Canada's $9 billion obesity problem

'People living with obesity are living with a chronic disease and they require treatment just like anybody else living with a chronic disease — regardless of the cost'

Vanessa Hrvatin, Special to the National Post 4 minute read November 5, 2019

The costs associated with rising rates of obesity worldwide are staggering and it doesn’t look like they’ll be dropping anytime soon. The disease costs the global economy an estimated $2 trillion each year. In Canada — where more than one in four people live with obesity — related health care costs are as high as $7 billion and are projected to increase to nearly $9 billion by 2021.

But experts say many of these costs are a result of the health care system’s failure to properly treat obesity. Rather than taking a proactive approach, the system is instead set up to treat conditions that develop as a result of the disease, explains Obesity Canada’s scientific director Dr. Arya Sharma. The result? More money being spent in the long-run.

Canada spends roughly 11 per cent of its total health expenditure on treating medical conditions that arise as complications of obesity, according to a recent report from the Organization for Economic Co-operation and Development (OECD). On average, in the 36 countries that form the OECD, being overweight is responsible for 71 per cent, 23 per cent, and 9 per cent of all treatment costs associated with diabetes, cardiovascular disease and cancers, respectively.

Part of the problem is that access to obesity treatments in Canada are hard to come by. Obesity Canada released a report earlier this year concluding that none of the three federally approved anti-obesity medications are covered under provincial or territorial health plans. Waitlists for bariatric surgery are long — up to eight years in some places — and medically supported weight loss clinics are few and far between.

Tackling obesity head-on is a must in order to save money and ensure patients are getting the treatment they deserve, says Dr. Sharadh Sampath, director of the Richmond Hospital Metabolic and Bariatric Surgery Program in B.C. According to Sampath, B.C. only funds 400 bariatric surgeries a year, even though the financial savings associated with the surgery make it a “no brainer.” He says the total cost of surgery is about $13,000 — significantly less than what it costs to treat some of the associated conditions that can develop in patients who qualify for the surgery.

Catching people who are at risk of developing obesity or related conditions early on is also something the system isn’t good at, says Sampath.

“What we see a lot of now is we’ve allowed the ship to sail by not providing care up front. So people come in with a high body mass index and co-morbidities that are too severe to tolerate anything surgical or otherwise, so they spend a long time in the hospital and their quality of life rapidly declines,” he says.

Hospitals themselves are part of the problem. Many aren’t equipped to take on heavier patients, which contributes to high costs says Dr. Mary Forhan, chair of the University of Alberta’s occupational therapy department.

“The system is actually causing an inconvenience for people living with obesity because they’re willing and ready to get help and it’s just not available,” she says. “This is a systemic issue and we have to look at the processes and the training and the capacities in our system that are causing these backlogs that are really expensive.”

Forhan points to things like X-ray machines that are unable to accommodate bigger body sizes and rehabilitation facilities that lack proper equipment as factors contributing to longer hospital stays for people with obesity. In preliminary research, her team found reducing extended stays by just one night for people with a body weight of 250 pounds or more would save Alberta $14 million annually.

Despite the clear economic argument for investing more in the prevention and treatment of people living with obesity, experts say there has been little federal direction on the issue. While there has been some progress — the updated Canada Food Guide and the recent approval of a third anti-obesity medication, for example — few other efforts have gained traction. Bill S-228 was introduced in 2016 with the intention of limiting the advertising of unhealthy food and drinks to kids, but it was stalled by the Senate and died in June of this year.

Pockets of obesity programming have popped up across the country, but Obesity Canada says many communities remain under-served. The Yukon, for example, is the only territory with a multidisciplinary team focused on obesity management in adults.

Experts say they’re frustrated by the lack of progress in preventing and treating obesity, which was officially recognized as a chronic disease by the Canadian Medical Association in 2015. And despite the economic pressures it places on the system, there’s consensus that the need to properly address obesity goes well beyond the cost.

“Why is it that it’s only in the context of obesity that we say it’s okay to treat it only if it saves costs,” says Sharma. “We have to try and treat it as cost effectively as possible, but people living with obesity are living with a chronic disease and they require treatment just like anybody else living with a chronic disease — regardless of the cost.”