Start Treating Obesity as a Disease

The Ottawa Citizen - December 10th, 2008

Douglas Bishop practised internal medicine in Ottawa for more than 20 years before reaching a conclusion that would change his life, and the lives of others. What his sickest patients really needed, he concluded, was not more tinkering with their dosages, but real help losing weight.

Excess weight was behind many of his patients' illnesses, Dr. Bishop believed, and addressing it was the only way they would ever get healthy. But the public health-care system was poorly equipped to do so. Instead of spending his career putting Bandaids on chronic problems such as diabetes, heart disease and osteoarthritis, Dr. Bishop decided to tackle the underlying issue -- obesity. To do so, he essentially had to turn his back on the public health system.

He set up the private Dr. Bishop Weight Management Clinic in 2001. Dr. Bishop, 62, says his behaviour modification program has had amazing success with many patients -- getting them off pills, out walking and even running. "Finally, for the first time in my life, I am really being a doctor," he says.

Which is a happy ending, in a way, for Dr. Bishop and his patients. But not for the overall health of Canadians. When physicians such as Dr. Bishop conclude that Canada's health care system is either unable, unwilling, or both, to tackle one of the most serious challenges facing the country, it is an ominous sign.

"We are treating people at the wrong end and not doing any kind of preventative medicine," he says.

It might seem surprising at a time when the public is constantly being warned about the dangers of obesity that we are also hearing about the system's failure to treat it. But treating obesity is complex and time-consuming, and the public health system is designed to deal with quick treatments rather than the inevitably complex and messy underlying causes of disease.

Helping patients lose weight is preventative medicine at its most basic. A failure to address obesity is a cost the overtaxed system can't afford.

Last week, renowned Ottawa heart surgeon Wilbert Keon warned that the coming economic crisis means Canada can no longer afford to support a sick population and that it must, finally, get serious about preventative medicine.

Dr. Yoni Freedhoff, an outspoken Ottawa doctor who treats obese patients at his Bariatric Medical Institute, calls the health system's approach to obesity -- the number two cause of preventable death in Canada -- "absolutely astounding."

As of 2004, 23.1 per cent of Canadians were obese, according to Statistics Canada, and another 36 per cent were overweight, which also increased their risk of health problems. Obesity is linked to high blood pressure, diabetes and heart disease, some of the costliest diseases to the public health system.

Yet Health Canada does not call it a disease -- it carefully refers to obesity as a risk factor for other diseases -- although the World Health Organization, the Centres for Disease Control and the American Heart Association all label it as such.

What difference does that make?

"If they say it's a disease, they have to treat it." says Dr. Freedhoff.

There is some help for obese patients within the public health-care system. In Ontario, OHIP covers gastric bypass surgery for some obese patients, which pays for itself in three years with reduced costs to the health system, according to Dr. Bishop. OHIP also covers some of the medical treatment at weight reduction clinics, but it does not cover counselling, nutrition and behaviour modification, which are key to losing weight.

Like Dr. Bishop, Dr. Freedhoff finds weight-loss management rewarding. "I think I am giving back more to my patients than when I was in family practice. I get to stop drugs now, whereas I used to start drugs."

Dr. Freedhoff argues that Health Canada must take obesity more seriously and that recognizing it as a disease is a good place to start.

And to seriously treat it, Dr. Freedhoff says, there must be a regulatory system for weight management programs. "Doctors say: 'You need to lose weight' but they don't tell you where to go."

In addition to an established system of treatment programs for obesity, weight management needs to be part of the medical school curriculum.

Meanwhile, helping patients lost weight can be both rewarding and somewhat frustrating. Although both Dr. Freedhoff and Dr. Bishop both feel they are finally fulfilling their roles as doctors, they sometimes bump up against a sentiment that helping people lose weight is not real medicine.

"The road has been paved by quacks," says Dr. Freedhoff. "As soon as someone hears you are a doctor trying to deal with nutritional weight management, people don't trust you."

Canada's overtaxed health-care system can't wait much longer for obesity to be taken seriously.

Elizabeth Payne 

Elizabeth Payne is a member of the Citizen's editorial board.

Back to Headlines