By Sarah Dobson
More than one-quarter of Canadians are obese, and yet there are disconnects among employers, health-care providers and employees when it comes to understanding and combatting the disease, according to a recent report.
Obesity is a complex, multifactorial, progressive chronic disease — similar to diabetes or high blood pressure — and yet 47 per cent of employers believe employees’ weight is completely within their control, while 63 per cent feel people with obesity could manage their weight if they set their mind to it.
And 72 per cent of health-care providers believe people with obesity are not motivated to manage their own weight, found the Obesity Canada report Awareness, Care and Treatment in Obesity Management Study (ACTION).
However, 82 per cent of people with obesity say they are highly motivated to manage their obesity and are actively engaged in weight management on their own.
“It goes back to decades of stigma around obesity that the general public and health-care providers, even more so… [who] feel that this is a lifestyle condition and don't often believe or understand that it is actually a chronic disease. And that comes down to the bias aspect... which has its foundations in a lack of understanding,” says Sue Pedersen, a physician, obesity expert and ACTION study investigator in Calgary.
“There's very little education for the public or for health-care providers to understand the multiple issues that underly a person's weight struggle that actually has a lot more to do with: genetics; perhaps medications that their doctor has prescribed for other reasons that have caused weight gain; eating to treat other issues like depression or anxiety; the emotional relationship with food; the bacteria we have in our gut — there's so many things that contribute to the weight struggle, but because there's not much understanding, it's perceived as a lifestyle issue.”
Greater employer support needed
Employers need to treat obesity as a chronic disease and move it out of the lifestyle category in the benefits plan, said the report, based on a survey of 2,000 people with obesity, 395 health-care providers and 150 employers.
“What we need from them is access to other treatment options for weight management, like paying for medication, paying for psychology, research, support, dietitian care, better programs,” she says.
However, 50 per cent of employers feel they are an important partner in managing weight, and health-care providers also feel employers are important (43 per cent). But people with obesity are less inclined to echo that sentiment (19 per cent).
And while more than three-quarters of employers (77 per cent) say their wellness programs contribute to successful weight management, that’s in sharp contrast to the perspective of people with obesity (32 per cent).
Very few private medical plans pay for treatments for chronic weight management, and very few cover the three obesity medications available, says Pedersen.
“Things like psychological support and dietician access are sometimes a little better with private medical plans. But really there's very limited access both from a public perspective and private insurance perspective.”
The large proportion of people who may use these benefits is one consideration for employers, as is the cost, she says.
“But there's other medications for other chronic diseases that are much more expensive like rheumatoid arthritis or cancer drugs, or there's some newer cholesterol medications that eclipse the cost of obesity medication, and yet they're covered by drug plans because [it] would be unethical not to provide those treatments. So, similarly, it's unethical not to offer obesity treatments.”
Employers should also understand that by covering obesity treatments, that will help with the prevention of other obesity-related issues such as diabetes or cancer and “actually end up being more expensive for that employer to have to pay for treatment,” says Pedersen.
“If we can help the patient manage weight, then they would have a lower risk of many types of cancer, high blood pressure, sleep apnea, fatty liver, which can lead to liver cirrhosis.”
And it’s not just employers and health-care providers that don’t fully understand the disease: 74 per cent of people with obesity feel obesity management is completely the individual’s responsibility (compared to 40 per cent of employers and 23 per cent of health-care providers).
“They feel like it's their own problem and they should deal with it themselves — they're not reaching out to health-care providers, which is probably because the patients themselves don't understand that it goes far beyond just what we're eating and whether we're being active, and also comes down to a likelihood that they've been stigmatized by health-care providers in the past,” she says.
Also, only a minority of people in both groups feel bariatric surgery is useful when it’s actually the treatment that has the greatest amount of weight loss, says Pedersen.
“Most people and health-care providers… feel that diet and exercise is still the best treatment. And yet only about 10 per cent of communities in the ACTION study were able to lose 10 per cent of their weight and keep it off for a year. So, obviously, this isn't working. And when we asked them if they thought that medication was a success, there were very few in both groups who thought that medications would work — and actually medications are shown in very robust clinical trials to reduce weight by five to 10 per cent.”
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