Treating Obesity Without Fatphobia

More than a billion people are obese, the World Health Organization (WHO) recently said. This state, defined by a body mass index (BMI) greater than or equal to 30, concerned 27% of the Canadian population in 2018, according to data from Statistics Canada; hypertension affected 30% of this group and type 2 diabetes, 13%. In thinner people, we are talking about 10% for hypertension and 3% for type 2 diabetes.

Interview with the D^D Julie St-Pierre, of the Cardiovascular Health Action Network (RASC), who announced on April 5 the creation of a « new interdisciplinary training program for health professionals and students involved in the prevention and for Obesity and Related Complications,” made possible by a $2 million donation from Novo Nordisk Pharmaceuticals.

The position of the WHO, which considers obesity as a disease, is controversial. What does your working group think?

Obesity is a disease in itself. There are pathophysiological modifications of the adipose cell which induce a whole inflammatory cascade and can lead to about forty insidious complications in children and adults. From a population point of view, the increased risk of cardiovascular disease, type 2 diabetes, cancer, orthopedic problems, and even death from COVID-19, has been well demonstrated. It is a complex disease that can depend on hormones, psychological status, medication or genetics.

Obesity is often assessed by body mass index (BMI). Is this a good measure?

BMI is not a perfect measurement because it does not always reflect a person’s health. Each individual is in a unique environment with unique genetics. Some people will fill their fat cells with fat more easily. Others will eat very poorly, stay thin and be very susceptible to cardiovascular disease.

That said, we must not overlook the fact that people with an increased BMI have a higher risk of cardiovascular disease and type 2 diabetes. A British study* that followed tens of thousands of people showed that those with a high BMI without initially having cardiometabolic disturbances [NDLR : comme le diabète, l’hypertension ou l’hypercholestérolémie] have a higher long-term risk of mortality than people who have a BMI in the appropriate zone for their weight and height.

What is your working group’s approach to addressing obesity?

We advocate Approach 180 [NDLR : que la D^re St-Pierre a créée en 2013]a holistic and multidisciplinary approach based on lifestyle habits, eating habits, sleep, time spent in front of screens and physical activity.

It is an education program with 25 hours of teaching over a period of six months, where scientific knowledge is popularized to awaken the patient, so that he becomes equipped and chooses the diet that suits him. Everyone thinks that obese people lack willpower, but that’s not true. They are motivated to get healthy, but they lack the knowledge to do well.

Only a few groups in Quebec do this multidisciplinary support, and it has nothing to do with a doctor or a nutritionist who meets his patient alone in his office.

Are drugs part of your approach?

Several medications, called anti-GLP-1, are approved by Health Canada but are not reimbursed by the RAMQ. They act on the fat cell and on the balance between satiety and hunger. They can be given as support, but the basic treatment remains multidisciplinary support to modify lifestyle habits. The National Institute of Excellence in Health and Social Services is conducting a study to find out who could use this medication and be reimbursed. The group of experts is very pleased with this progress.

The idea of ​​working on lifestyle habits is not new. What do you think is missing to make it work better?

It takes education to reduce medical fatphobia, present in all health-related professions. The tools that we provide to workers must be free from prejudice, deconstruct the various myths around obesity and promote an inclusive and respectful approach. To conclude from the outset that the patient must move more and take charge, or that he lacks willpower, is an outdated discourse. Obesity is a complex disease and it is still blamed on those affected, whereas a thin patient who suffers from diabetes or hypertension will not have the burden of his illness placed on his shoulders.

We are going to teach caregivers how to address people with obesity in a respectful manner, how to advise them and encourage them to adopt healthy lifestyle habits with non-guilt-free speech.

It may be necessary change the speech beyond the health sector?

This is why we are offering two training modules, including one in three indigenous languages, which will be free and open to the public. There is education to be done at all levels, among health personnel but also in the political class and the population in general. We have social work to do.