10 Days Until The Canadian Election – Why Hasn’t Anyone Mentioned Obesity?

Oh Canada!

Canada is in the midst of an election campaign which will see us voting-in our next Parliament and Prime Minister on May 2nd.  That is 10 days away.  And yet, during a 5-week campaign which has discussed the Canadian healthcare system with regularity (see here), to date no party has explained how they would deal with the obesity crisis, or said anything to suggest that they believe this is an important issue that requires a cohesive strategy for moving forward.

That’s pretty shocking, given that 60% of Canadian adults and 25% of Canadian children are overweight or obese.  This is how our colleague Yoni Freedhoff framed the issue this morning on his blog Weighty Matters.

Let’s say there was a virus out there, and for arguments sake, let’s say it was killing 25,000 Canadians a year while afflicting millions. And if that’s not bad enough, lets say that this virus was a particularly nasty one, in that if it didn’t kill you, it markedly increased your risk of getting a whole slew of other medical conditions. Worse yet, this virus wasn’t silent. Infection with this virus was visible to the naked eye, and consequently sufferers became regular targets of societal bias. Infection also lead many to suffer with marked fatigue, and also made completing activities of daily living more challenging, with difficulty rising with degree of infection.

Let’s say too that while there was no vaccine or treatment that worked for everyone, there were both public health and medical interventions that might make a difference, if even just to combat the rising negative bias in society, as sufferers were ridiculed regularly, and even had their visible affliction leading them to lower salaries and fewer promotions. Let’s also say that amazingly and shockingly, medical schools and other health care professions weren’t being taught how to deal with this virus, and that the media had a bad habit of blaming those with it as being personally responsible for contracting it.

And let’s say that one quarter of all Canadians were infected.

This is a problem.

And Canadians seem to agree – in a recent survey more than 1/3 of Canadians, potentially more than will vote for any one federal party in this election, named obesity as the top health-issue facing the country.  This shouldn’t be that surprising – a 2010 study found that the direct health care costs overweight and obesity in Canada in 2006 came to $6 billion dollars – more than 4% of the entire healthcare budget.  And that’s just the direct costs – indirect costs such as lost productivity and psychosocial costs were not included in that analysis.

Other estimates suggest that even these high numbers are too conservative. A new study from Alberta Health Services suggests that obesity-related illnesses cost Alberta more than $ 1.25 billion in 2005. Given that Alberta only accounts for 11% of Canada’s population, it is likely that the healthcare costs for the country as a whole are over $10 billion.    This is supported by a recent study from Australia (a country with very similar demographics and obesity rates) that puts the direct annual cost of overweight and obesity (including health-care and non health-care related expenses) at $21 billion, plus another $35.6 billion in subsidies (pension and unemployment benefits, etc).  And as everyone worries about the healthcare costs associated with our aging demographics, don’t forget that obesity increases with age.

As we discuss the future health of our healthcare system, it only seems reasonable that the most prevalent disease in the country (one which is both preventable and treatable) should be discussed as well.  Keep in mind that our two largest federal parties have spent weeks bickering over corporate tax cuts that are estimated to bring in somewhere between $1 and $6 billion – as opposed to overweight and obesity, which almost certainly costs double that if not more.  And obesity (especially childhood obesity) is an issue that impacts people from all political persuasions and in all regions of the country.

Regardless of which party wins the election on May 2nd, we need the government to take this issue seriously.  We need strategies that focus on both treatment and prevention (remember that roughly half of Canadians are already overweight or obese, so the prevention boat has largely sailed for many individuals), and that are evidence-based, as opposed to overly simplistic eat-less/move-more campaigns.  As Dr Freedhoff said is a recent press release from the Canadian Obesity Network:

“There is still time to make obesity an issue in this election, and we encourage local and federal candidates of all parties to educate themselves on the complexities of this condition and incorporate evidence-based advice into their health platforms” .

They have 10 days, let’s hope they make the most of it.

For more on the importance of obesity as an election issue, be sure to check out the full press release from the Canadian Obesity Network, as well as accompanying posts by DrsYoni Freedhoff and Arya Sharma.  And don’t forget to contact your local candidates.

Travis

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31 Responses to 10 Days Until The Canadian Election – Why Hasn’t Anyone Mentioned Obesity?

  1. WRG says:

    Here’s what I wrote on Yoni Freedhoff’s site:

    So let’s say this horrible virus, which you’ve described in great detail in your post, does exist.

    We’ve tried appealing to people’s amour-propre (“the virus makes you really ugly and unappealing”), we’ve tried telling people that they are simply morally weak and could beat the virus if they only really tried (“why don’t you have enough willpower, you lazy, gluttonous slob?”), we’ve tried slicing and dicing their bodies in an effort to turn around the virus’s effects (aka “weight loss surgery”) and for the past few years we’ve been trying to frighten people into curing themselves of the virus (“you will die a horrible, early death if you don’t do something drastic NOW”).

    None of this works, at least in 95% of cases. It’s a pretty dismal success rate, I’m sure you’ll agree.

    So what tactics are we implementing to turn this ship around? All of the above, with a special emphasis on fear-mongering.

    Add to the mix the fact that repeated dieting actually often exacerbates weight gain and, as they say, “look at the fine mess we’re in now”.

    There has got to be another paradigm. A completely different paradigm. Otherwise, nothing will change. Can I hope against hope that your conference in Montreal (which I would dearly love to attend, but can’t) will look at “health at every size”? Even for just a minute or two?

    And I now add: So far, obesity has shown itself to be an intractable problem–treatable???? with a 95% failure rate??? Surely you jest.

    During our federal election, I agree that we should be talking a lot about health, health promotion and the social determinants of health–these are the issues that are going to improve our health and NOT screaming that we are in the midst of an obesity epidemic and that the only answer is to LOSE WEIGHT NOW.

    Unless you know of a magic formula that people can follow without driving themselves crazy in the process, without making dieting and exercise into a part-time (or even full-time) job, without causing even more cases of disordered eating, medical disasters (what’s the complication rate for weight loss surgery? pretty high, I believe) and further stigmatization to those who don’t look like the two of you (yes, that’s a compliment, you’re two handsome young men who have probably never in your lives agonized over having an extra slice of bread, or a handful of nuts, or god forbid a chocolate sundae just once a year), for goodness sake, please stop concentrating on weight and start thinking about overall health, which is possible even if your BMI is over 25.

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    • Travis says:

      I’m not sure if there are any Health At Every Size sessions coming up at the summit, but I think most members of CON fully support that type of approach. I’m surprissed that you would think that any of us are advocating scare tactics, or demonizing individuals, or anything of that sort. It would be nice to see the major parties at least discussing an issue which has a large impact on the physical and economic health of the country… but that can’t happen if we don’t bring up the issue.

      I would point out that just because something is “treatable” does not necessarily mean it is “curable” – simply avoiding further weight gain can be seen as successful treatment for some individuals, with meaningful health benefits. Also, just because lifestyle interventions do not elicit meaningful long-term weight-loss does not mean that they don’t elicit meaningful health benefits. And when weight loss is absolutely necessary, there may be surgical options which have far higher success rates than lifestyle modification alone (you seem to be against bariatric surgery… this isn’t a cosmetic procedure – it can dramatically increase the health and quality of life for appropriate individuals).

      All that to say that I think we’re on the same side in this one. I don’t know who’s arguing that individuals need to LOSE WEIGHT NOW (it wasn’t my message, nor Yoni’s nor Dr Sharma’s). And no one is arguing that body weight should be the one and only focus for individuals, or of their physicians. We’re simply arguing that as obesity rates increase, the healthcare system and society as a whole need to adapt, and this is an appropriate time to have that discussion.

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  2. Rob says:

    I liked your viral analogy up to this part “the media had a bad habit of blaming those with it as being personally responsible for contracting it.” I don’t think it is clear to most people how obese people are not responsible for their weight.
    To me it is ultimately their responsibility – yes, education and regulatory changes to do with the ingredients in foods can help make that responsibility easier and in my opinion should be part of a government plan if they are concerned about the health and welfare of their citizens (and reducing healthcare costs), but it is still an individual responsibility so I’m curious where that part of the analogy came from.

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    • Travis says:

      There are a range of studies suggesting that socio-economic status, income disparity, environmental exposure in-utero, genetics, and all manner of non-controllable factors have an incredibly strong influence on your risk of developing obesity. And as WRG pointed out, long-term weight loss is extremely difficult due to physiological adaptations which are, again, completely outside of an individual’s personal control. I agree that most people think that obesity primarily comes down to personal responsibility, but that’s just not backed up by the evidence.

      In contrast, behaviours are a largely person’s responsibility – whether they eat well, exercise, etc. But obesity is not a behaviour, it’s an outcome. Just as some people develop cancer or heart disease regardless of their lifestyle, the same is true for obesity. If we can get the population as a whole to adopt healthier lifestyles we may see a difference in body weight at the population level, but it’s unlikely to make a tremendous difference (e.g. >5 body weight) for individuals who are already overweight or obese.

      So we should support individuals when it comes to engaging in healthy behaviours, without putting the focus explicitly on body weight. To come back to my response to WRG, the “obesity epidemic” is something that does need to be addressed and dealt with, but that doesn’t necessarily mean that everyone needs to lose weight or become obsessed with the numbers on their bathroom scale.

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      • Rob says:

        I’d be interested in reading some of the studies you referred to – or at least seeing PubMed abstracts of them. I disagree that socio-economic status is a “non-controllable factor” in the same way genetics and in utero environmental exposure is. I highly doubt socio-economic status has any causative role at all in obesity – more just correlative – as it is correlated with less education. The distinction of whether obesity is a behaviour or outcome (I agree it is an outcome of behaviours though) isn’t the important part – the important part is how much influence you have over that outcome with better behaviours. Is it the case that we have less influence over obesity than we do with cancer and heart disease? I agree, as with cancer and heart disease, once it has set in, the preventative measures of diet and lifestyle are usually not enough anymore. I’m interested in the historical differences in terms of diet and lifestyle as obesity is often seen as an outcome of relative luxury and convenience. High fructose corn syrup can be found in many processed foods and drinks and studies have linked it with obesity – this is one example of education and better choices being able to positively influence the outcome. I agree diets and calorie counting have not been shown to be productive and even calories themselves cannot all be counted as equal – the source of the calorie itself matters. I don’t have any answers for the obesity epidemic as it exists but I did want to stress that prevention and education about diet/lifestyle seemed missing in the blog piece – abdicating personal responsibility and framing obesity as a “disease that you caught” doesn’t seem the right direction to me – based on my current understanding and education of course – if it really is mostly due to circumstances beyond these people’s control then I don’t think that case is seeing the light of day – but as I said I’d be interested in reading more on that.

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  3. Travis says:

    I guess I don’t entirely disagree with respect to education being somewhat different that the other risk factors. But if it comes down to improving education for everyone, that still largely falls under control of government (with prodding from individuals) rather than being under an individual’s control. Does an 8-year old have much control over their education? Do most adults with an income below the median? Most of these issues still come down to a concerted societal effort, rather than simply being in the domain of the individual. After all, we’ve been telling people to eat less and exercise more for decades, and it really hasn’t made any difference at all – in fact things are now far worse.

    Obesity and SES is a complicated relationship – obesity is associated with high SES in poor countries, and low SES in rich countries. I have a presentation with some of these refs at home, will try to grab some of them soon. In the meantime, income disparity seems to be associated with obesity rates more consistently than SES itself – not sure what that means exactly, but it’s interesting :)

    http://jech.bmj.com/content/59/8/670.full

    And of course you’re right that we can’t tell if it’s correlative or causative – unfortunately we can’t do an actual experiment to test that out.

    As for obesity being harder to treat than other chronic diseases, I’m not sure I can properly answer that since I’m not a clinician. As WRG pointed out, even under the best circumstances less than 5% of people manage to keep off a significant amount of weight for 5 years or more using lifestyle modification alone. These are people who have been given top notch education and oversight, and yet weight loss is still unsustainable (preventing weight gain, on the other hand, may be far more realistic). Maintaining a reduced body weight is extremely simple in theory, but extremely difficult in practice.

    I’m not suggesting that people have no responsibility for their own lifestyles at all. But we need to do a much better job at supporting people to adopt healthy lifestyles.

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  4. Rob says:

    I did find this study:
    Hebebrand J, Hinney A.Environmental and genetic risk factors in obesity.Child Adolesc Psychiatr Clin N Am. 2009 Jan;18(1):83-94.

    Which says: “the effect sizes of most such environmental factors are likely to be small, thus rendering their detection difficult. In addition, the validation of the true causality of such factors is not a straightforward task. Important factors are socioeconomic status and television consumption.”

    Even genetics is not truly “non-controllable” as various genes turn on or off in response to environmental (including dietary) factors so there is some influence possible there. It’s interesting because I’m aware I’m inherently biased towards wanting to focus on controllable factors that we can influence – mostly because they mean we can be preventative and have an influence! And I’m resistant to the idea of “Oh I have no control over it so I have no personal responsibility and the government and doctors should fix it for me! What a relief!” I think that attitude is extremely counter productive and shouldn’t be encouraged unless there is overwhelming evidence that that is the case.

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    • Travis says:

      Again, I don’t think I or anyone else would argue that individual’s have no control/responsibility. But I’m saying that it’s not entirely the individual’s responsibility. And even in those areas where it is under a person’s control, we can be more supportive of them.

      Depending on your income, education, level of free time, age, living environment, etc, things which are quite easy to control for you may not be that controllable for others, or vice versa. If you want to take smoking as an example – the decision to smoke is a personal choice. But we as a society realize that that decision is associated with increased health risk, and so we’ve done many things to dissuade people from smoking, and make it easier to quit. In the same way, I believe we need to dissuade people from having poor diet and low levels of activity, and make it easier for them to adopt healthier behaviours (by improving education, the built environment, etc).

      Keep in mind that this blog is almost entirely focused on giving people evidence-based information so that they can make better decisions regarding their health behaviours – so I do think it’s important for individuals to take responsibility for their own health. I just don’t think it’s realistic to expect that to be enough to solve the issue of obesity-related health problems on its own.

      With that in mind, here is a recent meta-analysis of diet & exercise programs – although people initially lose weight (~13kg on average), the average person gains half that weight back by the end of the first year:

      http://www.nature.com/ijo/journal/v29/n10/abs/0803015a.html

      And again, these are people who have had the best lifestyle treatment available. Of course some people continue to lose weight, and some people are able to avoid weight gain successfully their entire lives.

      Sorry for the rambly-ness of this comment, it’s the end of the day and I’ve got to head-out! I’ve enjoyed the discussion, but with the long-weekend starting tomorrow I won’t be checking the blog as often as usual. Feel free to continue commenting, it just might take me a few days to get back to you.

      Have a good weekend!

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  5. Aggie says:

    The essence of government is force. So, what exactly are you suggesting the government do? Put people in camps until they lose weight? Deny them health care if they are not at what the authorities consider to be an acceptable weight? Force them to have surgery?

    If the problem is saving the Canadian health care system, then I suggest gassing everyone over the age of 60, since the #1 risk factor for almost every disease is aging. Come to think of it, only the healthy should be allowed access to the system. There, it’s fixed.

    As long as government runs the health care system, there will be constant battles over who pays and who benefits. Government always pits groups of people against each other. The result is always scarcity and rationing, and those who are reviled by society will be the first ones cut off. Scary stuff, if you aske me.

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    • WRG says:

      Yeah, as if the insurance companies don’t turn thousands of people away, denying them the health care they need to survive and thrive.

      I’ll take universal health care any day over the vicious, “every man for himself”, “only the rich deserve care” system that masquerades as health care in the States.

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    • Gwen says:

      If you’re actually interested in how the government could help, the CMAJ just published a good editorial outlining potential legislative measures that may help: http://www.cmaj.ca/cgi/rapidpdf/cmaj.101522v1 It’s not about legislating individuals (as in your examples of camps, denying health care, etc.). It’s about using legislation to alter the “obesogenic environment” and trying to improve public health outcomes as a whole, rather than effecting weight loss in particular people.

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      • Travis says:

        Thanks! Somehow I don’t seem to have access to it, but I will keep working on it. Can’t believe I hadn’t seen that yet!

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  6. Rob says:

    Thanks Travis – I’ll take a look at the meta analysis – I’m interested in what changes were made and why the weight went back on. I also completely agree the degree of control we have over a lot of these variables is itself variable from person to person – and that blame and guilt are also very counter-productive – being supportive and encouraging personal responsibility and helping point out previously unseen areas where personal influence can have an effect is an important part. It’s difficult to generalize about – but I feel that in many cases the solution/ information/education is often available but people don’t follow through with it. We’ve known for decades that smoking leads to various cancers and respiratory diseases but people still do it…even obesity itself is unlikely to be easily categorized – I recognize that the degree of influence over it developing isn’t going to be on a level playing field for everyone. Rate of metabolism, disability, parental upbringing, etc there are a lot of potential factors. I think a lot boils down to education and personal motivation though in the end for most, but not all, factors.

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  7. WRG says:

    First, thank you Travis for your response. We probably are pretty much on the same wavelength, however a linguistic analysis of your post (which is essentially the same as those of Drs. Freedhoff and Sharma) would show that it is replete with words meant to shock, appall and incite fear and loathing: “the obesity crisis”, “pretty shocking”, a “particularly nasty” virus, “challenging”, “difficulty”, “a whole slew of other medical conditions”, “visible affliction”, “top health issue facing the country”, “the most prevalent disease”…

    As a fat person who eats healthily and exercises to the best of her (handicapped) abilities, words like these sting, insult and rob me of any sense that I am doing the best I can. I am simply part of a visible crisis, a person who is looked down upon by the general population for my gluttony and laziness.

    Yes, Travis, words are amazing weapons and the longer we keep crying “crisis-epidemic”, the more the general public and even people who seem to have an academic background such as Rob above, will further stigmatize and isolate the fat amongst us , decrying our evident lack of willpower and personal responsibility.

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    • Travis says:

      This may be a naive question, but I always appreciate your perspective on these things. How do we talk about the very real health issues that are associated with obesity, without stigmatizing individuals with obesity. I realize that obesity is a bit unique in that it’s visible, and seen by many people as a disease of the individual (e.g. if I used the same terms as above to describe an increase in type 2 diabetes or prostate cancer, I doubt it would cause the same type of personal reaction). I’ve discussed this with a number of obesity researchers, and while we can do certain things (e.g. refer to individuals with obesity as opposed to obese individuals, etc), I still haven’t seen an effective way of presenting the obesity-related information that doesn’t pose a risk of inadvertently stigmatizing people. Any thoughts?

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      • WRG says:

        I’ve been blogging about these issues for the past two + years. It’s hugely complicated.

        First, the mainstream is solidly in the camp of personal responsibility/stigmatization. Even most weight loss bloggers hate (truly hate) fat people. They hate themselves or at very least, they believe that the fault is theirs and theirs alone. It’s going to be very, very difficult to turn this juggernaut around. Certainly, the kinds of words being bandied about (see the selection I pulled out of your post) by health care “experts” are not helping the situation at all.

        Next, yes, we have to look at our children and our youth. As long as phys ed in the schools is reserved for the athletically gifted, most kids are going to hate it. I’m 54 and still remember the sting of being chosen last for every team, or being barely able to jump the lowest hurdle. We must make phys ed mandatory throughout primary and high school, but as a purely pass/fail course, based on participation. If kids who are good in sports want to score 90s on their report cards, give them advanced classes (a little along the lines of gifted programs).

        Nutrition is also a complicated issue. One person’s super food can be another’s ticket to weight gain, heart disease, etc. But I think we can all agree that candy and fast food (especially due to horrifically high salt content) are just not good for you. At very least, we should take all commercials for sugary cereals, the various hamburger and fries emporiums and soft drinks off the air. Nor should vending machines selling this dreck be allowed in the schools. Junk food should be treated the way we treat tobacco today: yes, it’s still legal, but the Marlboro man is long gone from our TVs. We should do the same with R. McD.

        Public health campaigns should focus first and foremost on health at every size. How many people give up doing any exercise or making even small changes to diet (let’s say just cutting out soft drinks in favour of drinking more water), because the results in terms of weight loss are usually negligeable? Why are we not telling people about the many tangible benefits of physical activity that have nothing to do with weight loss? We must make a conscious effort to decouple physical activity from weight loss. Physical activity is extremely beneficial, but people don’t persevere because they don’t see the results on the scale.

        The word “diet”–except as it applies to people who must, due to severe medical conditions, avoid certain foods (i.e. peanut allergies)–should be banned. The only thing dieting does is create fear and the inability to think for oneself when it comes to food choices. Intuitive (or mindful) eating is a step in a much healthier direction. And need I remind us all of how many people end up much fatter after years of “dieting”?

        OK, so the medical profession has to do something about conditions that are associated with overweight and obesity (though causal relationships are not necessarily that clear). Doctors are, for the most part, woefully uneducated when it comes to weight management. They make the same assumptions as the general population: you’re fat because you eat too much and spend too much time in front of the computer or the TV. Doctors have to learn about health at every size and mindful eating and promote both concepts at every occasion; they have to be aware of what kind of resources are available in the community to help people nourish themselves and their families more successfully and encourage people to enjoy moderate physical activity (i.e. even just taking a 15 minute walk in the evening, if at all possible.)

        I have also observed that a lot of weight loss bloggers live seriously disordered lives. They binge because they are deeply unhappy. This is not a food issue, it’s a mental health issue. How about the doctor asking that mom stuck at home with three screaming kids what it would take to stop her from downing a tub of ice cream? Maybe she needs to get out of the house. This may be a facile example, but there’s a lot of pain out there. I read about it every day. Sadly, many of these people (in particular, women) continue to hate and blame themselves and see their only salvation in weight loss.

        Well, those were just a few ideas off the top of my head. And I’m just a little, fat, middle-aged lay person. But believe me, I’ve thought a lot about this over the past two years. Buy me a coffee (I take it with milk, no sugar–unless it’s expresso!) and I’ll tell you about my aha! moment with Brussels sprouts that got me on the road to ditching diets forever. BTW, I love Brussels sprouts.

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  8. Aggie says:

    There is no unlimited supply of anything, including health care. Canadians are denied care – they often wait for months for treatment or go to the US. When something is “free”, then demand increases and inevitably, rationing is the result.

    Government is the problem in the health insurance and health care businesses. When government gets involved, it produces increasing costs, scarcity, rationing, and declining quality. The specialties where the doctor and the patient deal with each other directly (for example cosmetic surgery and lasik eye surgery) are precisely the ones where the most innovation has occurred at the same time costs have decreased and more people have access.

    Government couldn’t manage a 2-car funeral, so it always amazes me when people turn to it to take care of them.

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    • WRG says:

      Fox News speaks!

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    • NSX says:

      I deal directly with my patients. I just don’t charge them for it. Neurosurgery is FULL of innovative techniques and advances. And patients don’t have to wait and save up to have their brain tumour dealt with (or, you know, die because they can’t afford the surgery.)

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      • Aggie says:

        You deal directly with your patients, but you answer to the bureaucrats in the government health system. That is a major barrier between you and your patients.
        People die in the US because they cannot pay for surgery? Examples, please. Meanwhile, I can give you many examples of people who suffer, and yes, die waiting for treatment in nationalized systems. Just recently a Canadian woman died waiting for a second stomach surgery. It was repeatedly postponed until it was too late.

        The Price of Free Health Care
        http://www.thefreemanonline.org/featured/the-price-of-free-health-care/

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  9. Ashartus says:

    I actually went through all the party platforms (as part of a post I was writing on policies relating to science and science education) and did find a section in the Liberal Party platform dealing with addressing obesity; it can be found here: http://www.liberal.ca/platform/families-finances-future/health-and-health-care/ (under “Health Promotion, Sport and National Food Policy” – you have to click “show more” to see the details). I didn’t see anything from any other party though.

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  10. fred says:

    So if you were in charge, what would you do?
    What would your “Canada Food Guide” look like?
    What would be your recommendations for weight loss of us who have the tendency to become obese be?
    I am looking for a “real solution”.

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  11. FrauTech says:

    Thanks for your post Travis and your thoughtful followup comments. To those who think the government can’t do anything…

    The government can subsidize healthy foods (low calorie, fresh fruits, fresh veggies) and stop subsidizing unhealthy foods (indirectly subsidized high fructose corn syrup). They can design infrastructure in such a way that there are easily accessible parks and paths near where people live and work, both urban and suburban. They can make sure these parks and paths are safe so that people aren’t afraid to use them. They can create healthcare incentives (maybe this is a private thing only) for preventative care, for joining proactive health groups for healthy eating and exercising education. They can provide more spaces for the public to exercise and create a general atmosphere where this is enc0uraged (as in, stop killing yourself for 60 hours a week at work, it’s okay to get up and go for a walk that doesn’t make you a communist). They can provide incentives to employers to encourage healthy living and exercising in their employees. Maybe employers who don’t have gyms could provide discounts at local gyms etc. Employers could sponsor healthy living activities and receive some incentive from the government to do so.

    I just thought of all this in the last couple minutes, so I’m sure a bunch of doctors and specialists could probably do a lot better. That’s what I’d like to see, and shift away from the personal blame NewMe is talking about and Rob seems to be embodying. Shame just makes me give up and eat more. Publicizing the studies that shows that calorie reduction and activity are not equally effective on everyone is a step towards finding things that ARE effective and towards paths to health for people for whom dieting and exercising do not result in weight loss.

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  12. Jennifer says:

    Rob: “Is it the case that we have less influence over obesity than we do with cancer and heart disease? I agree, as with cancer and heart disease, once it has set in, the preventative measures of diet and lifestyle are usually not enough anymore.”

    Unfortunately, we are not even certain what aspect of the diet causes cancers and heart disease. In the case of cancers, do we even know for certain that diet is the culprit in most cases?

    We were told for years that eating too much saturated fat causes heart disease. Now we are told that saturated fat is benign when it comes to our health. We are told that “junk food” makes us fat. But what is junk food exactly? We might all agree that it’s McDonalds, but what about granola bars? Yogurt? Macaroni and cheese? Chocolate milk? Cold cuts that you put in your lunch? Granola? Certain brands of supposedly healthy bread? All of these foods can be loaded with sugar and/or salt and/or additives. Yet we are led to believe they are healthy. To say the onus for being slim is on the individual is so unfair, considering that we don’t even know what we can actually eat without making ourselves sick.

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  13. Tracy says:

    Fascinating discussions in this section. I really like what WRG has to say.

    I am a clinician working in rural BC, and I know personally the ineffectiveness of obesity “prevention and treatment”, at least in the context of the standard doctor-patient dyad. There is a large Aboriginal population (40%) in this area with obesity rates far exceeding national averages. The scale of this problem, although framed as a “health issue”, goes well beyond the medical establishment’s ability to contend with.

    I think societal factors need to be closely examined as they set the context that leads to obesity. When there are carefully designed weight loss trials involving thousands of highly motivated, usually well educated people with the finest in a team of health care professionals — the most we see is 5-15kg weight loss, an inevitable plateau and then an inexolable wt gain as the physiology adapts. An interesting study from Scandanavia looked at a whole community intervention. Everyone, from the grocer to the teachers, got it in mind to adopt healthy messages — get out from behind the computer, avoid the crap. It made it socially unacceptable to make poor choices. This is really how smoking rates dropped, through making it very uncool to smoke. The outcasts huddling together outside buildings are looked down upon. They are embarrassed. They change. Yes, it is uncool to look fat, but it is NOT uncool to blog, to facebook, to game, to eat at McDs or Tims, to drink carbonated beverages. Until we connect societal disdain to the behaviors that lead to obesity, we can’t be effective and it just makes people feel bad about themselves. The messages currently coming at us are exactly those that make the healthy choices subconsciously impossible. Kids TV programs are heavily sponsored by companies that create junk food consumers. This then creates a cyclically reinforcing circle of product availability (it’s there because it sells, the healthy stuff gets less shelf space, the crap multiplies and takes up more space). Just try going into 7-Eleven. It is really hard to choose healthy even if you want to. The role of society really needs to be looked at, taking some of the burden of blame from the shoulders of the individual.

    And this is where the politicians can make a difference, though I think it is naive to think they will. This is not something a 4-yr political cycle can tackle. And there are too many business interests tied to the status quo to allow it. Just think of how many gigantic industries that benefit from overconsumption and inactivity.

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  14. TLC says:

    This is clearly a topic that strikes a nerve. Without sounding too cliche (or beating a really dead horse), this country still has not made the shift from a disease care system to a health care system. Canada has to adopt a culture of health & wellness for all, and we know that health is not simply the absence of disease.

    All great points earlier on the built environment, media, social awareness/acceptability, education & big business…a couple of additional points…if dietitians are to truly be recognized as the nutrition professionals they are, why not provide better access/coverage to this health professional? Also, I believe a couple of folks may have alluded to mental health without naming it explicitly. Teaching our children how to be strong confident individuals who are equipped to handle the stresses life will inevitably hand them – in a healthy way, will go a long way towards taking responsibility for themselves and making good/healthy decisions as they grow.

    Politicians can ensure all government agencies operate through a lens of health and wellbeing for the citizens of this country… they all have a role to play.

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