The Toll of Obesity: Long-term impact, access to care and insurance support
“People living with obesity have a right to tackle their disease, to be treated just like someone who has migraines or hypertension. It’s just basic human rights.” by Angelica Bottaro
Roughly one in four Canadian adults is currently living with obesity. It is complex and highly misunderstood by the masses, with stigma and access to care continuing to be significant roadblocks in addressing obesity and its complications for people managing the disease.
The narrative is shifting, though, thanks to organizations such as Obesity Matters and companies such as Desjardins, which aim to change the way people view obesity and how people living with the disorder can access life-changing treatments.
Dr. David Attalla, an internal medicine doctor who works primarily in obesity medicine, cares for people living with obesity and the associated complications, such as hypertension and heart disease. He says that the disease is “multifactorial,” and the more people know about what goes into developing obesity, the better the understanding of it will be.
“There’s weight bias, which is the negative attitude of someone toward someone who’s living with obesity, and then there’s weight stigma,” he says. “Someone may assign a stereotype to them like, ‘Oh, that person is lazy. That person doesn’t care about their health.’ When it’s all untrue because obesity is a neurological process.”
Now that medical providers are learning more about how and why obesity develops, as well as the physiological processes that occur in the body that drive the condition, they hope to end the bias and improve the perception of the disease while working with others to create a more accessible treatment environment.
Rachel Atkins, who works in project management and is also the Board Vice-Chair, Director of Strategy, and Patient Advocate with Obesity Matters, understands what it feels like to live in a larger body from personal experience and through the community she has cultivated with Obesity Matters.
She sees firsthand how creating a community and having the right types of conversations can foster change for those living with obesity.
“We’re really discovering the truths about how we got here, how we can manage our way, what can we expect to happen and sharing stories and understanding that we’re not alone,” she said. “It’s really important to kind of have this community and sort of curate for yourself a different lens around the conversation of obesity.”
Neda Nasseri, product director of benefits with Desjardins Insurance and Advisory Board Member with Obesity Matters, is aware of obesity as a disease and wants that narrative to take over so that people with obesity have better access to care.
“Obesity is a disease. We need to treat it as such,” she said. “Just like we treat depression, hypertension, migraines, whatever.”
Long-term health implications of obesity
Like any other chronic disease, obesity has long-term health complications that could, at the end of the day, be life-threatening.
“Obesity can obviously affect a lot of different variables,” said Dr. Attalla. “Let’s say you look at the average person and you see they’re living with obesity, you tend to see the outside, right? There’s adipose tissue, which is fat under the skin, but what we don’t sometimes see is the fact that adipose tissue is everywhere, right? It’s in the organs. It’s in the heart. It’s in the liver. It’s in the kidneys.”
Dr. Attalla says that all of this fat tissue surrounding the organs increases the risk of various chronic diseases that add to a person’s overall health score. Having obesity and excess weight around organs can lead to:
- Chronic kidney disease
- Fat around the heart that increases the risk of heart problems, such as heart attack
- Steatotic liver disease (formerly known as fatty liver disease)
- Sleep apnea
- An increased risk for certain cancers
- Mobility issues and disability
- Chronic pain
We know that obesity is very closely related to tons of other diseases, of course, that can have devastating outcomes,” said Nasseri.
There’s a mental aspect of obesity that also fails to be addressed adequately. People living with obesity, more often than not, have a significantly reduced quality of life that brings on an increased risk for mood disorders, such as depression.
Roughly 6.4 per cent of people with obesity also have a mood disorder, and having obesity increases the odds of developing a mood disorder by approximately 25 per cent. These conditions can be brought on due to the negative self and perceived image from others due to weight stigma and bias.
“They go through stigma related to their obesity, and they have to endure a lot of stereotypes about their obesity,” said Dr. Attalla.
Long-term financial implications of obesity and barriers for access to care
The treatment of obesity is often expensive. As most know, only some aspects of care are free in the country, and the ones that are not are not always covered by insurance companies. Thus, people living with obesity have to pay out-of-pocket for medications, counselling services, dieticians, and other forms of care that could help them with their weight management.
In terms of the financial burden on Canada, since obesity is correlated with many other conditions, the cost of providing care for individuals living with the disease is high. According to the Public Health Agency of Canada, the total economic burden associated with obesity management is roughly $4.6 billion to $7.1 billion annually.
These costs range from treating obesity itself to caring for comorbid diseases. When it comes to private companies, people living with obesity also have to contend with missing work due to their condition and associated disorders, leading to lost wages for the person as well as a cost to the company overall.
“Obviously, any medical condition adds to the financial burden of a country, right?” said Dr. Attalla.
For example, Dr. Attalla notes that the overall cost of treating a heart attack is roughly $50,000 for one person. So, if a person living with obesity has a heart attack due to their disease, the province now foots that hefty bill.
That said, people living with obesity aren’t simply ignoring the risks of other diseases. They do not have the financial support to treat their disease adequately, leading to strain on everyone involved, especially the patient who has to suffer through the disease without help.
The areas of care that are currently not covered under OHIP, or in many cases, private and employer-provided insurance plans, leave people living with obesity feeling as though they have no support in accessing care.
“Let’s say they (people living with obesity) are really actively trying to treat their obesity. A lot of dieticians may not be covered under an insurance plan, so they may have to pay out of pocket for that,” said Dr. Attalla. “If someone wants to go to psychotherapy for that, that’ll be a couple hundred a session. And if they want to go on the medications and they don’t have insurance, the medications are anywhere from $300 to $500 a month. And these are chronic medications. You don’t do it for six months, and then you’re done. So, you’re basically signing someone up to spend $400 a month for the rest of their lives just to treat one condition.”
When a person living with obesity is paying for every aspect of care they require while also having to work while dealing with debilitating symptoms, the burden is significant, and that level of stress can only make matters worse.
Offering adequate insurance coverage can help mitigate these issues, but if it’s not available, it can put someone living with obesity back to square one, and that’s a discouraging place to be when facing a lifelong chronic disease.
“It comes to the point where they have worked through this idea; they have that mindset shift,” said Atkins. “They’re like, ‘It’s a bit more complicated, and I’ve tried everything, and now I might need to take medication,’ and then someone says, ‘Oh, by the way, you’re not covered because we think you can just white knuckle it and do it on your own.’ That doesn’t feel very good. It feels like you’re kind of going back to … what you’ve been doing most of your life, blaming yourself, thinking, ‘I just need to make some changes, I just need to be stronger,’ and that’s not true because we talked about it being a disease.”
Desjardins Insurance’s new initiative to foster change
Desjardins Insurance is aiming to change the way employers view insurance coverage for employees, especially those who are living with obesity. They have developed a new Healthy Weight Initiative that acts as a catalyst for better access to care through a combination of holistic and medical approaches, all of which will be covered through insurance plans.
Not only is it meant to cover medications that are often far too expensive for those with average incomes to afford comfortably, but it is also meant to address and provide access to other approaches by establishing a multi-pronged program that can tackle obesity from all angles.
“It focuses on treating obesity at the source,” said Nasseri. “In practice, what we do is that we recommend our employers or clients a package that they can include in the benefits that they offer their employees, and that would include coverage for the dieticians, for kinesiologists, for therapists, psychologists, or other mental health professionals that could be of help.”
Desjardins was also the first insurer to include anti-obesity medications in standard care packages, a milestone change that makes it more affordable for people to access drugs that could help them better manage their disease.
According to Atkins, having access to that type of covered care could be a game-changer for those living with obesity.
“It would be great if at least insurance companies could say, ‘Well, hey, if you get to that point, if your doctor is suggesting medication, we are going to cover it’ because there’s so many great benefits. If you’ve kind of done all the work to understand and get to a place where medication is the next step for you, then there’s a lot of great things that can come from being able to manage your weight,” said Atkins. “Obviously, better mental health.
Better physical health and then things like less chronic disease and less chronic disease means that for the company, for the insurers, for society, costs of managing one’s health goes way down.”
Creating more accessible care through a multifactorial approach
By providing people with access to care and reducing the stigma and weight bias that surround those living with obesity, people are far more likely to not only understand their disease better but also feel more motivated to treat it as such. This, in turn, ends the self-shame that often plays on a loop for people living in larger bodies, regurgitating the same false narrative that all they have to do is “eat less and move more.”
“If they (patients) are able to attain it, then the patient themselves can lose weight, then their risk of a lot of different things go down,” said Dr. Attalla, later continuing, “So, you’re really stopping things before they start, which is of course amazing for the health of the patient. But if we’re going to talk about finances, it’s also good for the finances of the patient and then for the province and for insurers.”
As for Desjardins, their opinion on the matter is simple.
“We really wanted to make sure that obesity was treated on the same level as any other disease and make sure that people that need treatment had access to them,” said Nasseri, later continuing, “People living with obesity have a right to tackle their disease, to be treated just like someone who has migraines or hypertension. It’s just basic human rights.”
This article was originally published by Healthing and is available here.
