EASO was pleased to host a unique session at European Health Forum Gastein 2-4 October 2019 in Bad Hofgastein Austria. The theme for EHFG 2019 was A healthy dose of disruption: Transformative change for health and societal wellbeing. Following the forum, ‘Obesity in Europe – time for a new approach?’, we share this interview with the moderator of this session, Ms. Jacqueline Bowman-Busato, Policy Lead, European Association for the Study of Obesity (EASO), who provided further insight, from a policy perspective and as a person with lived experience of this chronic disease.
Joseph Grech (JG): If Europe had to approach obesity like other major chronic diseases, across policy and practice, how do you think this would impact the obesity epidemic in Europe?
JBB: The science demonstrates that the impact would be phenomenal and in the right direction. A huge part of the challenge today is that there seems to be a gap between the science and how that informs policy in a holistic and outcomes-driven manner.
I think a large part of this is because even though obesity is already indicated as a disease by WHO, the sad reality is that although the science has moved on considerably to prove it is a chronic, relapsing biological disease, the policy frameworks and thereby behaviours have not followed so quickly.
When you look at other chronic diseases, we make efforts to make a clear linkage between the underpinning biological factors and then how the broader physical and lifestyle environment impacts on disease progression and indeed management. If we did this for obesity systematically, we would round the circle and tweak existing approaches and interventions to take into account the biological elements at every step of the way.
As a person of lived experience, to be frank, when I discovered that I was living with a biological disease it was a huge relief. It allowed me to have a frank and open discussion with my doctors about how to manage my symptoms and get the disease under control. On average, it takes 6 years for people to have similar discussions with their GPs according to a very interesting study called Action IO. It took me 20 years because I really didn’t understand what was happening; in my case obesity triggered by my endocrine system.
Normally, GPs, as their first point of contact, are not trained to actually have that kind of conversation, so there is a high chance of the person living with overweight to progress onto having to deal with obesity and other complications, like type 2 diabetes and cardiovascular disease if they do not receive proper treatment.
Hence, if we treat obesity through a chronic disease approach, we are more likely to end up with a system that takes obesity seriously. Thus, we are more likely to end up with a lower prevalence and progression rate of type 2 diabetes, as well as the other associated chronic diseases. Economically, we are more likely to save money because we are able to treat obesity at an earlier stage and prevent other costs and other burdens, as well as improving quality of life and employment rates of the person living with this often debilitating chronic disease. So, it’s a win-win for everyone in terms of the bigger picture; from systems thinking, down to the individual.
JG: In approaching obesity as a disease, a potential challenge could be the negative self-perception of those living with the disease. Having experienced obesity yourself, how do you react to this?
JBB: Okay, so as is public knowledge, I am a person of lived experience ofobesity! I still am an obesity patient, because obesity is a chronic relapsing lifelong disease, which sometimes from a patient perspective is invisible, like now, more or less.
For me, it started off because of endocrine issues, because of Hashimoto’s disease, which turned into hypothyroidism. Once I realised that’s what it was, I stopped looking at diet per se, calories in and calories out. I started looking at managing my leptin resistance, managing my cortisol, and all these things. In the end, that’s when I started changing my life habits as well as having bariatric surgery. But it was a relief, because I could do something about it, I knew what I was dealing with and it’s not an excuse. Far from it; it is actually a starting point. There’s something that says, a diagnosis is not an end in itself, rather it opens the door to healing. That’s how I view it. If you don’t know that you have a disease, how do you heal or at least minimise symptoms to manage it? So that’s been my starting point.
JG: Negative attitudes about individuals carrying excess weight have been reported by various health professionals. What impact do you think this approach will leave on healthcare professionals?
JBB: I think it would oblige them to learn how to have a non-discriminatory conversation about not just weight but obesity, because there are so many internal factors that are going on. It would actually force them to have a more integrated approach, to treat the person as a person, and to acknowledge that this person also has a life. Actually, there are various things that they could do together to manage the disease a bit better.
Moreover, healthcare professionals would come to a more informed diagnosis, because they would actually be able to diagnose obesity as a primary disease as opposed to just a risk factor. They would then be able to make proper integrated treatment suggestions and also monitor holistically to see how things are managed mentally, physically, and biologically. So, to me, it would just make such a big difference.
JG: As the Policy Lead in EASO, which three key messages would you give to sectors that can influence health and obesity, so as to encourage them to take this approach from policy to practice?
JBB: Basically, the first message is that there is consensus within the scientific community now, as to the six root causes, the six biological mechanisms, and the bucket, which underpin obesity as a chronic relapsing disease. Policy makers at WHO level have already said that obesity is a disease. There are a lot of different kinds of diseases. We need to see acceptance through practice and reference.
Secondly, follow science – if that wasn’t made clear enough – but in a meaningful way, in a language that can actually integrate the biological with the environmental factors that go outside all conventional healthcare policy. Yesterday, someone mentioned things like urban planning and the food industry came up a lot. One of the recommendations was very much about how we can be creative around financial policies, not tax, but other financial policies. These policies will actually encourage rather than punish or demonise the food and other industries to make sure that they are actually supporting healthy consumption – leading to better biological factor management – essentially.
And the final one would be to use data: be sure to use data in terms of outcomes. Having an outcome-based approach is significantly more advantageous for all concerned, rather than using an intervention approach.
This interview was conducted by Mr. Joseph Grech, Practice Nurse (Public Health), Malta and Dr. Mischa van Eimeren.