaring that obesity is a chronic medical condition (and not a lifestyle issue) in 2015, neither Health Canada, nor the federal government, nor any provincial governments have followed suit. This results in a lack of policies that support obesity care.
2. Medical schools have little to no formal obesity training, and very few Canadian doctors pursue additional obesity training of their own accord. Only 40 out of 80,544 doctors in Canada have completed certification through the American Board of Obesity Medicine. (there is no formal obesity training equivalent in Canada)
3. There remains a powerful and pervasive obesity stigma in Canada, which has been shown to be even worse in the medical community than in the general population. Person-first language is often not used in government resources nor in medical literature – meaning that obesity is used as a description of a person rather than as a diagnosis. (The correct terminology is a ‘person with obesity’, not an ‘obese person’.)
4. Government programs tend to focus on health promotion and obesity prevention, which is important, yes, but with a lack of attention to helping people who have obesity and need treatment for it.
So, where does this leave us? The Report recommends:
- Government, employers and the insurance industry need to adopt the position that obesity is a chronic medical condition and orient their approach and resources accordingly;
- Government needs to recognize and help break down weight bias and stigma;
- Obesity training for health care professionals needs to increase;
- Governments need to increase funding and access to interdisciplinary care, weight management programs, anti-obesity medications, and bariatric surgery;
- The Canadian Clinical Practice Guidelines, last published in 2006, need to be updated (and we are starting work on this!)