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opinion: reducing barriers to obesity treatments could avert a healthcare crisis
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"we can treat obesity effectively now or watch as our system crumbles under unsustainable costs, writes dr. ronald eliosoff, former assistant professor of medicine at mcgill university. above: preparing for bariatric surgery.
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canada’s healthcare system faces mounting economic pressure that threatens its sustainability, partly driven by a crisis hiding in plain sight. we spend billions treating obesity’s complications while restricting access to treatments that could solve the problem. the uncomfortable truth demands acknowledgment. we can treat obesity effectively now or watch as our system crumbles under unsustainable costs.
the covid-19 pandemic revealed the deadly cost of inaction on obesity. countries where more than half the population was overweight had death rates nearly 10 times higher than those with lower obesity prevalence. of 900,000 covid-19 hospitalizations in the united states, about 30 per cent were directly attributable to obesity.
effective treatment could have saved countless lives.
yet the pandemic only illuminated a broader truth clinicians see daily: obesity worsens outcomes across nearly every condition. obesity causes diabetes, non-2022年世界杯预选赛阿根廷 liver disease, gastroesophageal reflux disease, obstructive sleep apnea, and osteoarthritis. it accelerates cardiovascular disease, increasing rates of heart attack, stroke and heart failure. it raises deaths from pneumonia and influenza, increases surgical complications, worsens sepsis, prolongs hospital stays and drives intensive care use. obesity turns a manageable illness into a complex and costly challenge.
obesity isn’t a moral failing; it’s what happens when humans evolved for scarcity encounter permanent abundance. when you take a trip on a cruise ship with unlimited buffets, you gain weight—not from a lack of discipline, but because humans evolved for scarcity rather than abundance.
canadian clinical guidelines recommend referring obese patients to medically supervised weight loss programs, based largely on the u.s. diabetes prevention program research study. this landmark study’s actual results tell a sobering story. participants initially lost seven kilograms, but the difference between treated and control groups had dwindled to a meaningless one kilogram after 10 years. the even larger look ahead trial echoed this pattern, with weight dropping 7.9 per cent at one year, but only 2.5 per cent at 10 years, before researchers stopped the trial for futility.
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this cycle repeats endlessly as short-term weight loss is followed by long-term regain.
the economic devastation is staggering. in canada, the cost of inaction in treating obesity reached $27.6 billion in 2023. diabetes alone consumes $4.7 billion annually in direct costs, with 10-year projected costs of $15.4 billion for 2.16 million new cases. heart attacks, strokes and dialysis each generate tens of thousands in costs per patient.
what makes this crisis maddening is that we have effective treatments that could prevent these complications. while bariatric surgery is technically covered under public provincial health care — with eligibility and wait times varying by province — access is severely restricted by multi-year wait times and eligibility is limited to people with a body mass index (bmi) over 40, despite evidence-based international guidelines recommending surgery at bmi 35, or at 30 with metabolic disease.
(under canadian bmi guidelines, normal weight is 18.5–24.9, overweight is 25–29.9, class i obesity is 30–34.9, class ii obesity is 35–39.9 and class iii obesity is 40 and above.)
weight-loss medications remain largely unfunded despite revolutionary advances. new drugs, including semaglutide (ozempic, wegovy) and tirzepatide (mounjaro, zepbound), enable patients to achieve 15 to 23 per cent sustained weight loss while simultaneously improving diabetes, high blood pressure, fatty liver disease, kidney disease, sleep apnea and arthritis.
semaglutide reduces major adverse cardiovascular events by 20 per cent in patients with established cardiovascular disease.
bariatric surgery delivers even greater impact. all the health benefits seen with medications are shown even more robustly with surgery. a recent meta-analysis of more than 170,000 patients showed bariatric surgery extended life expectancy by nine years in diabetics and five years in non-diabetics.
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the most economically significant discovery was completely unexpected. bariatric surgery dramatically reduces the incidence of many common cancers, including endometrial, breast, ovarian, liver, pancreatic, gallbladder, colorectal, esophageal, and kidney cancers. recent systematic reviews show surgery reduces overall cancer incidence by 38 per cent, with reductions reaching 42 per cent in women. multiple studies have confirmed these findings, including a cleveland clinic study showing a 33 per cent cancer reduction after only 3.5 years.
advances in technique and technology have made bariatric surgery increasingly safe. these operations are offered routinely on an outpatient basis at major centres, including the mayo clinic and johns hopkins, as well as some centres in ontario. modern bariatric surgery carries mortality rates even lower than gallbladder removal or hysterectomy and is the most effective obesity treatment available today.
quebec has been at the forefront of bariatric surgery innovation. dr. picard marceau at université laval was a pioneer in this field, creating the duodenal switch in 1993, while dr. michel gagner created the sleeve gastrectomy, which is the most commonly performed bariatric procedure globally.
critics call these treatments expensive. medications cost $6,000 to $10,400 annually, while surgery runs $18,000 to $25,000. these figures trigger fear until you calculate prevention benefits.
with tirzepatide cutting diabetes progression by 94 per cent and diabetes consuming $4.7 billion annually, preventing modest case numbers pays for years of medication. one prevented heart attack funds multiple years of treatment.
avoiding one stroke covers a decade of medication. keeping someone off dialysis for six months pays for surgical costs.
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economic modelling from the united kingdom’s national health service shows that bariatric surgery becomes cost-effective within two to three years. a 2021 canadian study using real-world data from alberta’s bariatric program found that from a public healthcare perspective, surgery becomes cost-effective within two years. surgery is the most cost-effective intervention available to healthcare systems facing obesity-related cost crises.
we can continue funding demonstrably failed lifestyle programs while obesity-related costs spiral out of control, or we can implement effective obesity treatment and begin genuine economic healthcare recovery. each delayed year produces more diabetic patients requiring dialysis, more stroke victims and more cancer cases.
the solution demands immediate implementation.
public and private insurance must cover weight-loss medications and more access to bariatric surgery is needed for patients meeting clinical criteria.
provincial programs must expand surgical capacity, reduce wait times and adopt international guidelines recommending surgery at bmi 35, or bmi 30 with metabolic disease.
this transcends individual patient care and could help prevent a canadian healthcare collapse. we possess effective treatments and economic proof that the fiscal crisis will not wait for further deliberation.
the choice is stark: treat obesity effectively now or explain to future generations how we chose a healthcare system collapse over proven solutions.
dr. ronald eliosoff is a primary care physician in ottawa and former assistant professor of medicine at mcgill university. he co-founded a bariatric surgery centre in louisiana and speaks internationally on obesity treatment.
this article was originally published in the montreal gazette on november 9, 2025.
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