Canadians living with obesity continue to face stigma, discrimination, and a lack of access to care, but the tides are slowly changing.
-by Angelica Bottaro
Obesity, a chronic and complex disease, is often viewed as a lifestyle problem amongst the general public and even some healthcare providers. On World Obesity Day 2024, organizations and healthcare industry leaders aim to push toward changing that narrative by talking openly about obesity and all the issues, challenges, and co-morbidities people living with obesity have to cope with every day.
This year’s theme, “Let’s talk about obesity and…” is designed to open the lines of communication for people with obesity to share and explore the factors that go into living with the disease and clear up misconceptions that have long been held by people across the globe.
One day a year, obesity is thrust into the spotlight, but for some organizations, creating safe spaces of advocacy and support is a year-round effort. Every day is vital in the fight against stigma, discrimination, and misjudgements, and two organizations in Canada, in particular, continue to spread awareness and education to foster a better understanding of and compassion for obesity and those living with the disease.
Ian Patton, Director of Advocacy and Public Engagement with Obesity Canada, and Priti Chawla, Founder and Executive Director with Obesity Matters, are both involved in the day-in-day-out push toward a more accepting society surrounding obesity. Their work in advocacy, patient outreach and support, and education and awareness continues to change the way Canadians view obesity.
Patton helps to bring the message of living with obesity to the forefront of the conversation through his work with Obesity Canada.
“I’m a patient advocate myself, so I often speak about my experience but also speak from the perspective of our community because I’m tapped into other people’s experiences as well,” said Patton. “From a lived experience, the most difficult thing to understand or something that’s a bit challenging is the concept of obesity being a chronic disease.“
A lot of people have ingrained beliefs about what obesity is and what causes obesity, and a lot of that falls on individuals and their willpower and their lifestyle. While lifestyle is an important part of any chronic disease management, it’s not a treatment in and of itself for obesity. There’s a lot more to it than simply eating less and moving more. It’s a very complex chronic disease.”
Chawla, who co-founded Obesity Matters because of the dire need for an organization of its kind in the country, echoed that same sentiment when speaking about how obesity affects Canadians and why it’s so challenging for the general public and healthcare professionals to adjust their perspectives. Obesity Matters celebrated it’s third anniversary on March 3, 2024.
A coordinated approach is required to address obesity as a serious public health issue, but it’s also crucial to improve public awareness that obesity is a complex disease,” Chawla said. “It’s not just willpower of lifestyle choices.”
Day-to-day challenges faced by those living with obesity
On an individual scale, people living with obesity are forced to contend with various day-to-day challenges based solely on the adverse health effects the disease causes. Patton has seen various aspects in which simply going through the motions can be challenging for people living with obesity.
“If we’re talking about living day-to-day life, for some people, it could be challenges with mobility or with their health and challenges with other comorbid conditions—things like diabetes, hypertension, and those types of things are all related and can complicate things,” said Patton.
While obesity is just recently being accepted as a chronic disease, studies published as long ago as the late 1990s found that it has many comorbid conditions, including:
- Insulin resistance
- Glucose intolerance
- Diabetes
- Hypertension
- Dyslipidemia
- Sleep apnea
- Arthritis
- Hyperuricemia
- Gall bladder disease
- Certain types of cancer
- Coronary artery disease
- Heart failure
- Cardiac arrhythmia
- Stroke
- Menstrual irregularities
- Mood disorders
Living with obesity goes hand-in-hand with a lowered quality of life, and those with the disease are at an increased risk of developing conditions that further progress life satisfaction in a negative direction.
Because of the heightened risk of developing other diseases alongside obesity, as is the case with other disorders and co-conditions, society continues to play catch up when it comes to establishing a proper medical definition, approach, and treatment for those living with obesity.
Facing stigma and discrimination with vigour
One of the most significant barriers people living with obesity have to face is stigma and discrimination from society, whether it be peers, friends, colleagues and employers, or healthcare providers. The perpetuated idea that people with obesity are choosing that for themselves is an outdated belief system backed by nothing more than a lack of proper education and knowledge surrounding the disease.
“Stigma is huge for them because, even though there’s been growing awareness, the individuals that are actually living with obesity continue to face stigma and discrimination,” said Chawla.
Healthcare providers who perpetuate the stigma further by ignoring symptoms or telling patients that their current ailments could all be solved through the simple act of losing weight are a huge part of the issue when dealing with obesity among Canadians. But Patton understands that, in many cases, it’s not always the healthcare provider’s fault.
“Doctors and other health professionals aren’t typically taught about obesity. It’s not a significant portion of their training,” said Patton. “It’s hard to fault health professionals for not knowing how to treat something they weren’t trained to do. There’s a delayed time there in that knowledge translation and getting things caught up.”
However, Patton acknowledges that a lack of training isn’t entirely to blame.
“The other part of it is just embedded biases that people have had—their own beliefs and biases that are ingrained from society about people in larger bodies or people with obesity—those narratives about them being lazy, and it’s their fault, and they’ve done this to themselves,” said Patton. “Those kinds of negative sentiments about people living with obesity are ingrained, and they’re hard to change.”
While the stigma surrounding weight coming from healthcare providers is severely detrimental to people seeking out care for obesity, it isn’t the only area where discrimination can make management of the disease nearly impossible. Even family members can sometimes create environments that foster shame, self-doubt, and a lack of motivation to see the right healthcare provider for proper treatment.
“I’ve got somebody who’s very close to our community, and she said, ‘I just started taking medication for obesity, and already I can feel the stigma from my sister who also lives with obesity, but she’s been following lifestyle changes and trying to lose weight just by following lifestyle methods, and she thinks that just because now I’m taking medication I’m taking the easy way out.’,” Chawla said. “So, I asked her, ‘Has your sister had success with her eat-less-move-more philosophy?’ And she said, ‘The funny part is that, yes, she did lose weight. But then she gained weight again.”
This only further proves that yo-yo dieting, excessive exercise, and barely eating enough to meet nutritional needs isn’t a treatment plan for obesity but rather society’s solution to a chronic health issue they don’t understand.
With weight stigma coming from all sides—from healthcare providers to family and friends—it’s nearly impossible for those living with obesity to feel safe to come forward for the medical treatment they need to help manage their disease.
Access to care continues to pose challenges
Aside from stigma, access to care is a big hurdle that stops people living with obesity in their tracks when it comes to managing their disease and forging ahead toward a healthier version of themselves. With the stigma so strong, it’s difficult to want to seek out treatment in the first place. But, even while doing so, the healthcare system isn’t yet primed to handle these patients with compassion, care, and advanced medical technologies that could act as game-changers.
“There’s been a lot of advancements in our understanding of obesity over the last decade or so, and there’s been advancements in treatment and management over that period of time. Things are evolving quite rapidly,” Patton said. “But while we have these advancements, access to these treatments or access to health professionals who understand obesity as a chronic disease is very limited. So, there’s a lot of people who don’t have access to the approved evidence-based treatments, and they’re kind of left to their own devices to try and manage a chronic disease, which is a big, big problem.”
Chawla also has experience working with people who lack accessible care, and she believes that it all comes down to stigma and beliefs held by people from all areas of the healthcare system, from providers to government and policymakers.
“In 2024, we’re seeing that the landscape is changing because now there’s a rise in demand for obesity treatment. This wave of attention emphasizes the urgent need for acceptance and accessible obesity treatments as well as increased public education,” Chawla said. “We’ve been seeing obesity medications for many years, but they are not covered by the government because obesity has still been seen as a lifestyle issue, and this stems from stigma.”
“They are looking to prescribe more medications for obesity care, but the problem is still getting access to it. Most of the private insurance companies feel that it may be too expensive because of the demand. It may not be cost-effective, but then that perpetuates the stigma even further because if it was a treatment for hypertension, they wouldn’t consider the cost. But with obesity medications, the cost is such a big factor, and again, is that not perpetuating discrimination and bias?”
Patton sees the same type of issues with the people he works with as well, finding that while medications and treatments are available, access to them is still on the wrong side of history.
“When it comes to the medications we have available, it comes down to coverage. They are not cheap options, and most benefit programs or providers or people’s private insurance don’t cover obesity medication. It’s classified in a lifestyle box,” Patton said. “For those insurance providers, it would be something that would be an add-on, or your employer would have to add on the obesity management medication, and that’s not happening. Whereas, with other chronic diseases, those medications are covered.”
Creating a society of acceptance
With access to care and stigma still running high, organizations such as Obesity Canada and Obesity Matters (who celebrated its three-year anniversary on March 3, 2024) continue to work toward an inclusive and discrimination-free society for people living with obesity. Their goals are to ensure that people not only understand obesity and the importance of recognizing it as a chronic disease but also lowering the stigma, practicing acceptance, and ensuring that people who live with obesity understand that it’s not a shameful part of who they are—it’s a disease to be treated and managed.
“Our goal for Worldwide Obesity Day and beyond is to create a society of acceptance where every individual living with obesity has access to good care and the support they need to lead a healthy and fulfilling life,” said Chawla. “That’s our take-home message. Talking about busting myths, busting misconceptions about it being a lifestyle.”
With the recent push towards acceptance of obesity as a disease and new and effective treatments being discovered more rapidly, Patton believes that the course of obesity management and the lives of those affected may be taking an upward trajectory toward more positive views of the disease and the ability of those with obesity to get the compassionate and stigma-free care they deserve.
“There’s lots of evolution as far as treatment options and effective treatment options go—in the next 10 to 15 years, there’s going to be a lot of new options,” Patton said. “We’re at an interesting and exciting point in time as far as obesity management goes. I think there’s a lot of positive on the horizon. I think there’s a cause for hope.”
This article was originally published in Healthing on March 4, 2024.
