opinion: canada can't ignore the gap between obesity science and care
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canada has the right information to understand the problem and the tools to begin solving it. what will it take to move forward and take action?
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conversations about obesity care are often shaped by stigma and driven by a societal tendency to blame individuals for their choices. however, a growing body of evidence-based research is reshaping our understanding of the science behind weight.
and yet, recent ipsos research reveals a troubling paradox – despite being highly aware of the health risks associated with obesity, canadians are hesitant to seek medical assistance. this gap points not to a lack of awareness, but to a failure of the health systems in place that have the tools to provide support.
a policy gap science has left behind
leading health organizations worldwide now recognize obesity as a complex, chronic disease. italy and portugal have formally recognized obesity as a chronic, progressive and relapsing condition, and have launched public health programs to address it. the world health organization has also added obesity medications for overweight patients with diabetes to its essential medicines list.
while canada has long been a global leader in developing high-quality clinical practice guidelines (cpgs), studies show that only a fraction of evidence-based guidelines are consistently implemented in canadian clinical practice. although alberta recognizes obesity as a chronic disease, the majority of other provinces, including quebec, have yet to formally acknowledge it.
if decision-makers in canada are serious about improving health outcomes, they must align policy with science and adopt a more accurate, evidence-based approach to obesity care. this begins with challenging the pervasive myths surrounding weight loss and body image. the idea that all individuals respond the same way to diet and exercise is simply no longer supported by today’s medical understanding of the disease.
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if canada is serious about improving health outcomes, we must dismantle these concepts and replace them with treatment grounded in science.
myths that medicine has moved past
when canadians living with obesity consult a physician about their weight, the recommendations they receive remain primarily focused on lifestyle changes, including exercising more (63 per cent), eating healthier (60 per cent), and reducing portions (33 per cent).
while these approaches are important for general wellness and essential steps in obesity care, obesity is a complex, chronic disease influenced by biological, genetic, environmental and social factors, and many individuals may require comprehensive, long-term clinical care.
at the heart of the new scientific knowledge is the role of hormones in regulating weight and influencing individual experiences with hunger. what is now understood is that these are physiological signals governed by complex systems that vary from person to person. recognizing this is essential to understanding why obesity behaves like other chronic diseases and can be managed with the right care.
despite these scientific innovations, weight bias remains deeply embedded in healthcare systems and society at large. this was reinforced in the ipsos data, which showed personal toll is significant, with over two-thirds saying it has affected their emotional and mental wellbeing. misconceptions shape policies, leaving canadians with limited access to care and influencing how individuals are perceived and treated.
the billion-dollar cost of inaction
according to obesity canada research, obesity also carries a societal cost exceeding $27 billion. the strain on the healthcare system alone is considerable, with nearly $5.4 billion in incremental annual costs, including an additional 19 million physician visits. individuals living with obesity also experience significantly higher rates of specialist consultations, emergency room visits, hospitalizations, and prescription drug use.
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nearly half of canadian adults living with obesity and disability have not worked in the past year, representing an estimated $10 billion in lost wages and income tax. women also face disproportionate impacts on salaries and workforce participation. these realities underscore a simple but urgent truth for canadian decision makers that obesity is not only a health issue, but also an economic one.
four steps toward meaningful change
to effectively address chronic obesity, its treatment must be approached with the same rigour and care as other long-term diseases. recent advances in obesity medications are equipping healthcare professionals and patients with evidence-based options that target the condition’s underlying biology. however, these innovations must be accompanied by equitable access to care to ensure their full impact.
to date, no obesity medication has received a positive recommendation in canada. these therapies appear to have a higher evidentiary standard than other chronic disease medications, discounting the clinical impact of weight loss itself and demanding additional outcomes data not routinely required, perpetuating bias against obesity as a chronic disease.
this will continue to contribute to delayed decisions and, ultimately, significant disparities in care across provinces, where a canadian in one region may eventually have access to treatments unavailable to someone in another.
addressing this requires meaningful action on four fronts: formally recognizing obesity as a chronic disease in both policy and clinical practice; building consistent, science-based pathways to care in primary care that help end stigma; modernizing hta and reimbursement processes to reflect chronic disease realities, including the value of real-world evidence; and improving equitable access to comprehensive care, including evidence-based treatment options and clinical support across all provinces.
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this means investing in effective, canada-wide public health strategies that prioritize both prevention and treatment. and it means recognizing that such investments are not only the right thing to do for canadians living with obesity, but they are essential to the long-term economic health of the country.
science has transformed our understanding of obesity, with medical professionals now recognizing it as a complex, chronic disease. the data underscores the significant and multifaceted financial burden of inaction. canada has the right information to understand the problem and the tools to begin solving it. what will it take to move forward and take action?
mathilde merlet is a seasoned pharmaceutical executive and trusted thought leader serving as president and general manager of eli lilly and company canada. mathilde is a passionate advocate for patients and a driving force in advancing innovation and strengthening canada’s healthcare ecosystem to improve outcomes for patients and communities.
mathilde merlet, president and general manager of eli lilly and company canada.
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