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Canadian report

Canada: Report critical of adult access to obesity treatments

On a yearly basis, bariatric surgery is available to only one in 183 (or 0.54% of) eligible adult Canadians (Class II or Class III obesity)
The number of bariatric surgeries in Canada continues to rise, though not at the pace at which the prevalence of Class ii and Class iii obesity rises.

An investigation into Canadians' access to publicly and privately funded medical care for obesity, by the Canadian Obesity Network (CON), has found a number of shortcomings when it comes to patient access to adequate obesity management options. The results of the research have been published as a ‘Report Card on Access to Obesity Treatment for Adults in Canada 2017’.

Despite the Canadian Medical Association declaring obesity to be a "a chronic medical disease requiring enhanced research, treatment and prevention efforts" in 2015, no level of the Canadian government has officially adopted this definition. For example, only a few Canadian physicians are pursuing formal training and certification in obesity management, and only 40 physicians across all of Canada have been certified in the management of obesity by the American Board of Obesity Medicine

The report covered four key areas:

  • Access to specialists and interdisciplinary teams for behavioural intervention
  • Access to anti-obesity medications through public and private means
  • Access to medically supervised weight management programs with meal replacements
  • Access to bariatric surgery and wait times

The highlights of the report state:

  • Canadians who may benefit from medically supervised weight-management programs involving meal replacements are expected to pay out-of-pocket between C$1,000-C$2000 to cover the meal replacements
  • Neither of the two anti-obesity medications approved in Canada are covered under any provincial or federal drug benefit. By contrast, the provincial public drug benefit programmes in all provinces and territories cover at least two medications for diabetes.
  • An estimated 8.8% of Canadians have private drug benefit plans have access to anti-obesity medications through their plans.
  • On a yearly basis, bariatric surgery is available to only one in 183 (or 0.54% of) eligible adult Canadians (Class II or Class III obesity). Average wait times between consultation with a specialist and surgery range between 6-12 months.
  • However, year over year, more physicians are being trained in obesity management while more bariatric surgeries are being performed.

Bariatric surgery

Regarding bariatric surgery the report states that there are 113 surgeons in 33 centres in Canada where bariatric surgeries are performed. The report found that:

  • Centres in many provinces do not accept out-of-province patients, which limits access to care for bariatric patients in provinces and territories with no surgical programs.
  • Gastric bypass and sleeve gastrectomy are more commonly conducted procedures, and few provinces offer gastric banding.
  • The number of bariatric surgeries in Canada continues to rise (Figure 1), though not at the pace at which the prevalence of Class ii and Class iii obesity rises.
  • Bariatric surgery is available to one in 183 (or 0.54% of) adult Canadians per year who may be eligible for it, i.e., adults with Class ii or Class iii obesity.
  • There is significant inequality in access to bariatric surgery in Canada. it can range from one in 90 adults in Québec with Class ii or Class iii obesity to one in 1,312 adults in nova scotia.
  • Limited resources for bariatric surgery and an increasing number of referrals have led to unacceptable wait times.
  • A significant proportion of the wait time experienced by patients referred to bariatric surgery is between referral and consultation with a specialist, with patients in most provinces wait for two years or more, and the wait can be as long as four to five years.
  • Typically, wait times between consultation with a specialist and surgery is six to 12 months.
  • Wait times can significantly vary from one province to the next.

Figure 1: The number of bariatric surgeries in Canada

The report makes seven key recommendations that, if enacted, could significantly improve access to adequate medical management to Canadian patients with obesity. These are:

  • Provincial and territorial governments, employers and the health insurance industry should officially adopt the position of the Canadian Medical Association that obesity is a chronic disease and orient their approach/ resources accordingly.
  • Provincial and territorial governments should recognize that weight bias and stigma are barriers to helping people with obesity and enshrine rights in provincial/territorial human rights codes, workplace regulations, healthcare systems and education.
  • Employers should recognize and treat obesity as a chronic disease and provide coverage for evidence-based obesity programs and products for their employees through health benefit plans.
  • Provincial and territorial governments should increase training for health professionals on obesity management.
  • Provincial and territorial governments and health authorities should increase the availability of interdisciplinary teams and increase their capacity to provide evidence- based obesity management.
  • Provincial and territorial governments should include anti-obesity medications, weight-management programmes with meal replacement and other evidence-based products and programs in their provincial drug benefit plans.
  • Existing Canadian Clinical Practice Guidelines for the management and treatment of obesity in adults should be updated to reflect advances in obesity management and treatment in order to support the development of programmes and policies of federal, provincial and territorial governments, employers and the health insurance industry.

The ‘Report Card On Access To Obesity Treatment For Adults In Canada 2017’ was produced by the Canadian Obesity Network with the support of an unrestricted grant from Novo Nordisk Canada Inc. 

To access the report (English), please click here

To learn more about the report, please click here

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