Canadian obesity care is ‘a patchwork’, says Obesity Canada

While Canada’s understanding of obesity has advanced, its care systems haven’t. That’s the central finding of Obesity Canada’s State of Obesity Care in Canada report.

Lisa Schaffer, executive director at Obesity Canada, noted the report benchmarks the country’s response against its own clinical practice guidelines and finds it falling short on nearly every front.

"Right now, it’s inequitable and it’s a real patchwork. It depends too much on where you live, who you see, and what your plan covers and what you can actually afford yourself," she said.

"There’s a gap and a disconnect," she added. "This isn't just another report saying we aren't doing enough. We need to think about how we can start moving towards closing this gap and making what we know to be true in evidence the reality that people are experiencing today."

Ian Patton, director of advocacy and public engagement at Obesity Canada, underscored the report’s core message remains that obesity is a chronic disease and is associated with more than 200 other health conditions, according to the report. Patton said Canada already has the clinical practice guidelines and evidence base to treat it effectively. The gap that needs to be addressed now is between what the science says and what patients can access, he said.

Five gaps in obesity care, one chain

According to Obesity Canada, the report identifies five key gaps: inconsistent measurement, inadequate primary care pathways, uneven surgical access, fragmented pharmacotherapy coverage, and near-invisible psychological support.

Patton framed the five gaps as links in a chain rather than isolated problems. Without recognizing obesity as a chronic disease, he argued there’s no incentive to measure it properly. Without proper measurement, health systems can’t plan for it. Without planning, there is no funding, and without funding, care delivery falls apart.

Employer-sponsored benefit plans sit inside that same chain, Patton said. When a physician deems pharmacotherapy medically necessary, but a patient’s plan doesn’t cover it, the care pathway breaks down.

Additionally, the alternatives might not be appropriate and even when they are, as in the case of bariatric surgery, for example, wait times can run years. In the meantime, the disease progresses, health outcomes worsen, and the eventual cost of treatment climbs.

"Even when you have coverage for primary care, that doesn’t necessarily mean that you’re accessing effective obesity care," said Patton, adding access to treatment options "varies widely and isn’t great across the board."

Geography over clinical need in obesity care

Still, Patton was quick to acknowledge how access to all three pillars of evidence-based obesity treatment - bariatric surgery, pharmacotherapy, and psychological behavioral intervention - depends heavily on where a person lives and what they can afford.

For many Canadians, Patton argued, that means no access at all. Surgical waits can stretch years by province, medications stay out of reach without coverage, and psychological care is inconsistent, even when a plan covers it, because providers may lack obesity-specific training.

"They’re left to their own devices and trying to figure out what to do," he said.

Schaffer emphasized that while some people are receiving excellent evidence-informed obesity care, others are struggling to get a proper assessment, referral, or encounter narrow insurance criteria. Meanwhile, psychological support, a critical component of obesity care, is largely invisible in the current system, she noted.

Moreover, coverage denials, long wait times, and a lack of clear care pathways mean that even when a clinician is ready to help and treatment exists, patients hit a wall. Schaffer stressed that employers and plan sponsors shouldn’t view this as a problem they need to solve in isolation.

"We really do need a collective push to come together and really help make sense of all of this," she said, underscoring that push has to involve industry, benefits providers, government, and people living with obesity.

Why BMI is not enough for obesity assessment

Both Schaffer and Patton pointed to BMI as a structural barrier keeping Canada’s systems locked in outdated obesity care thinking. That’s why the report calls for broader assessment tools, and Patton said the issue is not about discarding BMI but recognizing its limits.

"BMI is insufficient to appropriately assess and diagnose obesity, and we can’t rely too heavily on it for clinical decision-making," he said.

Both flagged the Edmonton Obesity Staging System - a Canadian-developed tool already used internationally - as a more meaningful alternative that captures how the disease affects an individual rather than reducing them to a number.

While Schaffer believes the slow pace of change comes down to decades of entrenched thinking across healthcare, funding, and policy systems, she does see encouraging signs that a rethink is underway. For example, she pointed to the Canadian Institutes of Health Research, which she said is signalling a need to better understand chronic disease and how conditions interact.

She also noted that Obesity Canada’s clinical practice guidelines have been adopted in eight other countries, and that some of those countries are outpacing Canada on implementation.

Obesity care sustainability over plan design

When it comes to integrating obesity care at the plan level, Schaffer urged employers to examine their chronic disease pathways and ask whether obesity is considered within them. She said benefit design should reflect the longitudinal nature of the disease and measure what matters - whether people are functionally healthy, able to work, and able to stay engaged - rather than anchoring coverage decisions to a single treatment.

While cost remains the dominant objection employers raise when asked to expand obesity coverage, Schaffer doesn’t see it as purely financial.

"I would say the largest thing we hear is it’s often about that sustainability. It would be easy to say cost, but I think it’s more about the sustainability of it than the actual cost itself," she said.

To that end, Patton challenged the logic of delaying coverage on cost grounds.

"We also have to balance that with not delaying care to the point where someone’s becoming sicker and getting to a point where they’re a more complicated medical case and it becomes more expensive and harder," he said, raising an example from Obesity Canada’s community: patients celebrate receiving a diabetes diagnosis because it finally unlocks access to the same GLP-1 medication they had been denied for obesity.

"It’s sad that we’re pushing people to that point," Patton added.

Looking to immediate next steps, both Patton and Schaffer offered complementary priorities. Patton said measurement is the most urgent gap, noting "we don’t actually know the full scale of the issue. We don’t know how many people have been formally diagnosed with obesity because we’re not measuring it," he said.

Treatment as prevention is the best starter

While Schaffer agreed measurement matters, she also emphasized that recognition - treating obesity as a chronic disease in policy and plan design - is the most transferable starting point for employers.

"Treatment is also prevention," she said. "Let’s start having the right conversations so that we can really see obesity for what it is so we can see people for who they are."

Ultimately, Schaffer argued employers have a significant opportunity to shift both the trajectory and the narrative around obesity care. She acknowledged that while the topic is uncomfortable for plan sponsors, she said treating obesity early carries enormous long-term value.

"Employers and plan sponsors don’t have to deliver clinical care, but their decisions and the ways these are designed can connect people to care or they can add just another barrier to it," she added. "The impact of that is going to be massive on the economy, the well-being of Canada, and the vibrancy of your own organizations."