'Stigma and bias' hinder health care for obese: Advocate


Ian Patton has struggled with obesity his entire life and is fully aware of the inequitable manner this chronic condition is treated.

Currently there is no public coverage for prescription anti-obesity medications and more than 80% of private health plans don’t cover anti-obesity treatments.

Pharmaceuticals can curb cravings or deal with mental health issues at the root of many obesity cases, experts say.

“It’s bias and stigma. It’s frustrating that there is help out there, but it isn’t accessible,” said Patton.

He is an advocate with the Canadian Obesity Network and has a PHD in obesity kinesiology.

“I live on both sides of the academic and patient advocacy,” Patton said, adding he knows many people who could be aided with medications.

“We know through science this is a chronic disease. and it’s not equitable people can’t access treatment for it. There is a long perception that it is lazy people eating too much. If it were that simple it would have been dealt with by now, Patton said.

Weight problems can be brought on by mental health issues, genetics or hormonal imbalances, said Dr. Sean Wharton, an internal medicine specialist in diabetes and weight management.

“A major problem can be self-esteem or problems with depression and using food to cope. Using medication to grapple with that for a reasonable period of time is a reasonable answer,” Wharton said.

“Then there are other techniques to deal with obesity.”

He says any meaningful change to having prescriptions covered will ultimately be up to obese patients to advocate for medications similar to the way HIV or Hepatitis C patients did for life-saving drugs.

“There is stigma and bias. Often people attach the behaviour to the medical condition,” Wharton said.

“There are new medications, combinations of medications that help with craving and emotional eating … medications that help people feel full as they lose weight.,” Wharton said.

Obesity is associated with a whole host of medical consequences at tremendous costs, said Dr. Roger McIntyre, who is with the department of psychiatry at the University of Toronto and the department of mood disorders and psychopharmacology at the University Health Network.

Those include diabetes, cardiovascular disease, high blood pressure and some types of cancer.

“Covering medication would be a useful return on investment. The cost of not treating (obesity) is not acceptable,” he said.

Obesity has been labeled as a chronic disease by the Centre for Disease Control and Prevention, but medications aren’t covered as they are for conditions like high blood pressure.

“It reflects the governments attitudes that they only cover real diseases,” McInyrye said, adding there is the perception obesity are simple “weak-willed” people .

For the past two decades, McIntyre has worked at the links of psychiatry and obesity.

He says there is an underlying biology where obesity is the result of changes in the brain which are responsible for chaotic eating patterns.

“It’s a brain-based problem,” McIntyre said, adding obesity is a physical and mental problem.

But the area of the brain that regulates the stop eating function can be targeted with pharmaceutical therapies.

Medications can be given to shut down appetite and prevent the body from absorbing fat.

Neuroscience is the great antidote to obesity, McIntyre said.

“The underlying causes of obesity is the consequence of a disturbance in brain function,” he said.

For drugs to be covered by the Ontario Drug Benefit program they must be reviewed for funding consideration based on an assessment of scientific and clinical evidence as well as the impact on health services by comparing them to existing treatments in the province, said David Jensen with the Ministry of Health.

There are only two drugs in Canada that are officially indicated for the treatment of obesity, which are Xenical and Saxenda.

Xenical was reviewed by the ministry’s Committee to Evaluate Drugs in 2006 at the request of the manufacturer to broaden reimbursement criteria.

“At that time the committee raised concerns about the real-world applicability of trail results as well as the cost-effectiveness of treatment with Xencial,”Jensen said.

“These concerns were not subsequently addressed by the manufacturer. ”

Saxenda hasn’t been submitted to Ontario or the national Common Drug Review for drug program consideration.

A third obesity drug has received marketing approval by Health Canada, but isn’t available on the market and it hasn’t been submitted for drug program funding consideration.

OBESITY ON RISE IN T.O.

Toronto Public Health says the percentage of over weight or obese adults in Toronto grew significantly from 2007 to 2014

Factors such as sex, age, and ethnicity were associated with obesity and being over weight in Toronto.

Adults in Rexdale/Etobicoke were most likely to be overweight or obese in Toronto.

Nationally, 60 per cent of Canadians over overweight and 30% are considered obese.

This is measured by the body mass index, which is calculated by a person’s wight and height.



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