The 4 Pillars of Obesity Treatment: Doctor on Call with Sean Wharton, MD PhD
The three pillars of effective, long-term obesity treatment are cognitive behavioral therapy, pharmacotherapy, and bariatric surgery according to the Canadian clinical guidelines for obesity treatment. Sean Wharton, co-author of the guidelines, believes there should be a fourth pillar: “don’t treat people like crap”. It may sound harsh, but Wharton believes that’s how many people living with obesity are made to feel and it stands in the way of treatment. The best way an employer can support their employees living with obesity is to act with empathy and support access to effective treatment.
How has obesity treatment changed during the pandemic?
For many people, the pandemic acted as an additional stressor in their lives. Stressors for those who are vulnerable or those who use stress-eating to deal with a stressor, may have experienced weight-gain. Other people were able to reduce their stress by working from home and even improved when faced with the stress of the pandemic as it led them to focus more fully on their treatment. Not surprising to me, the impact of COVID on my patients has depended on their individual characteristics and situation.
Our clinic is busier than it’s ever been. I don’t think this is specifically due to the pandemic but more to do with an increase in awareness about our weight-management clinic and our increased use of virtual care. A virtual care model means we can provide better care to our patients and we are able to reach a larger group of individuals than we ever have before.
Our virtual care model is also going to help improve outcomes for those who are most in need. Recent research from our clinic revealed that women of colour had worse outcomes than other women. When we looked more closely, we found that it was related to lower access to care. When the number of clinic visits was controlled for in each group, the discrepancy in outcomes disappeared. There was no genetic or behavioral reason for the discrepancy. The problem was that women of colour had greater difficulty attending clinic appointments and we believe virtual care can help to close this gap.
Why is obesity so hard to treat?
The answer to this is simple. Bias. We all have the bias that obesity is not a disease, it is a character flaw. If you have a character flaw you should just try harder and you will be able to get your weight under control. On the other hand, if obesity is a disease, you receive treatment. We have effective treatments for weight management but if someone feels blame and shame around their weight they will try and “get better” on their own without the appropriate care.
How does obesity impact the workplace?
I believe bias is the main factor that impedes progress in the workplace. A common workplace mentality is to work harder – including on health and wellness. For example, a workplace may decide it’s a good idea to have a contest to see who can achieve the most steps or who can lose the most weight. This type of workplace activity suggests that all it takes to lose excess weight is a little more effort when that is simply not what the science shows. Instead of the typical workplace messages around wellness and weight which can inadvertently breed blame and shame, workplaces need to support obesity as a disease and to help employees access effective treatment.
What can employers to better support employees with obesity?
Any type of wellness program within a workplace needs to be individualized and based on what the employee needs. Factors not associated with eating and exercise are often at play. They may need counselling or to look at their work environment such as the number of hours of work or how their family situation impacts work.
A lot of general wellness programs that target exercise and healthy eating end up sending the message that these programs will help to manage weight. Given the risks associated with sending this message including creating bias within the workplace around weight, I wouldn’t recommend this type of program. Again – focus on providing individuals with care that is specific to their individual needs and context.
What has been the impact of remote working on your patients?
The impact of working remotely on my patients has been interesting. Again, it really comes down to each individual’s situation and how working from home may have increased or decreased their stress levels. For someone with social anxiety or a long commute, working from home may have decreased their stress levels and allowed more time to focus on weight management. On the other hand, someone who lives alone or in a stressful home context may have experienced more distress working from home resulting in more difficulty reaching their weight management goals. There is no one size fits all impact of COVID on weight management. bh