The core Issue

The controversy stems from Quebec’s official response to a petition presented to the National Assembly in December by Liberal deputy Enrico Ciccone. The petition, bearing nearly 1,900 signatures, urged the province to acknowledge obesity as a “chronic disease” and to “make medication accessible to better control this disease.” The petition highlighted the growing concern among citizens regarding the management and treatment of obesity within the province.

In a letter dated February 13, Minister of Health Christian Dubé addressed the petition, stating that “even tho obesity is recognized as a chronic disease by the World health Institution (WHO) and certain Canadian organizations, it is indeed not officially recognized in this very way by the federal government or by the provinces and territories of Canada.” He further noted that no province or territory currently covers drugs for treating obesity, highlighting a nationwide trend of limited coverage for obesity-related medications.

Dubé added, “Whether obesity is considered a disease, as a meaningful risk factor for several diseases or both, the Ministry of health and Social Services (MSSS) deploys numerous interventions, both in terms of the institution of care for people living with an excess weight in prevention.” This statement suggests that while the province may not officially recognize obesity as a disease, it is indeed actively involved in addressing the issue through various health and social service programs.

Specialists Voice Concerns

The minister’s response has been met with dismay by obesity specialists in Quebec. Among them is Jean-Pierre Després, a member of the expert group convened by the British journal The Lancet diabetes & Endocrinology, which recently defined “clinical obesity” as a disease. This definition emphasizes the presence of specific health complications directly linked to obesity.

Després, a researcher at the University Institute of Cardiology and Pneumology in Quebec (IUCPQ) – Laval University, expressed skepticism about the province’s prevention efforts. If we wanted to be serious in prevention, we would do other things than relationships, he stated. This suggests a belief that current prevention strategies are inadequate and lack the necessary resources or focus.

The prevention policy in Quebec is exemplary: it’s just that it is indeed not applied.

Jean-Pierre‍ Després, researcher at‌ IUCPQ-Laval University

D^re Marie-philippe Morin, another obesity specialist at IUCPQ, questioned the nature and extent of Quebec’s “interventions” in care and prevention. Even in our clinics,we have almost no funding, she said. Multidisciplinary teams [formées de kinésiologues, nutritionnistes, etc.] are very poor. We are not able to have access to our patients. This highlights the challenges faced by healthcare professionals in providing comprehensive care to patients struggling with obesity due to limited resources and funding.

D^re Julie St-Pierre, a pediatrician and obesity specialist, described the Quebec government’s stance as “very disturbing,” lamenting that it “does not listen to science” and “the expertise of here.” this criticism suggests a disconnect between government policy and the scientific understanding of obesity as a complex medical condition.

I find it worrying to see that we do not value the patient’s health, commented the founder of the 180 approach, an interdisciplinary program focused on obesity prevention and management. We choose not to do it as we want to save money,we have cuts to make. This statement implies that financial considerations are prioritized over patient health, leading to inadequate support for obesity prevention and management programs.

The Financial Implications

A key concern for the government is the potential cost of reimbursing drugs for obesity,such as semaglutide,marketed as Ozempic and Wegovy. thes medications have shown promise in promoting weight loss but come with a significant price tag, raising concerns about the financial sustainability of widespread coverage.

We are afraid of current costs if we cover obesity, but there will be positive benefits for later. If we don’t do anything now, there will be huge costs in the future.

The D^re marie-Philippe ⁤Morin,specialist in IUCPQ obesity-Laval‌ University

enrico Ciccone clarified that his party is not advocating for universal coverage of obesity drugs but rather for targeted access for individuals “who need it,” such as patients requiring weight loss before surgery who have not succeeded through other methods. This suggests a more nuanced approach to medication coverage, focusing on specific patient populations who would benefit most from pharmacological interventions.

Even if we are 11 billion in the hole at the moment, that must be seen as an investment, Ciccone argued. It will bring us later. This statement emphasizes the long-term benefits of investing in obesity treatment, arguing that it can lead to reduced healthcare costs and improved health outcomes in the future.

A Glimmer of Hope?

despite describing the official response as “retrograde,” D^r Yves Robitaille, an obesity specialist, sees a potential opening.He noted that Christian Dubé’s letter indicates that the National Institute of excellence in Health and social Services (INESS) remains “on the lookout for new clinical data on profits” of pharmacotherapy, “particularly” regarding “the betterment of overall health going beyond simple weight loss.” This suggests that the government might potentially be open to reconsidering its stance if presented with compelling evidence of the benefits of medication beyond just weight reduction.

Dubé stated, If such benefits, supported by convincing data, were presented at the Inesss, it coudl manifest the opening for the evaluation for circumscribed therapeutic indications, which could open the way to coverage under medication insurance. This statement provides a potential pathway for future medication coverage,contingent on the presentation of strong evidence supporting the broader health benefits of obesity drugs.

INESS submitted a report in September concerning a possible pilot project on the use of drugs for obesity treatment. The MSSS stated it is “determining the best orientations” to follow up on the report, which aimed at “establishing the beacons that a possible pilot project would take” if it “came to be launched.” This indicates that the government is considering a pilot project to evaluate the feasibility and effectiveness of using drugs for obesity treatment, which could possibly lead to broader coverage in the future.

The Evolving Definition of Obesity

The expert group assembled by The Lancet Diabetes & Endocrinology distinguishes between clinical obesity, which is considered a chronic disease, and preclinical obesity, which is not. The criteria for diagnosing clinical obesity include the presence of dysfunction directly linked to obesity, such as heart failure, fatty liver disease, sleep apnea, hypertension, or chronic urinary incontinence in adults. This distinction highlights the importance of considering the presence of specific health complications when assessing the severity of obesity and determining appropriate treatment strategies.