Little appetite to tackle obesity

PREJUDICES ONE BARRIER TO ACCESSING NEEDED TREATMENT

Obesity specialist Arya Sharma hears the argument all the time: Why should the public health system pay for treatments for people who have essentially “done it to themselves”?

In fact, the public system pays for very little of that sort of treatment now, and a Senate report last year on Canada’s obesity epidemic was virtually silent on improving access to care.

In a new report, Sharma and colleagues are calling on Canadian governments to recognize obesity as a chronic disease in and of itself, like diabetes or cancer, and improve public coverage for anti-obesity drugs, weight-loss surgery and other interventions.

According to the report by the Canadian Obesity Network, bariatric surgery is available to only one in 183, or 0.54 per cent of adult Canadians who may be eligible for it; wait times between referral to surgery and consultation with a surgical team stretches up to five years; anti-obesity drugs aren’t covered by any provincial or territorial drug formulary; and fewer than 20 per cent of the Canadian population with private drug-benefit plans have access to prescription obesity meds.

“We’re basically at ground zero in terms of obesity management in this country,” said Sharma, the network’s scientific director and professor of medicine at the University of Alberta.

Two years after the Canadian Medical Association declared obesity a chronic disease, none of the provincial or territorial governments, or Health Canada, has recognized it as such, Sharma said.

In addition, none of the 21 recommendations contained in the 2016 Senate report on Canada’s obesity “crisis” called for providing better access to treatment — essentially, Sharma blogged at the time, writing off the seven million Canadians living with obesity “as being beyond help.”

While not going nearly so far, Kelvin Ogilvie, the senator who chaired the committee that produced the report, said in an interview Monday that severe obesity is “virtually irreversible,” available treatments have minimal benefit, bariatric surgery can cause “significant psychological problems,” including an increased risk of suicide, and, at some point, “people have to take some responsibility for their own situation.”

“Obesity, to be blunt, is very largely a lifestyle issue,” Ogilvie said.

He stressed that he sympathizes with those with excess weight and said that once obesity causes other conditions such as diabetes, care is covered.

However, he said that once a person becomes seriously overweight or obese, “there is virtually nothing that can be done to reverse that — the body system adjusts to the highest weight you achieve and wants to keep you there.”

In fact, studies suggest that excess weight gets biologically stamped in. When people cut back on what they eat, an anti-starvation response kicks in. The body slows down metabolism, stimulates appetite and people consume more.

Ogilvie said it was beyond the purview of the Senate committee to make specific medical recommendations, and that prevention “is really the best way to deal with” the obesity dilemma.

More than one in four adults in Canada have obesity, a leading cause of Type 2 diabetes, high blood pressure, heart disease, stroke, arthritis and some forms of cancer. It’s estimated obesity costs Canada up to $7 billion annually in health care and lost productivity.

But Sharma says despite all the focus on prevention, little is being done to help the millions of Canadians now living with obesity.

“When you call the ministries and say, ‘what are you guys doing for obesity,’ they point to prevention programs and policies and taxing fast food and putting calories on menu boards — which is all great. Do all of that,” he said.

“But there is no evidence that doing anything for prevention is going to help lower body weight in people who already have the problem.”

According to the obesity network’s report, antiobesity drugs (there are currently only two approved by Health Canada) run as high as $4,000 a year. People can expect to pay between $1,000 and $2,000 for the meal replacement portion of doctor-supervised weightloss programs, even though provincial drug formularies cover meal replacements for other chronic diseases like diabetes.

While studies have found anti-obesity drugs wanting, with such side effects as oily stools, nausea and vomiting, Sharma said one in seven people benefit greatly and that even a five-percent weight loss can lead to health benefits.

No one chooses to be obese, he added. “And we generally don’t make decisions on what gets covered, or what doesn’t, based on whether or not people have ‘done it to themselves,’ which, by the way, isn’t true for obesity.”

“Because if you start seeing things through that lens, you wouldn’t be covering a lot of things, starting with STDs,” he said.

While the number of bariatric surgeries in Canada continues to rise, wait times are the longest of any surgically treatable condition, according to the report.

“People are flying to Mexico and India getting private surgery, paying for it out of pocket and taking out loans,” Sharma said. “Why do we allow people to become desperate enough, their only option is to go to Mexico?”