Advertisement 1

Obesity treatment: 'Stop talking to patients like they are children'

Dr. Sean Wharton is working towards changing how we understand obesity, from how doctors treat patients to society's perspectives: "African-American women carry their weight on their hips and thighs. Yet, they’re demonized when they should just be called beautiful."

Article content

This is the second of five interviews in the “Your Health Matters Summit” series, where we spend a few moments speaking to each of the experts who shared their expertise for the summit, which was hosted by?Obesity Matters. These stories will explore obesity from a medical perspective; take a look at happiness and why it’s not necessarily connected to weight; learn about food addiction and binge eating; and finally why eating less and exercising more isn’t always the answer.?

Advertisement 2
Story continues below
Article content

Dr. Sean Wharton is the medical director of the Wharton Medical Clinic, a community-based internal medicine weight management and diabetes clinic, researcher and advocate for health equity in Canada. He also runs Wharton Medical Clinic Clinical Trials, a program that conducts trials that test new medications and therapies for weight management, Type 2 diabetes, and cardiometabolic health. Wharton is passionate about changing the dialogue around obesity — that it’s a disease and not a lifestyle choice. Healthing spoke with Wharton about the importance of compassion in treating obesity, why ethnic diversity needs to matter more in obesity care and the role that politics plays in obesity management.

When did you realize there needed to be some serious change in the ways health-care providers looked at obesity?

Dr. Wharton: I‘m an internal medicine physician, and as I was doing my residency, I was focusing on high blood pressure, Type 2 diabetes and a number of other internal medicine conditions. It occurred to me that for people living with obesity, frequently it was their obesity that was a causative factor when it came to their medical condition. Yet there was no physician that was capable of treating it. They were very reticent to have a discussion about it because there were no treatments available that could actually keep the patient’s weight down for a long period of time and treat the medical condition. So what we would do is we would continue to give more medications, more blood pressure agents, more insulin, more diabetes treatments, as opposed to trying to manage the underlying condition. So I’m an enthusiastic resident at this stage, between 2000 and 2004, and I thought we should treat the root cause which is obesity.

Advertisement 3
Story continues below
Article content

Then it became clear to me that there were no effective treatment options for people living with obesity. And that was the reason why physicians were not addressing it. That, to me, was unfortunate that there were no treatment options besides telling someone to have a diet or exercise more, which is not a long-term effective treatment for somebody living with obesity. If you want to lose five to 10 pounds, do a diet at, go to the gym a little bit more. But if you’re living with obesity that’s causing a medical condition, that’s not the answer.

When you talk to your patients about quality of life, what kinds of comments do you hear, and how are you using your work to help?

Dr. W: Speaking to people about quality of life, their primary issue is that many people, particularly the health-care providers, do not treat them with compassion and do not understand their medical condition. They treat them like a child and condescendingly tell them to have a better diet, stick to it and exercise more. It’s not just embarrassing, but frustrating, saddening. And it’s discrimination. Since it continues to happen again and again from learned people, it sometimes becomes internalized where people actually believe those paternalistic, condescending messages.

Advertisement 4
Story continues below
Article content

So quality of life is frequently immediately improved for somebody who has a practitioner who has compassion for their medical condition and does not treat them like a child who does not know about the simplistic reductionist concepts of eating better and exercising more. And they treat them as they treat this condition, as something more important, more complex and more sophisticated, and in that sophisticated manner, sits them down and has a real discussion of the science behind obesity.

Let’s talk about treatments. Wegovy was recently made popular by TikTok. What are your thoughts on treating obesity with medication?

Dr. W.: The way I feel about treating obesity with medications is the way I feel about treating high blood pressure, cancer or any chronic disease with a medication. Medication pharmacotherapy is effective for a disease state. As an internal medicine doctor, or any other physician who understands the biology and the physiology of a chronic disease has in their toolbox pharmacotherapy to treat many of these medical conditions. So obesity is one of those medical conditions. TikTok has not made Wegovy famous for treating obesity. TikTok has made Wegovy famous for treating elevated weight. They’re two different things.

Advertisement 5
Story continues below
Article content

So it’s like saying that TikTok has made Botox famous for aesthetic medicine versus famous for migraine treatment. We likely wouldn’t call a neurologist and ask them how they feel about Botox being used for aesthetics. But there’s a closer parallel between somebody wanting to lose five to 10 pounds versus somebody living with obesity. For those people living with obesity, this is a breakthrough medication that frees up the brain space that takes care of their cravings and their hunger, and finally addresses one of the root neurochemical causes of obesity. Do I have an issue with the TikTok craze of people using it for aesthetic medicine? Not really. I don’t have a big opinion on it because it’s not my field.

finger pressing a beliefs button
Health-care providers tend to treat people with obesity like a child, telling them to eat better and exercise more — as if they didn’t know the benefits of these actions, says Dr. Sean Wharton. GETTY

Do you have any thoughts on how TikTok is influencing health?

Dr. W.: I don’t know that TikTok is influencing health. I have not seen any information or any data that TikTok influences health. It helps people to identify how to identify lumps in their breast for breast cancer or helps with detection of when to check for prostate cancer or for colon cancer. That to me would be an influence on health. And maybe TikTok can be a platform. Clearly, it’s influencing people’s use of aesthetic medicine and using it because Kim Kardashian uses it. But does it address actual health problems? Does it make things worse? Is it making things better or is it just fluff and everything is neutral? I don’t know the answer to that. It would require a research study.

Advertisement 6
Story continues below
Article content

Will TikTok information help people living with obesity? I have seen videos with people living with obesity. They had Type 2 diabetes or other metabolic condition and significant elevated weight. They, of course, took the medication. They could have been a patient at my clinic and or any other weight management appropriate clinic, and they did better and better. That’s a good video. But the video of somebody 130 pounds going down to a 1 25 to get into a wedding dress, that’s an aesthetic video. That’s not necessarily a bad video, but it’s aesthetic medicine.

Much of the discussion around obesity is about lifestyle. What makes a person a candidate for medication?

Dr. W.: Everyone who is admitted to my clinic has a BMI [body mass index] of greater than 27. The qualification for pharmacotherapy is a BMI between 27 to 30 with one comorbidity or a BMI greater than 30. So there’s nobody by definition that comes to my clinic that does not fit the basic criteria to have the medication. Then you discuss the next criteria that you would see in any other physician’s office. Do they have adverse side effects? If they’ve had medullary thyroid cancer, they can’t take it. If they have had idiopathic pancreatitis, then they can’t take it. There are limited other products that they could take.

Advertisement 7
Story continues below
Article content

Semaglutide is the real name of the medication. It comes in the form of Ozempic. Wegovy is not yet available in Canada. So, what is the difference between Ozempic and Wegovy? It would be like saying Ozempic is Coca-Cola in a 350-mL bottle, and Wegovy is Coca-Cola in a 1,000 mL bottle. They’re both the same except one is in a bigger package. And the studies for weight management were done with the ones in the bigger package.

Ozempic, which is labeled for Type 2 diabetes, is the exact same product for weight management. So the question is, am I using semaglutide in my practice for obesity management? Yes, that is the treatment. From the medical obesity world point of view, that is the treatment for obesity. Not the Keto diet or going to the gym. The medication is the treatment. Then surrounding that are all of the other treatments, cognitive behavioural therapy, the right type of diet, exercise. So for instance, someone who has a heart attack, aspirin is the treatment, but you still tell them you’ve got to eat better and follow the Mediterranean diet, maybe, do some walking, go to gym. Obesity medicine doctors are very clear that the treatment for obesity is pharmacotherapy. And then that allows the patient to eat a better diet, allows them the capacity to go and exercise. Why? Because they’re smaller, they’re seeing success, and they’re motivated to be active on a regular basis.

Advertisement 8
Story continues below
Article content

[The obesity medication] is altering your brain chemistry. But it’s not a permanent alteration. It’s only an alteration during the duration that you’re taking the medication. Then your brain chemistry goes back to what it was before. Because your brain chemistry is genetic. Your obesity is genetic. If you get to 350 pounds, that’s genetic. Just like your eye colour is genetic.

Are there changes that could be made on a political level to help people with obesity live healthier lives?

Dr. W.: Yes, endorsement and recognition that the world is biased, which is a negative word. They’re biased or prejudiced against people living with obesity and that the world is full of stereotypes against people living with obesity, which is stigma. If you were to google “obesity man images,” you’ll see guys wearing shirts that are too small for them as if they’re not bright enough to know that that doesn’t look good. Sure there’s one guy who will wear that, but the majority of guys that live with obesity don’t do that because they’re bright, competent people — lawyers and doctors and everything else.

Advertisement 9
Story continues below
Article content

We also need to enact legislations that stop the discrimination against people living with obesity. You notice how a lot of what I have to say did not have to do with let’s tax sugary food. That’s putting more of the onus on the person, like it’s their fault. The issue is, we keep blaming the person with obesity, versus actually being compassionate, appropriate and understanding science. Living with obesity is not a choice. It’s a genetic epigenetic phenomenon that’s a result of progress in society, like having cell phones, TVs, air conditioning. We need to understand that, help people to understand that and also help people living with obesity to live with a healthy, elevated weight, and then treat their elevated weight when appropriate.

What are you hoping obesity management looks like in five years?

Dr. W.: More treatment choices for people living with obesity if they have obesity and more recognition that people with elevated weight may not have obesity. African-American women may need a BMI of over 32 before they start to run into blood sugar problems because they carry their weight on their hips and their thighs, not in their stomachs. Yet they’re demonized when they should just be called beautiful. They shouldn’t be called a woman with obesity or an obese lady. If they have Type 2 diabetes or they have heart disease, then they’re living with obesity and treatment should be available for them. If you’re South Asian and your BMI is 26, which would not be defined as obesity and barely defined as overweight. ut if you’re South Asian with a BMI of 26 and you have pre-diabetes, your mom has Type 2 diabetes, your auntie has it, and they all developed it at age 26 and you’re age 25, you’ve got obesity.

Advertisement 10
Story continues below
Article content

So a greater understanding of the ethnic diversity, as well as the difference between elevated weight and obesity. Obesity is obesity. It’s a disease. That’s where I’d like to see [obesity management] go: to the fact that it’s not a one-shoe-fits-all.

Read the other interviews in the series: Gillian Mandich, happiness expert,?on what it takes to be happy;?Tedi Nikova, a weight loss coach focused on helping people improve unhealthy relationships with food;?Dr. Vera Tarman?who helps people understand that food addiction has nothing to do with willpower; and Julie Mai, on why binge eating is a psychological diagnosis.

Karen Hawthorne is a Toronto-based writer.
Thank you for your support. If you liked this story, please send it to a friend. Every share counts.

Recommended from Editorial
  1. Obesity is a chronic disease that is hard to manage with just diet and exercise, says Dr. Sandy Van. GETTY
    Five myths of obesity
  2. None
    Obesity: How a doctor's comments began a lifetime of mental health issues
  3. None
    Obesity Matters imagines acceptance and equity of care

Article content
Latest National Stories
    universo-virtual.com
    buytrendz.net
    thisforall.net
    benchpressgains.com
    qthzb.com
    mindhunter9.com
    dwjqp1.com
    secure-signup.net
    ahaayy.com
    soxtry.com
    tressesindia.com
    puresybian.com
    krpano-chs.com
    cre8workshop.com
    hdkino.org
    peixun021.com
    qz786.com
    utahperformingartscenter.org
    maw-pr.com
    zaaksen.com
    ypxsptbfd7.com
    worldqrmconference.com
    shangyuwh.com
    eejssdfsdfdfjsd.com
    playminecraftfreeonline.com
    trekvietnamtour.com
    your-business-articles.com
    essaywritingservice10.com
    hindusamaaj.com
    joggingvideo.com
    wandercoups.com
    onlinenewsofindia.com
    worldgraphic-team.com
    bnsrz.com
    wormblaster.net
    tongchengchuyange0004.com
    internetknowing.com
    breachurch.com
    peachesnginburlesque.com
    dataarchitectoo.com
    clientfunnelformula.com
    30pps.com
    cherylroll.com
    ks2252.com
    webmanicura.com
    osostore.com
    softsmob.com
    sofietsshotel.com
    facetorch.com
    nylawyerreview.com
    apapromotions.com
    shareparelli.com
    goeaglepointe.com
    thegreenmanpubphuket.com
    karotorossian.com
    publicsensor.com
    taiwandefence.com
    epcsur.com
    odskc.com
    inzziln.info
    leaiiln.info
    cq-oa.com
    dqtianshun.com
    southstills.com
    tvtv98.com
    thewellington-hotel.com
    bccaipiao.com
    colectoresindustrialesgs.com
    shenanddcg.com
    capriartfilmfestival.com
    replicabreitlingsale.com
    thaiamarinnewtoncorner.com
    gkmcww.com
    mbnkbj.com
    andrewbrennandesign.com
    cod54.com
    luobinzhang.com
    bartoysdirect.com
    taquerialoscompadresdc.com
    aaoodln.info
    amcckln.info
    drvrnln.info
    dwabmln.info
    fcsjoln.info
    hlonxln.info
    kcmeiln.info
    kplrrln.info
    fatcatoons.com
    91guoys.com
    signupforfreehosting.com
    faithfirst.net
    zjyc28.com
    tongchengjinyeyouyue0004.com
    nhuan6.com
    oldgardensflowers.com
    lightupthefloor.com
    bahamamamas-stjohns.com
    ly2818.com
    905onthebay.com
    fonemenu.com
    notanothermovie.com
    ukrainehighclassescort.com
    meincmagazine.com
    av-5858.com
    yallerdawg.com
    donkeythemovie.com
    corporatehospitalitygroup.com
    boboyy88.com
    miteinander-lernen.com
    dannayconsulting.com
    officialtomsshoesoutletstore.com
    forsale-amoxil-amoxicillin.net
    generictadalafil-canada.net
    guitarlessonseastlondon.com
    lesliesrestaurants.com
    mattyno9.com
    nri-homeloans.com
    rtgvisas-qatar.com
    salbutamolventolinonline.net
    sportsinjuries.info
    topsedu.xyz
    xmxm7.com
    x332.xyz
    sportstrainingblog.com
    autopartspares.com
    readguy.net
    soniasegreto.com
    bobbygdavis.com
    wedsna.com
    rgkntk.com
    bkkmarketplace.com
    zxqcwx.com
    breakupprogram.com
    boxcardc.com
    unblockyoutubeindonesia.com
    fabulousbookmark.com
    beat-the.com
    guatemala-sailfishing-vacations-charters.com
    magie-marketing.com
    kingstonliteracy.com
    guitaraffinity.com
    eurelookinggoodapparel.com
    howtolosecheekfat.net
    marioncma.org
    oliviadavismusic.com
    shantelcampbellrealestate.com
    shopleborn13.com
    topindiafree.com
    v-visitors.net
    qazwsxedcokmijn.com
    parabis.net
    terriesandelin.com
    luxuryhomme.com
    studyexpanse.com
    ronoom.com
    djjky.com
    053hh.com
    originbluei.com
    baucishotel.com
    33kkn.com
    intrinsiqresearch.com
    mariaescort-kiev.com
    mymaguk.com
    sponsored4u.com
    crimsonclass.com
    bataillenavale.com
    searchtile.com
    ze-stribrnych-struh.com
    zenithalhype.com
    modalpkv.com
    bouisset-lafforgue.com
    useupload.com
    37r.net
    autoankauf-muenster.com
    bantinbongda.net
    bilgius.com
    brabustermagazine.com
    indigrow.org
    miicrosofts.net
    mysmiletravel.com
    selinasims.com
    spellcubesapp.com
    usa-faction.com
    snn01.com
    hope-kelley.com
    bancodeprofissionais.com
    zjccp99.com
    liturgycreator.com
    weedsmj.com
    majorelenco.com
    colcollect.com
    androidnews-jp.com
    hypoallergenicdogsnames.com
    dailyupdatez.com
    foodphotographyreviews.com
    cricutcom-setup.com
    chprowebdesign.com
    katyrealty-kanepa.com
    tasramar.com
    bilgipinari.org
    four-am.com
    indiarepublicday.com
    inquick-enbooks.com
    iracmpi.com
    kakaschoenen.com
    lsm99flash.com
    nana1255.com
    ngen-niagara.com
    technwzs.com
    virtualonlinecasino1345.com
    wallpapertop.net
    nova-click.com
    abeautifulcrazylife.com
    diggmobile.com
    denochemexicana.com
    eventhalfkg.com
    medcon-taiwan.com
    life-himawari.com
    myriamshomes.com
    nightmarevue.com
    allstarsru.com
    bestofthebuckeyestate.com
    bestofthefirststate.com
    bestwireless7.com
    declarationintermittent.com
    findhereall.com
    jingyou888.com
    lsm99deal.com
    lsm99galaxy.com
    moozatech.com
    nuagh.com
    patliyo.com
    philomenamagikz.net
    rckouba.net
    saturnunipessoallda.com
    tallahasseefrolics.com
    thematurehardcore.net
    totalenvironment-inthatquietearth.com
    velislavakaymakanova.com
    vermontenergetic.com
    sizam-design.com
    kakakpintar.com
    begorgeouslady.com
    1800birks4u.com
    2wheelstogo.com
    6strip4you.com
    bigdata-world.net
    emailandco.net
    gacapal.com
    jharpost.com
    krishnaastro.com
    lsm99credit.com
    mascalzonicampani.com
    sitemapxml.org
    thecityslums.net
    topagh.com
    flairnetwebdesign.com
    bangkaeair.com
    beneventocoupon.com
    noternet.org
    oqtive.com
    smilebrightrx.com
    decollage-etiquette.com
    1millionbestdownloads.com
    7658.info
    bidbass.com
    devlopworldtech.com
    digitalmarketingrajkot.com
    fluginfo.net
    naqlafshk.com
    passion-decouverte.com
    playsirius.com
    spacceleratorintl.com
    stikyballs.com
    top10way.com
    yokidsyogurt.com
    zszyhl.com
    16firthcrescent.com
    abogadolaboralistamd.com
    apk2wap.com
    aromacremeria.com
    banparacard.com
    bosmanraws.com
    businessproviderblog.com
    caltonosa.com
    calvaryrevivalchurch.org
    chastenedsoulwithabrokenheart.com
    cheminotsgardcevennes.com
    cooksspot.com
    cqxzpt.com
    deesywig.com
    deltacartoonmaps.com
    despixelsetdeshommes.com
    duocoracaobrasileiro.com
    fareshopbd.com
    goodpainspills.com
    kobisitecdn.com
    makaigoods.com
    mgs1454.com
    piccadillyresidences.com
    radiolaondafresca.com
    rubendorf.com
    searchengineimprov.com
    sellmyhrvahome.com
    shugahouseessentials.com
    sonihullquad.com
    subtractkilos.com
    valeriekelmansky.com
    vipasdigitalmarketing.com
    voolivrerj.com
    zeelonggroup.com
    1015southrockhill.com
    10x10b.com
    111-online-casinos.com
    191cb.com
    3665arpentunitd.com
    aitesonics.com
    bag-shokunin.com
    brightotech.com
    communication-digitale-services.com
    covoakland.org
    dariaprimapack.com
    freefortniteaccountss.com
    gatebizglobal.com
    global1entertainmentnews.com
    greatytene.com
    hiroshiwakita.com
    iktodaypk.com
    jahatsakong.com
    meadowbrookgolfgroup.com
    newsbharati.net
    platinumstudiosdesign.com
    slotxogamesplay.com
    strikestaruk.com
    trucosdefortnite.com
    ufabetrune.com
    weddedtowhitmore.com
    12940brycecanyonunitb.com
    1311dietrichoaks.com
    2monarchtraceunit303.com
    601legendhill.com
    850elaine.com
    adieusolasomade.com
    andora-ke.com
    bestslotxogames.com
    cannagomcallen.com
    endlesslyhot.com
    iestpjva.com
    ouqprint.com
    pwmaplefest.com
    qtylmr.com
    rb88betting.com
    buscadogues.com
    1007macfm.com
    born-wild.com
    growthinvests.com
    promocode-casino.com
    proyectogalgoargentina.com
    wbthompson-art.com
    whitemountainwheels.com
    7thavehvl.com
    developmethis.com
    funkydogbowties.com
    travelodgegrandjunction.com
    gao-town.com
    globalmarketsuite.com
    blogshippo.com
    hdbka.com
    proboards67.com
    outletonline-michaelkors.com
    kalkis-research.com
    thuthuatit.net
    buckcash.com
    hollistercanada.com
    docterror.com
    asadart.com
    vmayke.org
    erwincomputers.com
    dirimart.org
    okkii.com
    loteriasdecehegin.com
    mountanalog.com
    healingtaobritain.com
    ttxmonitor.com
    bamthemes.com
    nwordpress.com
    11bolabonanza.com
    avgo.top