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leaders in health: dr. sean wharton and compassion in obesity medicine
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dr. sean wharton started his clinic in 2008 to put weight and its associated risks of type 2 diabetes, fatty liver disease and osteoarthritis, among others, at the forefront because people with obesity deserve medical treatment.
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do you ever catch yourself looking at somebody going into a coffee shop to get a doughnut and thinking ‘why would they do that? they’re hugely overweight. don’t they have any self-control?’
even obesity specialists like toronto’s dr. sean wharton, who treat patients battling chronic weight problems and the medical complications of obesity, find themselves jumping to criticism, he says. “i’m going to the tim hortons too. why can’t they go into tim hortons? maybe they’re having one doughnut instead of having 10. maybe they’re down 50 pounds and have more willpower in their pinky finger than i do in my entire brain.”
he’s worked in weight and diabetes management for more than 15 years, championing health equity in canada and changing the conversation around obesity as a complex biological condition – not a character flaw. he’s also leading clinical trials on new drug therapies for people who are resistant to decreasing weight with the current prescription weight loss medications like wegovy so they can have another option to bariatric surgery to treat their obesity, fatty liver or type 2 diabetes. these conditions, as well as heart disease, are associated with obesity and projected to overburden the healthcare system as obesity rates climb.
self-reported weight and height data from the 2022 canadian community health survey suggest that close to one in three canadians aged 18 and older (30 per cent) were obese in 2022, up from just over one in five (21 per cent) in 2003.
“i have to remind myself of those biological principles to ensure that i understand that my bias doesn’t have to lead to stigmatizing words or actions which would be discrimination,” sean says candidly. “and then i ask myself, ‘how did i become biased?’ and i became biased because i watched cartoons when i was a kid. i walked by the grocery store and saw people magazine yesterday. it’s because my brain is being fed information all the time and it’s hard to push against it.”
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why, exactly? society is steeped in diet culture. thinness is a marker of success and health, and while you could say that getting thin for celebrities is part of the job, for the rest of us, it can lead to obsessive deprivation or cosmetic surgery to find the “best” version of ourselves that we can present to the world. eating disorders are now on the rise worldwide, with prevalence between 2000 and 2018 more than doubling from 3.4 per cent to 7.8 per cent of the population, the center for women’s health reports.
people with larger bodies are marginalized, bullied and made to feel ashamed. studies have demonstrated that heavier employees face systemic discrimination in the workplace, and a widely publicized 2006 survey by the rudd center for food and obesity at yale revealed that of 4,000 respondents, nearly half said they would give up a year of their life rather than be fat.
while the mantra “eat less and move more” continues to be advised by some healthcare practitioners for people living with obesity, sean has brought greater compassion and understanding to the healthcare community and his own clinic. he’s also an adjunct professor at mcmaster university in hamilton and york university in toronto, influencing the next generation of physicians with his outlook and expertise.
and he’s a recognized advocate for change so that people of all sizes and ethnicities are treated with respect and kindness.
“we’re offering a message beyond science,” he explains of his approach to the unknowns of obesity science. the condition is determined by a host of genetic, environmental and neurochemical factors. “it’s a message of love and compassion within medical treatment to all patients, because we don’t always have the biological and the scientific answer. i don’t really know all the scientific aspects of obesity or the visceral adiposity (body fat deep in the abdomen) or the brain neurochemistry. because we’re not there yet. so, at this stage, many times, love and compassion and understanding are what is necessary and can be a transformative change for many patients.” sean wants canadians to participate in clinical trials to further the research and help patients access medications that aren’t affordable.
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not surprisingly, he also says health is a priority in his personal life, where he and his wife, a family doctor, work out at a local gym. as a bonus, it has a children’s play area for their four-year-old son. “sometimes we go to the gym just to sit and relax,” he laughs, having a coffee while their boy is happily occupied. they live in a walkable neighbourhood for getting outside and have realistic expectations about balancing job responsibilities and home time together.
while he’s clearly dedicated to his work, sean didn’t grow up planning to be a doctor who would lead projects like canada’s new guidelines for treating obesity, published in 2020 in the canadian medical association journal, that call for a shift in focus to the root causes rather than weight loss alone (and many other notable achievements). his dad was a physiotherapist who wanted him to study medicine and sean had the grades and ability to go that path. he started with pharmacy at the university of toronto where he went on to get a doctorate degree. he became a pediatric pharmacist at toronto east general hospital, now the michael garron hospital. while he loved the work and the profession, he decided to go medical school at the university of toronto where he founded the black medical students association in 2000, now a recognized mentorship organization.
he says his residency in internal medicine was a turning point, giving him insight into obesity as a chronic disease and the need for treatment.
“as an internist, i primarily focus on diagnosing what a patient has or doesn’t have. but also the majority of our interventions are pharmacology based,” he says, like a cardiac medication that restarts a person’s heart or an antibiotic that treats an infection.
“once you do understand it (obesity), you’re able to dispense of your bias and understand the stigmatizing aspects of it and possibly not discriminate,” dr. sean wharton says.
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“so, i recognized that obesity medicine was missing the significant part of most chronic diseases, which is pharmacological intervention. when is the last time we saw somebody with true high blood pressure that could impact and kill them not get the pharmacological agent? not for a long, long time. and the last time we saw bias against a chronic disease is mental health and depression where we were told, ‘don’t treat it pharmacologically. do other interventions. be happy, smile, everything is fine.’ then in the mid-80s to early ’90s, we started to get rid of that bias and recognize that pharmacological intervention was necessary in many cases. that’s where i came to this field with the recognition that the one area where we could actually have a scalable impact would be in pharmacological intervention and obesity.”
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also enlightening, sean explored the association of obesity with other internal medicine specialties he was looking at, like why many people had fatty liver and could have liver failure, and why they had type 2 diabetes when at that point, 80 per cent of people with type 2 diabetes were living with obesity. now it’s 90 per cent living with obesity, he says. the common link was dealing with obesity and the dangerous visceral adiposity, or belly fat deep under the skin that surrounds the organs.
but at the time, the amount of information that was known about the biological aspects of the field was next to nothing.
“it was very, very limited. and there were a lot of social aspects to it as well like social discrimination. being a black man and understanding what it’s like to feel bias, which is prejudice and stigma, which is stereotype, and then discrimination, which is racism. they all equate to each other. people with obesity face these on a regular basis,” he says. “and there was a disregard for biology. that’s why i was interested in this field because i saw the similarities with other struggles of marginalized people, and i also saw the biological aspects that were disregarded based on biases.”
he started his clinic in 2008 to put weight and its associated risks of type 2 diabetes, fatty liver disease and osteoarthritis, among others, at the forefront because people with obesity deserve medical treatment. “just like someone with high cholesterol, we don’t turn them away and make them pay for high cholesterol care. i absolutely insisted that it have an ohip funded platform. there was a lot of emotion connected to that because somebody was finally trying and listening.”
obesity treatment at his clinic and in the field has come a long way, with lifestyle and dietary interventions based on research, such as the canada food guide, that are now complemented by the promising effectiveness of prescription medications like wegovy and ozempic as an alternative to bariatric surgery. these two medications are glp-1 agonists, the “winners” in the pharmacological space for weight loss treatment, sean says. the first generation delivered between eight to 10 per cent weight loss, and now generation three is coming out within a couple years, showing up to 25 to 30 weight loss, which is well into the surgical levels achieved by a bariatric procedure.
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for weight loss, these medications pump the brakes on appetite and the rate food exits the stomach, so people eat less and are satisfied with smaller portions. it doesn’t work for everyone and like many chronic illnesses, from asthma to rheumatoid arthritis to high blood pressure, patients usually relapse as soon as their treatment stops.
many people with obesity will likely need to remain on medication permanently, as the bbc reports, but clinical trials are planned to see whether higher doses of glp-1 drugs can be used in the acute phase to help patients shed pounds, followed by lower maintenance doses. they come with fewer side effects (like the nausea, stomach pain and heartburn that can happen with wegovy) and are prescribed long-term. the coming wave of lower-cost generic alternatives could make this scenario more viable.
for sean, he’s leading by example, understanding the stigma and providing evidence-based care and respect to those who need it most.
“this is the thing. the majority of the world still does not understand the biological aspects of obesity medicine. and i liken it to the fact that there are still some parts of the world that don’t understand that depression, true depression, is a neurochemical and biological disease state, or that hiv is a virus,” he says. “with obesity, it is a biological condition. it’s a genetic condition, and there are multiple factors of biology, physiology and genetics that connect to it, which makes it harder to understand. but once you do understand it, you’re able to dispense of your bias and understand the stigmatizing aspects of it and possibly not discriminate.”
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