Canada's healthcare system is facing a severe sustainability crisis, driven in part by the enormous costs of treating obesity-related complications while restricting access to effective solutions. According to Dr. Ronald Eliosoff, a former assistant professor of medicine at McGill University, the nation must act decisively: We can treat obesity effectively now or watch our system crumble under unsustainable costs.
The High Cost of Inaction
The COVID-19 pandemic starkly illustrated the deadly consequences of unaddressed obesity. Data shows that countries where more than half the population was overweight had COVID-19 death rates nearly ten times higher than nations with lower obesity rates. In the United States, roughly 30% of 900,000 COVID-19 hospitalizations were directly linked to obesity.
This public health emergency highlighted a truth clinicians witness daily: obesity significantly worsens outcomes for a host of serious conditions. It is a direct cause of type 2 diabetes, non-alcoholic fatty liver disease, severe sleep apnea, and osteoarthritis. It also accelerates cardiovascular disease, leading to higher rates of heart attacks, strokes, and heart failure. Furthermore, obesity increases mortality from infections like pneumonia and influenza, raises surgical complication risks, and prolongs hospital stays, turning manageable illnesses into complex, expensive medical challenges.
Effective Treatments Are Being Withheld
Dr. Eliosoff emphasizes that obesity is not a moral failing but rather a biological response. It's what happens when humans evolved for scarcity encounter permanent abundance, he notes. Traditional approaches, like medically supervised weight loss programs, have shown limited long-term success. Major studies, including the U.S. Diabetes Prevention Program and the Look AHEAD trial, demonstrated initial weight loss that largely regressed over a decade.
This cycle of loss and regain contributes to a staggering economic burden. In Canada, the cost of failing to treat obesity effectively reached $27.6 billion in 2023. Diabetes alone consumes $4.7 billion annually in direct healthcare costs.
Meanwhile, two powerful treatment options face significant barriers:
- Bariatric Surgery: Although technically covered by provincial health plans, access is severely restricted by multi-year wait times and strict eligibility criteria. Surgery is typically limited to those with a Body Mass Index (BMI) over 40, despite international guidelines recommending it for patients with a BMI of 35, or 30 with co-existing metabolic disease like diabetes.
- Weight-Loss Medications: New drugs like semaglutide (Ozempic, Wegovy) and tirzepatide (Mounjaro, Zepbound) enable 15 to 23% sustained weight loss and also improve diabetes, high blood pressure, and heart disease. However, they remain largely unfunded by public and private insurance plans.
Proven Benefits and Cost Savings
The clinical benefits of these treatments are profound. Bariatric surgery has been shown to extend life expectancy by nine years in diabetics and five years in non-diabetics. Remarkably, it also reduces the overall incidence of cancer by 38%, with reductions as high as 42% in women.
While critics point to high upfront costs—$6,000 to $10,400 annually for medications and $18,000 to $25,000 for surgery—the prevention of costly chronic diseases makes them highly cost-effective. For example, preventing a single stroke or keeping a patient off dialysis for six months can cover the cost of years of medication or a surgery.
Economic modelling from the UK's National Health Service and a 2021 Canadian study using data from Alberta both concluded that bariatric surgery becomes cost-effective within two to three years from a public healthcare perspective.
Dr. Eliosoff calls for immediate action, urging public and private insurers to cover weight-loss medications and for provincial programs to expand surgical capacity, reduce wait times, and adopt more inclusive international eligibility guidelines. He concludes that this is not just about individual patient care but about preventing a collapse of the Canadian healthcare system itself.
