Experts on top New Year's resolution: Diet and exercise alone won't address obesity

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Most common New Year’s resolutions:

“I will lose weight.”

“I will go on a diet.”

“I will get in shape.”

“I will be a size X instead of a size XX.”

That’s half the resolutions lobbed into the ether with the singing of Auld Lang Syne at midnight, according to a November 2024 survey from American company Statista Consumer Insight. It suggests people place health and weight above saving money, quitting smoking, and spending more time with family and friends.

‘The mother of all chronic diseases’

The numbers are sobering: one in three Albertans grapples with obesity, but help should be on the way from the medical community, according to an eye-opening new report from Obesity Canada.

Modeling the Cost of Inaction in Treating Obesity in Canada found the country can’t afford to ignore new science and treatment regarding one of Canada’s biggest health problems.

“We now realize what the cost is to the system for not treating (obesity) — almost $6 billion because of the complications arising from obesity,” said Surrey, B.C., endocrinologist Dr. Akshay Jain, who calls obesity “the mother of all chronic diseases.”

Adding in the costs to the economy for lost work and lost quality of life, and you have a $21 billion problem, according to the report commissioned by Obesity Canada and funded by Eli Lilly Canada, which combined data from national surveys and published literature to estimate the current economic burden of obesity.

Governments conflate cost with value, Jain said.

Obesity Canada outlines three pillars of obesity management: behavioural modification (psychological), pharmacotherapy (medications), and bariatric surgery.

Then add nutritional modification and physical exercise.

The cost of medications on the health-care system is dwarfed by the downstream value these management strategies hold, Jain said.

“Our own Canadian Medical Association recognizes obesity as a chronic disease, but we aren’t implementing the ability for doctors to even really give the right care and treatment, even when they know about the right care and treatment as well because these billing codes don’t exist.”

‘My brain was broken open’

When standing at the supermarket checkout, Lisa Schaffer has been known to turn magazine covers backwards — a little act of guerilla rebellion against the bombardment of society’s messages about physical beauty.

The Edmonton-born executive director for Obesity Canada has a lifelong understanding of obesity, seen in her family for generations.

“I knew I was always going to kind of be a bigger person. But then you move into teenage years, you really start feeling that difference of being the other person and that biggest person in the room,” Schaffer said.

Successful in school, in sales, and even in exercise (running 5 km and 10 km races), Schaffer was frustrated. Why couldn’t she figure this one part of her life out?

A decade ago, Schaffer got on the list for bariatric surgery, which went well.

Others in her cohort kept losing weight. She stopped.

“I really broke my own heart. I was in a really dark place, like I messed even this up,” Schaffer recalled.

Then she heard a speech from Dr. Arya Sharma, then scientific director of Obesity Canada and now ex-emeritus at the University of Alberta.

“I feel like my brain was broken open that night, and I understood all of the impacts that come into living with obesity, and it really is so much more complex than what we’ve been told by diet culture,” Schaffer said.

“It’s about genetics. It’s about the environment my mom grew up in, my dad grew up in. It’s about these deep neural pathways that I was never going to be able to access by only working out in this really disproportionate way or tracking every almond I ever put in my body.”

Where will Alberta be on the scale?

Obesity Canada is waiting to see where obesity treatment will fit in with Alberta’s health authority restructuring in the wake of the dismantling of Alberta Health Services into “four pillars:” primary care, acute care, long-term care, and addiction and mental health.

The organization has meetings scheduled with Alberta Health Minister Adriana LaGrange in January.

The province’s pharmacists’ greater scope of authority than in other jurisdictions could help relieve the strain obesity places on the primary-care system, Schaffer said.

“If we treat obesity first, we actually have the potential to remove a lot of conversations about 200 other diseases because we’ll get ahead of the diabetes, the hypertension, liver disease, the cardiac issues — which we’re all happy to fund and pay for, all of those treatments and surgeries,” Schaffer said, revisiting a common adage in an age of misinformation.

Stigma and shame

If a doctor wags a finger and says, “Eat less! Move more!” Schaffer said an empowered patient who understands their rights and treatment options can come back with confidence to say, “Well, actually there are three pillars of care for obesity, and those are pharmacological interventions, psychological interventions, or surgical interventions, and once I navigate one or more of those things, then diet and exercise are going to pay off.”

Bottom line? Diet and exercise are not a treatment plan for a chronic disease, Schaffer said.

“Weight is not a behaviour; it’s an outcome. You’re never really going to be able to control (it) the way that you think you can, so move to things that you can control and focus on empowering yourself to have the right conversations. Empower yourself to be courageous enough to not indulge in that diet culture conversation and talk about what you packed for lunch that day or how many calories you ate over Christmas,” she said.

“Be kind to yourself and understand that this is a lot more complicated than probably what you’ve been told for many years, that you deserve to have the right conversations with health-care practitioners to help you understand what might work for you.”

But there’s no silver bullet, she said.

“The bias that we put on people probably does almost more damage than even what their physical health is doing to them because it’s so hard to navigate life when you when you can’t stand yourself, and when you get messaging from everywhere around you that you don’t belong.”

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