Back row from left: Karen Chopra (Nestlé Health Science); Lisa Machado (Healthing); Jennifer Brown (Dietitian and Advocate); Neda Nasseri (Desjardins); Dr. Megha Poddar (Obesity Specialist); Marsha Rosenberg (Novo Nordisk Canada); Patrick Manfred (TACT); Adam Marsella (Novo Nordisk Canada)
Front row from left: Rosemarie Childerhose (Communications and Policy, Obesity Matters); Priti Chawla (Executive Director, Obesity Matters); Sandra Elia (Chair, Obesity Matters)
Addressing the pervasive challenge of obesity and its treatment options in Ontario, Obesity Matters convened a pivotal policy roundtable on June 2, 2023. The forum brought together a diverse group of stakeholders with a shared focus: to explore and advocate for enhanced reimbursement strategies for obesity pharmaceutical treatments within the province, and to provide various patient supports. This collaborative effort aimed to bridge the gap between the current state of pharmaceutical treatment accessibility and the ideal landscape of support and coverage for individuals dealing with obesity.
In an effort to dissect the multifaceted nature of this issue, participants were divided into two principal cohorts—Community and Organizational Perspectives—to facilitate a targeted and comprehensive discussion. The Community Perspective comprised Obesity Matters associates, media members, and a food addiction counsellor, all of whom contributed insights on the societal and individual nuances of obesity. Conversely, the Organizational Perspective brought together obesity experts, healthcare institution affiliates, and representatives from the pharmaceutical, insurance, and food sectors, providing a more systemic viewpoint on the matter.
The discourse centred around critical questions designed to pinpoint actionable solutions for expediting and optimizing access to obesity treatments. Both groups deliberated on the essential conditions and supplementary services needed to enhance the efficacy of obesity medications, the ideal criteria for reimbursement, and the realistic goals for reimbursement progression in the next one to two years. This dual approach ensured a robust exploration of the issue from both the grassroots and organizational levels, setting the stage for strategic advocacy and policy development that could have an impact on the management of obesity in Ontario and potentially across Canada.
Prior to the event, participants were required to fill out a comprehensive questionnaire, the results of which were analyzed and distilled into a summary presentation to direct the roundtable’s dialogue. Each participant began by sharing their insights and suggestions pertinent to their sphere of expertise, which paved the way for a series of open discussions.
The roundtable discussion on obesity treatment in Ontario underscored a pressing need for accessible and effective treatment strategies in the face of rising obesity rates. Participants examined the inadequate current treatment infrastructure, noting the disconnect between available lifestyle modification strategies and the need for funded pharmacotherapy, as well as the absence of integrated care. The social stigma surrounding obesity further complicates the emotional well-being of affected individuals.
Ontario lacks a coherent adult obesity treatment policy, despite the growing prevalence of obesity, which has dramatically increased since the 1970s. The community perspective revealed that while participants may not directly influence policy, there is room to shape discourse and raise awareness about the necessity of obesity treatment. They identified key issues with reimbursement, such as underfunding and potential misuse of pharmacotherapy for cosmetic purposes, but also pointed out the potential health and economic benefits of effective treatment strategies.
Group discussions highlighted that patients’ voices are often overlooked, and there is a demand for greater transparency in regulatory processes. The complexity of obesity as a disease makes it difficult to demonstrate the comprehensive benefits of pharmacological treatments. Current evidence does not sufficiently impact policy due to its focus on weight loss rather than broad health outcomes and cost-effectiveness. The cost of drugs and a lack of data on long-term survival at the time the policy roundtable was held are key factors hindering the demonstration of their value.
To influence Health Technology Assessment (HTA) bodies toward recommending public funding, the argument for obesity treatments must be simplified and backed by more robust clinical evidence. A targeted reimbursement approach could provide a spectrum of options that align with the strongest data available. Finally, the roundtable underscored the significant challenge posed by misinformation, which leads to policy paralysis. Accurate and clear information is essential for developing a robust policy framework for obesity treatment.
From the organizational perspective, there was a strong sense that while the comprehension of obesity treatment policies was high, participants did not directly engage in decision-making but could sway opinions through advocacy and data sharing. Key reasons for prioritizing obesity treatment included improved health outcomes and the potential to alleviate healthcare burdens. However, concerns such as access issues tied to comorbidities, rising costs, and policy focus on prevention rather than treatment were raised. Opportunities for positive change were seen in making healthy food options more accessible, promoting educational initiatives, and setting a precedent in Ontario for medication coverage that aligns to recommendations found in the Canadian Adult Obesity Clinical Practice Guidelines.
Participants noted that obesity management requires a multidisciplinary approach, and that pharmacotherapy alone is insufficient. Private payers are cautious about covering treatments without robust data to support cost and efficacy, which aligns with the group’s sentiment that Ontario might lag behind other regions in chronic disease prevention. The group also challenged the adequacy of BMI as a measure of obesity, suggesting that more progressive metrics could influence reimbursement decisions. They acknowledged the need to consider diversity, equity, and inclusion in obesity support and called for policy interventions to improve food quality and workplace health measures.
The discussions suggested that while developing a national framework for adult and pediatric obesity treatment was daunting due to its complexity, focusing on specific opportunities that can quickly improve health outcomes might simplify the policy approach and increase its likelihood of success.
Recommendations
To stimulate an effective Obesity Policy framework, a multi-faceted approach is recommended. It involves collaborating with the media to share compelling stories of individuals affected by obesity to increase social understanding and acceptance. Coverage for obesity treatments should be sought under special authorizations with necessary follow-ups by primary care or specialized clinics. Mobilizing individuals living with obesity could be enhanced by identifying influential spokespeople to unite and amplify their voices.
There’s a need for structured obesity advocacy, particularly at strategic times when the government may be more receptive. Obesity could be reframed as an aspect of secondary prevention within existing health policies, rather than proposing a separate framework. Utilizing social media, including platforms like TikTok, can engage the public and policymakers alike. Aligning with educational programs like those from Obesity Matters and integrating real-world evidence could bolster advocacy efforts.
Other recommendations included, developing economic models to demonstrate the financial burden of untreated obesity, drawing from learnings from the bariatric surgery program in Ontario. Additionally, alternative obesity measures, like the Edmonton Obesity Staging System, may better indicate the level of care needed. Harnessing the existing community of health professionals and expanding multidisciplinary care aligns with the sWorld Health Organization (WHO) recommendations and could be more efficient than creating new specialized clinics.
Promotion of healthier living through diet, exercise, legal reforms, and societal support aims to prevent obesity. Early intervention before the onset of complications and incentivizing healthcare providers to focus on health outcomes is crucial. In family medicine, a value-based compensation model with specific billing codes could facilitate the optimal management of obesity and its associated health complications. Establishing clear referral patterns and treatment pathways is essential to improving patient care.
Next Steps
The next steps for Obesity Matters include a thorough review of the proposed recommendations to create an advocacy strategy and an action plan aimed at engaging Ontario policymakers. The initial focus will be on garnering support for obesity treatments, securing public funding, and developing targeted policies.
There’s an imperative to enhance abilities to conduct and collaborate on research related to obesity, improve policy, increase community engagement, and provide training for healthcare providers in sophisticated obesity management techniques. Gathering and analyzing data on the efficacy of various existing treatment strategies is essential for this endeavour.
Additionally, it’s important to leverage data from ongoing Obesity Matters programs to foster a more informed dialogue with government officials, thereby enhancing policy discussions with insights from the lived experiences of Ontarians affected by obesity.
Expanding the model of the Obesity Policy Roundtable to other critical provinces is also under consideration. This would involve public consultations with healthcare and industry professionals, as well as patients, to further the dialogue and policy development concerning obesity treatment options across Canada.
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