As Canada prepares to celebrate the 100th anniversary of Dr. Frederick Banting’s insulin discovery, it feels fitting to reflect on how far we’ve come. Only a century ago, a diabetes diagnosis was a sure death sentence. “The average life span for a diabetes patient was about six months to two years from diagnosis,” says Grant Maltman, the Curator of Diabetes Canada’s Banting House National Historical Site of Canada in London, Ontario. “Then a simple twenty-five-word hypothesis that Dr. Banting came up with here in London led to the great insulin breakthrough.” That innovation has enabled diabetes patients worldwide to live long and healthy lives.

Though we have a lot to celebrate in diabetes treatment advancement, our work is not done yet ­— recent innovations still prove difficult to get into the hands of patients.

For example, many Canadians do not have access to anti-obesity medications (AOMs), which could be used to help patients manage obesity  and reduce the risk of later developing type 2 diabetes or other complications. Despite official recognition by the World Health Organization and Canadian Medical Association of obesity as a chronic disease requiring appropriate medication, AOMs are excluded from public health insurance plans and many private plans. If patients are fortunate enough to have a private plan that provides coverage of AOMs, they may still run into issues related to the level of coverage available,  because these medications are typically categorized as lifestyle drugs. As a result, less than one percent of Canadians suffering from obesity receive the proper treatment they need.

“Weight bias” preventing access to medication

According to the Canadian Obesity Network, a major barrier to medication access is the perception — or weight bias — among decision-makers that obesity is a lifestyle choice rather than a complex, progressive disease.

“There is a tendency for some individuals and the public to blame individuals with type 2 diabetes or obesity as simply lacking self-control, and therefore categorizing it as a lifestyle disease,” says Dr. Daniel J. Drucker, Senior Scientist at the Lunenfeld-Tanenbaum Research Institute of Mount Sinai Hospital in Toronto. “But we have a huge amount of scientific data showing that there are genetic determinants as well as metabolic changes that occur during the development of obesity that make it extremely difficult for individuals to manage the disease.”

Not managing obesity raises the risk of developing diabetes and other serious conditions. Excess body weight puts increased demand on the pancreas to produce insulin. When the pancreas is no longer able to meet that demand, glucose (sugar) builds up in the blood instead of being used for energy, resulting in type 2 diabetes. Diabetes complications include nerve damage, kidney failure, blindness, and even death.

Obesity also increases the risk of developing other diseases and comorbidities, such as non-alcoholic fatty liver disease (which can result in liver failure and transplantation), high blood pressure, sleep apnea, arthritis, cardiovascular disease, stroke, cancer, and depression.

Recognizing obesity as a disease, not a lifestyle choice

Many physicians, policymakers and insurers still regard obesity as a lifestyle choice rather than a serious medical condition, with few other diseases receiving as much negative stigma. In reality, obesity is a very complex disease involving a combination of genetics, behaviour, and socioeconomic factors.

Roughly six million Canadians are living with obesity. To improve patient access to obesity treatment and medication, health organizations — both in Canada and globally — are calling for a change in the way people perceive the illness. Without proper management of the obesity epidemic, Canada faces a ticking public health time bomb, warns Dr. Drucker. “Our health care system will end up paying the price, as well as the individuals with obesity, if it’s not properly treated.”