Understanding Obesity

console.log("asd"); const foo = document.getElementsByClassName('th-hero-container')[0]; foo.insertAdjacentHTML('afterbegin',`

IN PARTNERSHIP WITH ELI LILLY CANADA

`);

.gallery {/*margin-bottom: 0; top: -40px; position: relative;*/} div.gallery span.hm-tagged {/* margin: 0; */} @import url('https://fonts.googleapis.com/css2?family=DM+Serif+Text&family=Roboto:ital,wght@0,100;0,300;0,400;0,500;0,700;0,900;1,100;1,300;1,400;1,500;1,700;1,900&display=swap'); @import url('https://fonts.googleapis.com/css2?family=Barlow+Condensed:ital,wght@0,100;0,200;0,300;0,400;0,500;0,600;0,700;0,800;0,900;1,100;1,200;1,300;1,400;1,500;1,600;1,700;1,800;1,900&display=swap'); @import url("https://use.typekit.net/anr4psv.css"); @import url("https://use.typekit.net/anr4psv.css"); @import url("https://use.typekit.net/anr4psv.css");

Lisa Schaffer remembers how it felt to be one of the biggest kids in every room. She remembers the sting of having to wear a mother-of-the-bride dress instead of a graduation dress like her peers, and the isolation of not fitting in—sometimes literally, into chairs at her doctor’s office or desks in university lecture halls. Schaffer, now the executive director of Obesity Canada, says living with obesity took a disastrous toll on her mental health, “I broke my own heart,” she says with a rueful smile. “I kept trying to understand why I was successful in so many other parts of my life, but this one spot just continued to evade me.”

LISA SCHAFFER Executive Director Obesity Canada

DR. TASNEEM SAJWANI Medical Director Edmonton Weight Management Centre

Schaffer’s story is shared by millions. Nearly one in three Canadians live with obesity, and obesity rates have more than tripled since 1985. In addition to its devastating impact on mental health, obesity is linked to hundreds of other conditions, including heart disease and diabetes. Despite its prevalence and far-reaching ripple effects, the advice for the millions of Canadians living with obesity has remained mostly unchanged: eat less, move more.

Messages like these lead to a frustrating cycle of diets and disappointment, as people like Schaffer blame themselves for being unable to lose weight (and keep it off) through diet and exercise alone. Dr. Tasneem Sajwani is the medical director of the Edmonton Weight Management Centre and a certified Diplomate of the American Board of Obesity Medicine. As a family physician specializing in obesity, Sajwani says that an explosion of research into the disease is providing a new understanding of obesity for healthcare professionals and new hope for her patients.

Sajwani says, “We can now objectively say that obesity is a chronic disease, versus what we previously thought—that this was a lifestyle choice or something that we could quickly fix ourselves.”

Schaffer and Sajwani are among a growing number of advocates, researchers, and healthcare professionals dedicated to sharing this new understanding of obesity, hoping to eliminate bias and stigma, streamline access to evidence-based obesity treatments, and save the Canadian healthcare system billions of dollars each year.

“Obesity is a Disease, Not a Decision”

Understanding obesity as a chronic disease comes after tremendous research advances into the physiology of weight regulation. Sajwani explains that over 300 genetic variants are associated with obesity risk, influencing a person’s appetite, satiety (the feeling of being full), energy expenditure, and body fat. Even factors that may seem like conscious choices aren’t quite so black and white: those living with obesity often have more ghrelin (an appetite-stimulating hormone) and less GLP-1 (glucagon-like peptide-1, a hormone which makes you feel full), creating frequent hunger that can feel almost impossible to satisfy.

When someone living with obesity does lose weight, Sajwani says it can be challenging to maintain, “Our brain has a robust biological drive to regain that lost weight—and more for good measure.”

Identifying the complex factors contributing to obesity explains why lifestyle changes alone are often insufficient in treating this disease and provides an evidence-based counter to misconceptions that those with obesity are lazy or lack self-control. “Obesity is a disease, not a decision,” says Schaffer. “You can’t willpower your way out of a chronic disease.”

The Cost of Obesity

Despite this new research, obesity bias and stigma persist, creating devastating effects on mental health, physical health, and even employment, particularly for women. A recent economic analysis by Obesity Canada found women living with obesity earn about 12% less each year compared to healthy-weight women and are also 5.3% less likely to be employed, while 54% of all people with obesity report stigma from co-workers.

According to Obesity Canada, 64% of people living with obesity have experienced bias in healthcare, which can lead to delayed surgeries, missed diagnoses, or an erosion of trust between patients and their doctors. Obesity stigma also comes with a steep price tag. The economic cost of Canada failing to recognize and treat obesity as a chronic disease is an estimated $27.6 billion annually, which includes increased healthcare costs, reduced personal income, and reduced workforce participation.

Myths vs. Reality

Myth

Obesity is a result of poor lifestyle choices

Reality

Obesity is a disease, not a decision

Chronic diseases result from a combination of genetic, biological, and environmental factors — according to Obesity Canada, up to 70% of obesity risk factors are determined by genetics.

Myth

People living with obesity just need to eat less and exercise more

Reality

Weight is not a behaviour

People with obesity can control their behaviour, not their weight. Effective obesity treatment plans include appropriate nutrition and physical activity; however, complex genetic and biological factors mean that diet and exercise alone may not result in weight loss.

Myth

Taking treatments is the “easy way out”

Reality

Like many other chronic diseases, obesity can be effectively treated with pharmacotherapy

Those living with obesity deserve individualized, evidence-informed care. Pharmacotherapy can be an important pillar in the management of obesity, just like it is in other chronic diseases like type 2 diabetes or hypertension.

“We need to understand that the weight of the stigma and bias that people with obesity receive is deadly, and very, very problematic,” says Schaffer. “It’s not just that we want people to be nice to us—it’s costing people’s income, it costs them their health, it costs them their basic dignity. We all deserve all three of those things.”

Treating Obesity

Breaking through obesity stigma is crucial to educate and support healthcare practitioners in providing access to effective obesity treatments. “This is a complex disorder that requires, and deserves, multimodal management and evidence-informed care,” says Sajwani.

In her practice, this involves individualized treatment plans that take into account dozens of patient details like weight history, sleep habits, and overlapping disorders like attention deficit hyperactivity disorder (ADHD) or polycystic ovary syndrome (PCOS), address medical nutrition, and explore pharmacotherapy options.

Sajwani believes a multi-modal approach is crucial for sustainable care, but she stresses that patients shouldn’t need to “earn” pharmaceutical interventions. “Everything around pharmacotherapy is important too, but it can’t be held hostage to it. It can’t be ‘Go home. Try this diet first, and if it fails, then come back and then I’ll consider medications.’”

Pharmacological options include new advances in obesity medications, which work by regulating hunger hormones and signaling a sense of fullness. “These medications turned that wanting off in my brain. I hadn’t even realized how much space it was taking, and how much of your life you get back, even just from that,” Schaffer says.

While Sajwani has spent time specializing in obesity, some primary care practitioners may feel out of their depth in treating the disease. Schaffer says Obesity Canada designed its Clinical Practice Guidelines to support physicians, synthesizing the most recent and accurate obesity research and evidence into a document that she says has become the “global gold standard for understanding obesity,” including obesity management for Indigenous Peoples.

Moving from Shame to Science

Schaffer believes that including the new advances in obesity medications as one element of an obesity treatment plan can be a powerful source of change. She urges provincial healthcare systems to recognize obesity as a chronic disease (Alberta is currently the only province to do so) and treat it accordingly by creating obesity-specific billing codes and covering Health Canada-approved treatment options in healthcare plans.

“We’re at a really amazing, once-in-a-generation opportunity to reset and get this right, because we also know if we intervene on obesity early and correctly, we can remove the ripple of over 200 other diseases that can come downstream,” she says. “I believe we can build a future where care is truly compassionate, and where policy is informed by science, not shame and misinformation.”

If you are living with obesity, speak with your doctor to learn more about the disease and new advances in obesity care.

The post Understanding Obesity first appeared on The Walrus.