Battling Canada's obesity epidemic
Statistics show that almost 60% of Canadians are overweight or obese. In Alberta, a growing number of researchers are studying the complex problem from several angles.
Story by Connie Bryson/Illustrations by Davey Thompson
"I haven't gained weight. Your eyes are fat."
It is the kind of snappy rejoinder many of us would love to have at the ready. Sadly, every year, there are more of us who feel self-conscious about our weight. According to Statistics Canada, the percentage of Canadians who are overweight or obese has risen dramatically in recent years, mirroring a worldwide phenomenon. The 2004 Canadian Community Health Survey found that 23% of Canadians aged 18 or older (an estimated 5.5 million adults) had a body mass index (BMI) of 30 or more, indicating that they were obese. This was up from 14% in 1978–1979. Another 8.6 million, or 36%, were overweight. Yikes! That means the majority of Canadians are overweight or obese.
Albertans are overweight too—our average BMI is the third highest among provinces in the country. An estimated 100,000 Albertans are severely obese (a BMI of 35 or more). Edmonton's Weight Wise Adult Weight Management Clinic is one of the largest tertiary-care obesity programs in the country.
Although Albertans may be part of the problem, they are also part of the solution. Over the past 10 years, more researchers in Alberta have focused their work on obesity. The research is highly collaborative and cuts across several disciplines including medicine, nursing, nutrition, social sciences, engineering, and law. "In Alberta, we're starting to have a critical mass of people with an interest in studying obesity. This generates more funding, which in turn attracts more people with expertise in this important area of research," says obesity expert Dr. Arya Sharma, who joined the University of Alberta in 2007 and holds the Chair in Obesity Research and Management.
Dr. Sharma notes that a multidisciplinary approach to obesity is vital. "One thing we know for sure is that the answer to obesity is far more complex than simply telling people to eat less and move more. It's much more complex in terms of the biological, societal, and mental health factors that drive obesity. We're up against root causes that are very much related to evolutionary biology and the environment we've created—not just food but things like escalators, elevators, and remote garage door openers, everything we've done to eliminate physical activity from our lives.
"I believe there is no health problem more important than obesity. Just about every chronic disease you can think of is linked to obesity. If you are dealing with an obesity-related chronic disease and you're not treating obesity, you are really just doing palliative care. That, unfortunately, is true for most of our chronic diseases like hypertension, diabetes, hip and joint problems; the list goes on. We've got to get to the root of the problem."
Dr. Sharma's own research is based on his clinical work as medical director of the Alberta Health Services Weight Wise Program. "In the clinic, we see people with high BMIs who are surprisingly healthy and people with low BMIs who are not healthy at all. It made us think that we need a classification system that goes beyond just saying how big people are and should really tell us how sick they are."
The Edmonton Obesity Staging System has five stages of obesity, from stages 0 to 4. At stage 0, patients have no symptoms of obesity-related health problems. At stage 4, patients have severe obesity-related health problems. The system is simple for doctors to use—they can easily classify their patients through taking their patients' medical history, conducting physical exams, and taking routine tests like blood sugar and cholesterol levels. The system also provides doctors with specific treatment approaches for each stage.
The classification system is part of a broader effort by Dr. Sharma to change the way physicians treat obesity. "Obesity is a very complex condition," he says. "As physicians, we need to be able to understand the determinants of obesity for individual patients. For example, if a patient's weight problem is related to a mobility issue because of back injury, the approach to treatment is going to be very different from a patient who has a history of sexual abuse and uses food as a coping strategy. It's not the same thing, even though they both may have the same body weight."
Dr. Sharma and his team are testing a new way of assessing patients at the Weight Wise Clinic in Edmonton. The ultimate goal is to develop tools that would work for general practitioners.