Here in Nova Scotia, we are losing the fight against obesity. About 36% of Nova Scotians have obesity, while another 31% are overweight. That means that over two-thirds (67%) of Nova Scotians have either obesity or are overweight. (1)
Lack of Access to Care
Research is now showing that adult obesity in Canada has tripled in the last 30 years. (1). Obesity increases the likelihood of various diseases, particularly heart disease, type 2 diabetes, obstructive sleep apnea, certain types of cancer, and osteoarthritis. In fact, obesity now outranks smoking as the biggest contributor to chronic illness in health care costs (2).
Based on the Canadian Clinical Practice Guidelines, it is recommended that adults with clinically severe obesity (BMI ≥ 40 kg/m2 or ≥ 35 kg/m2 with severe comorbid disease) may be considered for bariatric surgery when behavioural intervention is inadequate to achieve healthy weight goals (3). In Nova Scotia, about 58,600 (or 8%) adults have Class II obesity, while 30,900 (or 4% ) adults have Class III obesity (1).
With appropriate patient education and follow up, bariatric surgery can offer sustainable weight loss (20% to 30% reduction) with improvements in mental health and quality of life and an even longer life. (3)
Figure 1. Report Card on Access to Obesity Treatment for Adults in Canada 2019 (2)
Though the number of bariatric surgeries in Canada continues to increase, the numbers of surgeries in Nova Scotia fail to rise. Figure 1 shows the high inequality in access to bariatric surgery throughout Canada. Bariatric surgery is available to one in 171 (or 0.58%) of Canadian adults per year who may be eligible to get the surgery versus here in Nova Scotia, where it is 1 in 1,073. Limited resources for bariatric surgery and an increasing number of referrals have led to unacceptable wait times. Figure 2 shows high wait times not only between consultation and surgery but also between referral and consultation. Between 2009-2016, Nova Scotia has performed 393 bariatric surgeries, averaging 56 surgeries a year. At the end of the day, wait times for bariatric surgery in Canada, particularly in Nova Scotia, are the longest of any surgically treatable condition putting those who are in need at higher risk of death while waiting. (2)
Figure 2. Report Card on Wait Times for Bariatric Surgery in Canada 2019 (2)
Weight Bias and Stigma
The impact of weight bias and stigma against people with obesity is comparable to that of racial discrimination, and it’s just as common.
Individuals living with obesity also face widespread weight bias and discrimination from:
Family (highest discrimination)
- Healthcare settings are a significant source of weight stigma, which undermines the opportunity for patients with obesity to receive effective medical care.
Both self-report and experimental research demonstrates that weight discrimination and attitudes toward those living with obesity are viewed as: lazy, lacking in self-discipline, dishonest, unintelligent, annoying, and noncompliant (4). Weight stigma can be verbal or physical such as insults, ridicule, teasing, touching or grabbing.
Stigma also comes from a none inclusive environment that creates barriers and obstacles in daily living, such as medical equipment that is too small, chairs and seats that do not accommodate, close parking spaces, and stores that do not carry clothing in a variety of larger sizes. (5)
Despite age, gender, obesity onset, and BMI, negative psychological outcomes are linked with experiences of weight-based stigmatization (4).
This has negative consequences including shame and guilt, anxiety, depression, poor self-esteem and body dissatisfaction that can lead to unhealthy weight-control practices and avoidance of physical activity (4).
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obesity research, management and care.
1. Measured adult body mass index (BMI) (World Health Organization classification), by age group and sex, Canada and provinces, Canadian Community Health Survey - Nutrition. www150.statcan.gc.ca. 2018 [cited 27 June 2018]. Available from: https://www150.statcan.gc.ca/t1/tbl1/en/tv.actionpid=1310079401&pickMembers%5B0%5D=1.4&pickMembers%5B1%5D=2.1&pickMembers%5B2%5D=3.1&pickMembers%5B3%5D=5.1
2. Pearce, N. (2019). Report Card on Access to Care - Obesity Canada. Retrieved 18 July 2019, from https://obesitycanada.ca/resources/report-card/
3. Understanding Obesity Stigma [Internet]. Obesity Action Coalition; 2017 [cited 2018 Apr 27]. Available from: http://www.obesityaction.org/wp-content/uploads/UOS_9_12_17.pdf
4. Bhargava K, Hussey B. Obesity in Canada - Obesity Canada. Obesity Canada. 2018 [cited 5 July 2018]. Available from: https://obesitycanada.ca/obesity-in-canada/
5. Puhl R, Heuer C. Obesity Stigma: Important Considerations for Public Health. American Journal of Public Health. 2010;100(6):1019-1028.