In November, The Press described the increase in the obesity rate in Quebec, which affected 27.6% of the population in 20211. Unsurprisingly, the data demonstrates the rise in obesity for decades. At the beginning of the year, many are active in the gym and go on a diet hoping to reduce their weight. But in the government, what is the 2023 resolution to fight obesity?
According to the November article, the government was committed to “creating environments that support healthy lifestyles and a healthy body image.” A response largely insufficient to respond to the most widespread medical condition. The solution ? Tackling obesity for what it is: a chronic disease.
Indeed, obesity has been considered a chronic disease by the Canadian Medical Association since 2015, but is not treated as such. Let’s take the example of another chronic condition, diabetes (mainly type 2), the prevalence of which is around 10%. In Quebec, more than twenty antidiabetic medications are available on the market and are all covered by the Régie de l’assurance maladie du Québec (RAMQ), some requiring certain reimbursement criteria.
For obesity, there are only three drugs on the market. How many of them are covered? Zero.
How come obesity, which is almost three times more prevalent, has no dedicated and easily accessible treatment options? As physicians, we pray that patients have private insurance to cover appropriate treatment. Alternatively, we can prescribe an anti-diabetic drug which reduces weight, but this is only reimbursed for those with sufficiently severe diabetes. In practice, we are forced to wait until our obese patients are ‘sick enough’ to treat them adequately.
Another trajectory would be to refer the patient to bariatric surgery. The latter is covered if the patient has severe obesity or obesity associated with complications. However, access to the operation and the delays are extremely variable depending on the region. In addition, obesity is a complex disease requiring a multidisciplinary intervention: nutritionist, kinesiologist, mental health care, etc., and it is almost impossible to obtain the services of a nutritionist to the public. However, it’s free at the CLSC… if they have diabetes! There are also a few public obesity clinics in Quebec with multidisciplinary teams, but once again, resources are limited and the wait is significant.
Inconvenient comparison
When talking about obesity clinics, it is embarrassing to compare the situation in Quebec to that of other Western countries. Let’s mention France, where there are 37 specialized obesity centers spread across the country and designated by the government since 2012. These specialized clinics are guided by a national coordination group which defines the standard of care quality in particular. A system that seems well established in a country where the prevalence of obesity is nevertheless less than here.
At the same time, medical research into obesity is increasing. New drugs on the horizon have impressive efficacy rates. Their performance is close to that of bariatric surgery, never seen before. Bariatric techniques are diversifying, with procedures being done in particular by endoscopy in the United States. However, these exciting innovations will have no impact if they remain inaccessible to affected patients. The problem of obesity will grow, along with the more than 200 associated complications, such as hypertension, respiratory disorders and cancer.
So, the potential resolutions for the government are numerous: guarantee coverage of obesity-specific drugs, make professional resources more accessible, increase access to bariatric surgery, among others. But the most important, the cornerstone, is to recognize obesity as a chronic disease in its own right. It is only once this condition is taken seriously that we will see concrete changes.
Finally, to people new to the gym and a healthy diet: yes, healthy lifestyle habits are the foundation for improving your weight. This also includes sleeping well and looking after your mental health. But know that obesity is a complex disease that often requires professional support. So don’t hesitate to ask for help. Our collective resolution in 2023: call on our leaders for more resources for the treatment of obesity. Let’s be heard this year.