Blog dedicated primarily to randomly selected news items; comments reflecting personal perceptions

Thursday, April 27, 2017

Obesity as a Chronic Disease

"[Severe obesity is virtually irreversible. [Current treatments have minimal benefit, bariatric surgery can cause] significant psychological problems [inclusive of suicide risk increase]. People have to take some responsibility for their own situation. Obesity, to be blunt, is very largely a lifestyle issue."
"There is virtually nothing that can be done to reverse that [obesity] -- the body system adjusts to the highest weight you achieve and wants to keep you there."
"[Prevention] is really the best way to deal with [the dilemma of national obesity]."
Senator Kelvin Ogilvie, chair, Senate committee on Canada's obesity epidemic
Canada Food Guide
Canada Food Guide    An overhauled food guide should be based on the latest science and must make strong statements about restricting consumption of highly processed foods, the study added
"We're basically at ground zero in terms of obesity management in this country."
"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."
"But there is no evidence that doing anything for prevention is going to help lower body weight in people who already have the problem."
"[No one chooses to be obese] 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."
"People are flying to Mexico and India getting private surgery, paying for it out of pocket and taking out loans. Why do we allow people to become desperate enough, their only option is to go to Mexico?"
Arya Sharma, scientific director, Canadian Obesity Network, professor of medicine, University of Alberta
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A new report has been produced by the Canadian Obesity Network, pointing out that bariatric surgery -- as a remedy for gross obesity and to improve the quality of life for obese people when all other steps have failed -- is available to one in 183 people, representing 0.54 percent of adult Canadians who, though they may be eligible for the surgery, must undergo wait times from referral to surgery and consultation with a surgical team, which can take up to five years. And nor are anti-obesity drugs included in any of the provincial or territorial drug formularies. Furthermore, less than 20 percent of the Canadian public has access to prescription obesity meds, even with private drug benefit plans.

The Canadian Medical Association took the step of identifying obesity as a chronic disease, two years ago. Despite which, no provincial or territorial government, let alone Health Canada has taken steps to recognize obesity as having chronic disease status. Alarmingly, 48,000 to 66,000 Canadians die from conditions linked to excess weight, yearly. In 2016, the Senate of Canada held consultations into the problem and produced a report on the epidemic  focusing on prevention and side-stepping the issue of needed improvements in access to care for those struck with and living with obesity.

But their report did list 21 recommendations to help deal with the national dilemma, none of which addressed the issue of ensuring improved access to treatment. Dr. Sharma responded to the report by asserting that the Senate had, in effect, written off the seven million Canadians living with obesity "as being beyond help". Senator Ogilvie, chair of the committee, stressed that though he sympathizes with people whose excess weight deleteriously impacts the quality of their lives, that when obesity triggers other conditions, like diabetes and heart problems, care does come into play.

Research studies appear to indicate that biology steps in to accustom the body to excess weight. That once someone has become obese and attempts to modify their diet by reducing the food intake, the body sends out an anti-starvation response, slowing metabolism, stimulating appetite, and driving people to eat greater amounts of food. Obesity, which strikes roughly one in four Canadian adults, is a leading cause of Type 2 diabetes onset, which itself leads to high blood pressure, heart disease, stroke, arthritis and some types of cancer.
Image of fast food
Obesity is estimated to cost Canada some $7-billion in health care and lost workplace productivity on an annual basis. Dr. Sharma's concern is that focusing on prevention to the exclusion of helping millions of Canadians living with obesity does little to solve the problem. Anti-obesity drugs, points out Dr. Sharma's network, cost up to $4,000 a year, with people having to pay an additional $1,000 to $1,000 in respect of doctor-supervised weight-loss program meal replacement foods. A situation that itself is inherently unfair when meal replacements are covered for other chronic diseases through provincial drug formularies.

The two anti-obesity drugs approved for use in Canada have side effects with their use. Those using the drug experience the effects of nausea, vomiting, and oily stools, though the drugs have an uneven effect on patients where one in seven people realize great benefits, with a five percent weight loss which comes with its own modest health benefits. Finally, the number of bariatric surgeries undertaken in Canada are on the rise, but the vexing problem of wait times for that surgery represents the longest of any surgically treatable condition, points out the Canadian Obesity Network report.

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