2023-09-02 03:43:34
Popular obesity drugs have been making headlines for months. Who should they be prescribed to? Should Quebec reimburse them? Isn’t there a risk of drift? While the debate rages, another reality is passed over in silence: many obese Quebecers are unable to obtain follow-up with a nutritionist and a kinesiologist. Experts are calling for an action plan on obesity to prevent and treat this chronic disease that has become a veritable epidemic.
In Quebec, one in four adults is obese. One in ten children. But the “majority” of them do not have access to a multidisciplinary clinic to change their lifestyle, report doctors consulted by The duty.
It is however the “basic treatment of all chronic diseases”, recalls the Dre Marie-Philippe Morin, specialist in bariatric surgery, who practices at the University Institute of Cardiology and Pneumology of Quebec (IUCPQ).
“Currently, to have access to lifestyle modification programs, you must be diabetic, have cardiovascular disease or chronic obstructive pulmonary disease,” she explains. If you don’t have that, you don’t fit into the program. »
Nothing can change that: even cirrhosis due to obesity. “You have a BMI of 60, osteoarthritis in the knee, you are unable to walk, to wipe yourself to go to the toilet and you are no longer able to work, you do not fit into the program! »
“It’s terrible to say, she concludes, but when the patient is diabetic, we are happy, because he will have services and access to care. »
And again, retorts the Dr Rémi Rabasa-Lhoret, director of professional advice for Diabetes Quebec. “Even with diabetes, it’s not easy,” notes the endocrinologist, who practices at the CHUM.
According to him, it is high time for Quebec to adopt a “clear prevention and management policy” for people suffering from obesity. This chronic disease is the source of problems such as type 2 diabetes, cardiovascular disease and cancer. “We are fighting over whether we should have access to Ozempic — more, less, for whom, when, how and so on — but at the same time, refer a patient to a nutritionist, to a kinesiologist and to a psychologist, if you don’t have private insurance, it’s very difficult,” laments the vice-president, clinics and clinical research at the Montreal Clinical Research Institute. Access to professionals is limited in the public network.
Few resources for children
Pediatric endocrinologist Mélanie Henderson, who practices at the Sainte-Justine University Hospital Center (CHU), has at her fingertips the multidisciplinary care programs for young people living with obesity. “Most regions don’t have one,” she laments.
There are long waiting lists for the Circuit program at the CHU Sainte-Justine, which has branches in Terrebonne and Rimouski. The eligibility criteria have been tightened. “Now we see young people with a minimum of two comorbidities associated with their obesity [ex. : diabète de type 2 et hypertension]because we couldn’t meet the demand when we just had a risk factor,” says Dr.re Henderson.
The specialist believes that the government must deploy more such programs, which include mental health resources. “These are young people who live with victimization, stigmatization, who often have a collapsed self-esteem, a body image…, we don’t talk about it, and who also have anxiety and depression rates higher than the pediatric population not living with obesity,” emphasizes Dr.re Henderon.
Despite a change in lifestyle, medication or bariatric surgery may prove necessary, underline the experts consulted. However, drugs aimed at losing weight are not covered by the Quebec drug insurance plan. Several private insurers have recently stopped reimbursing, to treat obesity, the drug Ozempic, authorized by Health Canada for type 2 diabetes.
Since then, many doctors have denounced the situation. They are calling for the Institut national d’excellence en santé et en services sociaux (INESSS) to be able to assess the relevance of these medications, which INESSS is unable to do, because weight loss medications are excluded from the Quebec prescription drug insurance plan.
A pilot project with INESSS
The case is evolving. In Quebec, the Ministry of Health and Social Services (MSSS) indicates that it has given a “support” mandate to INESSS for “the implementation of a pilot project on the targeted use of drugs for the treatment of obesity”.
A step in the right direction, according to the Dr Claude Garceau, internist at the IUCPQ. However, he believes that Quebec must recognize obesity as a chronic disease and pay for treatment to those who need it. The doctor admits that the government is faced with a dilemma. “It’s a mass issue,” he observes. If you have a rare disease, cystic fibrosis for example, we can give you a drug for $300,000 a year. There are not many patients. It’s not serious. But if you have 20% of the population that is obese, well, you can’t. I understand this is a big decision. »
When asked if it recognizes obesity as a chronic disease, the MSSS replies that it has “not officially taken a position” on this subject. “Although the majority of medical and scientific bodies recognize that obesity is a complex, progressive and relapsing chronic disease that requires long-term support, no provincial or territorial government in Canada has endorsed this recommendation,” we write. in an email.
In the eyes of the Dre Henderson, obesity is still a chronic disease, one that society has yet to take full measure of. “The pediatric obesity rate has tripled over the past 30 years. We have not yet seen the consequences in adulthood of this epidemic. »
When will there be a waistline campaign?
To see in video
1693878576
#Tackling #Obesity #Epidemic #duty