When you see ads for diet pills and quick-fix weight-loss methods, the message they often give is that obesity is a social problem. What if, instead of telling people that being thinner is important because it makes them more attractive and likeable, these messages told people that being thinner will reduce their chances of developing and living with chronic health conditions and give them a better quality of life?
If this were the case, Prof. Paula Brauer, Family Relations and Applied Nutrition, would have a much easier job. She has received more than $125,000 from the Canadian Institutes of Health Research to develop several strategies to manage obesity within Canada’s primary-care setting and advance health-system services for local obesity management.
“Recognizing obesity as a health problem rather than a social issue is key when developing strategies to fight it,” says Brauer, who’s working with Dr. Nick Kates and the Hamilton Family Health Team. “Part of our problem is that we haven’t been treating obesity in the health system as a problem unto its own. It’s been left to the commercial sector, which often promises a magic cure-all solution.”
Obesity is an important issue because it’s often connected to other chronic health problems such as diabetes, high blood pressure, high cholesterol, arthritis and heart disease. Today, one in four Canadian adults is obese, and the number of children living with obesity is skyrocketing.
“It’s time for real change,” says Brauer. “People’s lives depend on the decisions being made now, and what has traditionally been done in the past simply isn’t working.”
The Hamilton Family Health Team, which is made up of more than 150 health professionals, including general practitioners, psychiatrists, psychologists, social workers, pharmacists and dietitians, is one of 150 family health teams in Ontario. Family health teams are a relatively new addition to Ontario’s health-care system and are designed to promote health, reduce wait times and improve access to team care, she says. An additional 50 family health teams have been proposed for Ontario and are expected to be implemented over the next several years.
Dietitians in the family health team model play key roles in bringing about changes in the way obesity is addressed, says Brauer. Historically, dietitians have worked in larger institutional settings such as hospitals and health-care facilities, but now they’re being brought into primary care, where patients can be better supported in making needed lifestyle changes.
“Questions related to diet and nutrition are asked in 20 to 25 per cent of doctor visits,” she says. “In most cases, these questions are directly connected to the condition the patient is seeing the doctor for, which illustrates the importance of having nutrition expertise readily available to patients and other health-care providers on the team. It makes sense to have dietitians positioned in primary care, where most of the disease prevention and health promotion work is occurring in the health-care system.”
Brauer’s research focuses on studying the effectiveness of health intervention programs in the community. These programs have their challenges, she says. She cites as an example a study that involved registered dietitians doing one-on-one counselling in family physician practices. Although 40 per cent of the patients with dyslipidemia (a lipid disorder) and 62 per cent with diabetes knew they could bring their cholesterol and glucose levels down to clinical targets by changing how they ate, only 16 per cent of them lost five per cent or more body weight, which is considered a moderate target for health benefits.
“These are not ideal situations involving eager volunteers,” says Brauer. “Health behaviour change is very complicated, and you have to be relatively well to undertake any kind of diet or physical activity change. In our field, only 50 to 70 per cent of people will finish the intervention no matter how ideal it is.”
Part of the challenge is that primary care serves people of all ages, who each have their own set of challenges and circumstances, she says. There is no one-size-fits-all model of care.
“It also serves every geographic setting, and the availability of primary care varies greatly among urban centres, suburban environments, small to medium-sized towns, and rural and remote settings. More than 80 per cent of Canadians see a doctor at least once a year, so how do you develop a range of services that will result in maximum effectiveness? That’s what we’re helping to bring into focus through this project.”