Beyond BMI: Defining Obesity with Ian Patton and the Weight Loss Drug Conversation

On this episode of "All Things Fitness and Wellness," host Krissy Vann is joined by Ian Patton, who shares his personal and profound journey with obesity. Marking World Obesity Day on March 4th, this episode dives into the complexities and challenges of living with obesity, a condition affecting approximately 27% of Canadian adults according to 2018 Statistics Canada figures.

Ian Patton, Director of Advocacy and Public Engagement for Obesity Canada, opens up about his life-threatening struggle with obesity and his path to better health. Despite the prevalence of obesity, misconceptions abound, and the healthcare system's advice often falls short of evidence-based solutions. Patton's experience highlights the frustration many feel when conventional wisdom—like the advice to simply "eat more salad and go for more walks"—proves inadequate.

Diving deeper, we explore the definition of obesity as a chronic disease, challenging the traditional reliance on Body Mass Index (BMI) as a measure. 

The episode also features a comprehensive discussion on the role of GLP-1 Agonists Semiglutides, like Ozempic and Wegovy, in treating obesity. Through Patton's insights and expert commentary, we uncover the myths, misconceptions, and the cutting-edge treatments transforming the fight against obesity.

Patton shares his perspective on programs by fitness professionals that incorporate GLP-1 Agonists, cautioning about their potential effectiveness and the importance of informed implementation.

Join us on "Exercise Snacks: Bite-Size Science" as we navigate the complex landscape of obesity, offering hope, understanding, and the latest scientific advancements. Whether you're living with obesity, know someone who is, or simply interested in wellness, this episode is a must-listen, shedding light on a topic that touches many lives.

Connect with Obesity Canada:
https://obesitycanada.ca 

Connect with All Things Fitness and Wellness:
www.atfw.ca
https://www.instagram.com/allthingsfitnessandwellness/ 

#fitnesspodcast #worldobesityday #obesity #ozempicweightloss #weightloss

Transcript

0:00

It's not just about eat less, move more, that's not going to solve this problem. We can tell people to be active and exercise and eat healthy and I preach all those things myself, but there is a lot more going on. It's time for Exercise Snacks Bite Size Science brought to you by Alln1 super blend. It's super food for superhumans visit alln1superblend.com. We also have a giveaway going on for you to enter your very own super blend starter kit. And you can head to ATFW dot CA to enter world obesity Day is on March 4. And on today's episode, we welcome Ian Patton who is the Director of Advocacy and public engagement at obesity Canada, and also a certified exercise physiologist and registered Kinesiologist. Now in this episode, we're going to talk about what is the clear definition of obesity. As we know it often gets muddied in conversations online. Why access to evidence based treatments is important accessibility and the use of GLP one agonists like ozempic, and with govi, and the integration of obesity management programs and fitness facilities. Before we get to it, be sure to hit like and subscribe. We have new podcast episodes weekly featuring industry thought leaders and influencers. I'm your host, Krissy Vann and this is at FW. At the time of recording world, obesity day is approaching. And I think we've seen a lot of elevated discussion around the subject matter, particularly because we're now living in a time and we're going to be getting to them but GLP one agonists have been a huge part of the conversation. So those are your Zabbix will go V's where we know they were initially created to address type two diabetes, and one of the side effects was weight loss, which obviously can have a momentous impact on the obesity crisis. But before we even dive in, because there's a lot of people in the arena, sometimes the definitions themselves get lost in the mix. So first of all, what is obesity? Now? That's a it's a great question, I think, and it's something that we haven't quite got the message out, effectively to the to the wider population right now. So you know, a lot of people think obesity is simply just a BMI, your BMI classification on a scale. And, you know, historically, that's what we've used as, as an easy go to assessment of obesity, but it's not really accurate. And we know that there's lots of issues with BMI and limitations with you know, it's a measure of size and weight, essentially, it has nothing to do with all the factors that go into someone's weight status, or their, you know, their health and well being and their value and those sorts of things. So it's just not sufficient so that when 2020, there is new clinical practice guidelines published here in Canada. And the definition that we use is that obesity is a complex chronic disease where excess or abnormal adipose tissue impairs health. And so that impairs health pieces is a really important part of that definition, because it does recognize that there are people who, you know, might have a higher BMI might have a higher weight, and they do not have obesity, just because they have a higher weight, there's more to the equation there. So when it comes to being recognized as a chronic disease, I know that is something in itself. That's a big conversation and not just among the public within our healthcare system. I think anybody that's gone online, has seen or heard anecdotes of individuals, not necessarily getting proper care. Sometimes the language that's used with them in those settings can be quite derogatory at times. So talk to me about a little bit of that landscape and the importance of having it recognized as a chronic disease. Yeah, it's it really is an important piece of the puzzle here in terms of getting people the care that they need, and recognizing that this is a very complex issue. There's, you know, so who the World Health Organization is recognized obesity as a chronic disease for a long time, I think it was 2015 when the Canadian Medical Association recognized it as a chronic disease. There's many of the provincial medical associations have already made those recognitions. But the government's themselves and the actual health system that we're operating in, does not currently recognize obesity as a chronic disease. So, you know, that means that people are not necessarily getting the treatment that they deserve or the the, that they need in order to manage this issue. So, you know, that means as far as like education Even for health professionals and what they're learning in their training, the, you know, you can get down into things like even the billing codes and how they the time that they're spending with people trying to manage this issue, they can't, you know, properly bill for it so that, you know, that's a limiting factor. There's, there's lots of pieces to this puzzle. So the recognition of obesity as a chronic disease is really a starting point, as you know, for getting people what they need and treating this properly. We're going to talk to some of those treatments in a moment. But why would it be important for somebody to seek treatment because I know that you were saying there, just because somebody necessarily has excess weight doesn't necessarily define as obesity. But as we understand it, there certainly are preventable complications that one can experience if they are living life with obesity. Yeah, we know that obesity is related to a number of comorbid conditions, you know, you can go down the list, it's, you know, diabetes, and hypertension, sleep apnea, and, you know, liver disorders, and even cancer and certain types of cancer. So like, there's lots of things that it's related to So treating and managing obesity as it could be prevention or considered prevention of other chronic diseases. So it is important to address it early. Now, that doesn't necessarily mean that everyone with a higher weight needs to have a an aggressive treatment, like I've had myself, you know, I've gone through bariatric surgery, and I've taken medications and those sorts of things, and not everyone, that's not the right choice for everyone. So it doesn't necessarily mean that everyone with a high BMI needs to have treatment. But, you know, In instances like myself, where I was very, very sick, and you know, I probably wouldn't be here right now, talking with you if I hadn't seeked out that treatment. So for people like myself, it is extremely important to address it early on before the disease progresses, before you have other complications. And you know, you can live a happier, healthier life, as you're speaking there. And I'm not sure when you went through this journey. But we know that options weren't as ample as they are currently. So bariatric surgery was probably one of the leading outlets for people to go. But now we have seen this evolution of GLP one agonists. So first of all, I kind of touched on where their origin story began, but maybe explain a little bit about what those are. I know most of you that are listening to the podcast, at this point, are well familiar with these because I mean, it's not just made headlines within the fitness industry, it's made headlines as Oprah now has gone public and her usage, and we've seen many other celebrity endorsements as well. But that cover of People magazine certainly elevated the talk around it. Yeah, there's a lot of attention. And I kind of have mixed feelings about it. Because the attention initially, I think, was very positive, I think it was opening up the door to a lot of really good conversations about taking obesity a little bit more seriously. And recognizing that it is more than, you know, someone's weight, it's it, it's going to take more than eat less move more, which hasn't worked and will not work because it's an oversimplification of a very complex problem. So these, you know, the advent of these newer generation of medications is really opened up a lot of really positive conversations around that. But, you know, if we're looking at the treatments that are available, the clinical practice guidelines that I mentioned earlier, they they highlight three pillars to obesity management. And so that would be the cognitive behavioral therapy, the bariatric surgery, and then the pharmacotherapy. Those are the three pillars. And within those pillars, you know, like, if we're talking about the bariatric surgery pillar, there's different surgeries that are available within that pillar. Now, all those pillars support the behavioral, like the diet and exercise and allow individuals to be more successful in those attempts. So it's not suggesting that, you know, eating healthy and exercise are not important parts of chronic disease management. They are the treatments that we're talking about the GOP ones, the bariatric surgery, the cognitive behavioral therapy, they all help an individual be much, much more successful in maintaining those healthy behaviors that we want. I am curious to know because I have mixed feelings as well over GLP one, what are some of those reservations or feelings that are coming up for you? I don't have I don't have reservations about GLP ones as a treatment they are proven to be extremely effective and they are a very, very good tool to have in our toolbox. They're not going to be the right choice for everyone. Like I said, everyone's going to be a bit different but for the people that they are effective for they are life altering. And so I don't have any resin ration is about that the reservations I have about that conversations, the things that are coming out the media attention and the Miss categories, you know, misunderstanding of how these medications work and how they should be utilized. There's a lot of attention that came from, you know, particularly in down in the states where, you know, there's influencers and all these sorts of things going on on social media and people taking the medication, maybe for the wrong reasons, more of a cosmetic reason rather than a chronic disease management. And that's the stuff that's actually creating problems for people like myself, who are advocating for people who need to have these medications for medical condition for actual chronic disease management. And it makes it more challenging to have those positive conversations when there's so much noise going on out there. I hear you completely I have gone down the rabbit hole and seen a lot of those influencer videos. And as much as I think, as a culture conversations around body positivity. I mean, I grew up in the 90s. So diet culture was shoved down your throat excessively. And, unfortunately, we've come so far, but not come so far, because I do see in a lot of those avenues, exactly what you're saying. It's not necessarily being used or promoted in the right way. And unfortunately, we're in a situation where pharmaceutical companies do have, quote, unquote, the magic pill they've been looking for. And I want to make it very clear as well. One, that's not something anyone should enter into without consulting with a healthcare team with a physician, because I know there, there's a whole nother rabbit hole of black market, and so on and so forth. I know it's terrifying, especially when it's something even if you're getting it through the right means there can be some very real complications, obviously, on a case by case situation with somebody with obesity, it's weighing out what those potential complications are, versus the risk versus reward versus the health implications of continuing on that same path. But when you talk about some of the issues there, I know one of them has been shortages and access to medication and having it covered by insurance. I believe it was the province of Ontario recently, at the beginning of this year that made the announcement that they no longer would be supporting it for obesity, it was type two only. So what are some of the issues that come up with these shortages and these types of policies that are coming out, especially for what you're advocating for? Yeah, it is a it's a messy space right now, I have to say that. So I guess, when it comes to the shortages, I guess we should say it out front, the shortages are mostly resolved right now. So you know, Health Canada, we've been working with Health Canada and the manufacturers and stuff like that. So there's information that should be coming out shortly, the shortages that we've talked about for particularly ozempic are mostly resolved and should not be an issue going forward. And then to add to that, you know, we go V, which has been approved in Canada for obesity management for more than two years now, but we haven't actually had any supply in Canada ever. It's never it's all the shipments, I guess, went to the States or something like that. So we weren't getting any of it. That's why there were so many people using ozempic, it is the same medication, it's the same active molecule semaglutide in both those medications from the same manufacturer. But we didn't have access to we go V even though it was approved for quite a long time. Now. We go v will be in Canada, probably a little bit later this spring. So we will have supply of what GAVI the shortages of ozempic should be mostly resolved. So this shouldn't be too much of an issue going forward. Now, I think we're kind of in a space now where that's hopefully better. But for a lot of these policies that you've been hearing that question about, like Ontario, removing coverage for people taking ozempic for weight management or obesity management, you know that that's hard. I get a lot of people reaching out to me from our community that have been on the medication for quite some time. They've been very successful on it. And now they're stranded, they have no idea what they're going to do. And there's no clear indication right now, whether we go V the obesity version of semaglutide will be covered the same way that they had their ozempic covered. But I guess, you know, the government was essentially making this statement that during the shortages, medication should be used for what's on the label. So, you know, technically speaking, ozempic is a diabetes medication. Even though it's the same medication, it's the same active molecule. That's kind of what they were cutting down onto, so it makes it a bit challenging. There's a lot of people that are struggling right now without the treatment that's been very, very effective for them for a long time, when it comes to advocacy work, how is obesity Canada then involved to help ensure that it's accessed for all that need? It? It's, it's not an easy, it's not an easy question to answer there, I think, you know, we do a lot of work, sometimes that work is like on an individual basis. So I'll help people that have, you know, they're they're going to their private insurer, and they're trying to do, you know, their private insurance doesn't cover obesity treatments. And so they're doing an appeal or whatever, to try and get an exception made. And so sometimes I support people, you know, providing evidence and those sorts of things with that. Sometimes it's a larger thing where we're talking with, you know, policymakers about how they can change that sometimes we're talking and working with the insurers themselves, and trying to get them to change their policy. So right now, a lot of the private insurers, for example, would have obesity medications classified under a lifestyle box. So it's, it's if you're an employer, and you're buying insurance for your employees, that is generally not going to be something that's included in the standardized formulary, it's something that would have to be added on. So the employer would have to add that into their insurance policy. And so, you know, trying to get those insurance companies to recognize that obesity management isn't the same as you know, those other things that fall into that lifestyle category. And as should be considered a chronic disease medication, just like diabetes medication. So there's lots of people who have, you know, ozempic, covered under their plan for diabetes, but don't have what govi covered or any obesity management treatments. So it's, there's a bit of bias there. weight bias and stigma about whether we should be treating it as a chronic disease or whether it is a chronic disease. And I'm sure when we talk about the chronic diseases that it can cause like type two diabetes, certain cancers, heart disease, the cost of those I mean, I just know from the fitness industry side in regards to our inactivity crisis, what those costs in health care. I mean, I feel like the obvious answer ensures this would most likely save if they actually put this under the umbrella, and then we're treating it as a chronic disease, because it's subsequently going to cause less chronic disease and illness. But that's probably the obvious answer between you and I. And for some reason, when it goes up the chain into creating these policies and these rules, it's never that black and white. And I can see some of the insurers hesitations when we speak to what we discussed earlier that there are many people that are using these medications for I mean, I'll flat out say it because I've seen it, you know, people that are like I want to lose the 15 pounds for the wedding and kind of just want to fast track because it is something that it's going to work. But the evaluation over. This is where I get messed up over it because I'm like choosing to do that. I mean, you're using it as a resort because you need help if you're dealing with a chronic issue like obesity, but otherwise, I don't understand why you would subject your body to injecting yourself with a medication unnecessarily. But that's just my personal two cents that I do find quite frustrating. And on that notion, I know. Well, a separate notion, you may have seen Equinox lifetime gyms in the States, we saw Noom and weightwatchers, being able to kind of subscribe through their platforms, equinox and lifetime gyms, they are basically creating programs where it would be prescribed and helping people through that journey. And you kind of mentioned earlier that any of these interventions are happening in tandem to exercise and healthy eating. So talk to me a little bit about your thoughts on programs being built. I mean, for ourselves, personally, I'm speaking from the fitness professionals side, and things that they may want to be aware of if they are entering that space. Oh, that's a good question. I think I come at this from two kind of angles. So there's part of me that is recognizing that we are in a period of incredible evolution in the obesity space and our understanding of it. And the way we can go about treating and managing it is quickly outpacing the ability to kind of fit that knowledge into the existing health system that we operate in, especially here in Canada, things might be a bit different down in the States with how they do things. But here in Canada, you know, change doesn't happen fast. And so it is a long slow change that's going on here. So having these spaces come out that you know could potentially if done, well could Increase access. You know, I mentioned earlier that there's lots of people you know, who don't have access to treatment, they don't have access to a physician or health care professional that has any sort of real training in obesity management or obesity at all. And so if we can, you know, through some of these programs are whether it's, you know, virtual care, and those sorts of things, increase access to evidence based obesity management, that's fantastic. My hesitation with it would be in those situations where, you know, people are just getting prescribed something, they don't actually speak to a health care professional or doctor, they fill out a questionnaire online, answer a couple questions, and then there's no follow up like this is a chronic disease. And we're talking about chronic disease management. So it should be treated just the same way as you have someone with diabetes, you should be following up with your doctor. And they should be tracking you closely and making sure that everything's working out well. And I don't know whether these programs that you mentioned, whether they're going to have that capacity or ability to closely monitor things and I think that's going to be where there's going to be some issues. As somebody that's walked in these shoes and gone through a major life transition during the bariatric surgery. What are some of the biggest misconceptions about obesity, that irk you to this day may be rhetorics that continue to be said over and over again, that you really hope people have their their ears attune and are able to absorb and perhaps change their lens or perception. So again, I come at this from a really from from two kinds of angles. Yes, I'm someone who I'm a patient advocate, I've had bariatric surgery, I've utilized all the pillars of obesity management that I talked about. So I talk freely about my experience there. And I'm very proud of being able to have that opportunity to change my life. So those things are all great. But I'm also a kinesiologist. By training, I was an exercise physiologist. And I have a PhD in kinesiology, I've taught nutrition at, you know, post secondary education in college and stuff like that. So like, I have an in depth knowledge of exercise activity and those sorts of things. So my biggest pet peeve, my biggest thing that I want people to understand is that it's not just about eat less, move more, that's not going to solve this problem. We can have, you know, we can tell people to be active and exercise and eat healthy, and I preach all those things myself, but there is a lot more going on. People believe that it's Oh, it's so simple. You know, I did this, I lost, you know, X number of pounds, you know, doing certain diet, there's no one diet, that's going to be right for everyone. And there's, like I said, there's just lots that go on obesity is a chronic disease that is largely controlled by the brain and largely controlled by things that are not necessarily in an individual's kind of conscious control. It's not something that we have a great deal of control over there are certain aspects of it that we have control over. And we can work on those things. And those are fantastic. But there's pieces to it that are very, very complicated. No, fair enough. And I think that I almost want to peel that back just a little hair further. Because I do think that is where the disconnect and misunderstanding is for a lot of people. So what are some of more of those complexities as you start to unfold? I guess, a way I can try and explain it is for me personally, like I said, I've got a very in depth background, I know more than most of the population about these sorts of things. And I know what I should be doing to live a healthy life and I know all that stuff. So you know, and I wouldn't even say it was an issue that I had a lack of willpower or anything like that. But for me, prior to treatment, food my relationship was with food was really different than what it was with any of my peers. So I had almost this ravenous kind of drive for food. It was it was something that was uncontrollable. I could It was exhausting. It was I'd wake up in the morning and it was the first thing on my mind food, food, food, food, what I was going to eat and that drive to eat food was always there. And it was distracting and it consumed my life. It was very, very difficult to do anything. Once I received my treatment, that food brain that I call it was silenced and I had it gave me control. So now I feel under treatment that I have control over food, the way that my peers that we're dealing with this issue. So it's given me a sense of normalcy, which I've Never heard, which is an you know, it's unreal, unbelievable and life altering. So I think well, the empowerment that would give you especially because, really, I mean, it's I have people in my life that I'm very close with that have suffered with addiction. And it sounds so similar when you're saying that the minute that you get up and those cravings, and it's just that never enough, and I don't want to bridge the two, but I do say it's also something that has heavy stigma, because people always say to them, Well, why don't you just stop? And you're like, it's not that simple. And I think that's where Curiosity and asking the questions, and I appreciate you for coming on this platform and taking the time to answer them. Because that is how we have greater understanding, we are in a society where, you know, somebody posts one thing, and everybody wants to have their two cents in a comments thread. But what's resulting there is quite damaging. Whereas if we had a better understanding of our fellow humans that we're sharing the world with, and now we have these solutions that aren't quite, I don't want to say exciting when I'm talking about a medication, but I know they can be quite life changing for a lot of individuals. But there's strides to make in regards to accessibility, and again, reducing that stigma because I think there has definitely been a lot of strides taken, but there's still a lot of work to do. So on this world obesity day, what's a final message that you'd like to leave us with here? I think you've said it earlier. You know, we got to be a little bit better to each other as humans. So the the stigma pieces is really important trying to understand people, you know, don't judge a book by its cover. You know, if you see someone you can make a judgment of whether they're healthy, or whether they're good people or you know, those sorts of things, you don't know the path that they've gone down. So have a little, little bit of grace and sympathy for people or understanding, empathy. And yeah, ask questions. Talk about it openly and be kind. Yeah, be kind. That's the big one. Well, Ian, I thank you so much for your time today. I really appreciate you sharing with me. Yeah, no problem. Thanks for having me. You've just listened to the All Things fitness and wellness podcast posted by Krissy Vann This episode was brought to you by fitness world your fitness your way. Be sure to hit like and subscribe. We have new podcast episodes weekly featuring industry insiders and influencers together we're on a mission for everyone to live a life fit and well