Source: The Conversation – Canada – By Muhammad Ilyas Nadeem, PhD Candidate in Obesity & Diabetes | Public Scholar (2024-2025), Concordia University
Canada is recognized globally for its world-leading obesity care guidelines — yet Canadians continue to struggle to access the very treatment plans we’ve developed. Meanwhile, the same model of care is now the one the World Health Organization (WHO) is urging other countries to adopt.
The WHO recently released its first ever guideline on anti-obesity medications, reinforcing a chronic disease model of care that Canadian experts have championed for years.
WHO’s stance mirrors the Canadian framework laid out in 2020 clinical guidelines: obesity is a chronic, relapsing disease that requires comprehensive, lifelong care — the kind that includes timely diagnosis, trained providers, co-ordination among the various health professionals involved, mental-health support, and — when appropriate — pharmacotherapy and bariatric surgery.
Despite Canada’s leadership in shaping this global shift, progress at home remains slow and uneven. More than one in four adults now live with obesity and wait times for specialist care have soared to a record high of 30 weeks in Canada. What’s more, in high-income countries, obesity and related chronic diseases tend to disproportionately affect people facing social and economic disadvantage.
When will Canadians see this research put into practice?
Either directly or indirectly, all Canadians are affected by obesity. Obesity remains largely framed as a willpower problem solvable through lifestyle change alone, despite decades of evidence showing it is a complex chronic disease shaped both by biology and environment. It is linked to more than 200 health problems worldwide and contributes to more than 3.7 million deaths annually.
Most health-care systems, including Canada’s, still rely on fragmented, weight-centric guidelines rather than holistic, chronic disease approaches. Even clinicians and clinics that want to follow these evidence-based models often find themselves constrained by limited resources, training, inconsistent insurance coverage and a system that still doesn’t put comprehensive obesity care at the forefront.
Canada has invested millions of dollars in obesity research, leading to the development of forward-thinking, science-backed approaches to obesity care, but system-wide implementation remains painfully slow.
The Canadian paradox: world-class guidance, patchy access
Here’s the bright side: Canada has quietly become an unexpected leader in global obesity care guidelines. Over the past five years, Canadian clinicians, researchers and people with lived experience have helped rewrite the international rulebook for treating obesity.
The 2020 adult guideline was a turning point that reframed obesity. It moved beyond using BMI as the main compass, and reorganized care around what matters to patients: quality of life, function and reduction of related complications, not just kilograms lost. That patient-centred, stigma-free model, along with Canada’s guideline process itself, has since been adapted in Ireland using the ADAPTE framework and in Chile through an international pilot. Several other nations are also integrating elements of the Canadian approach into their own guidelines.
In 2025, two major updates pushed the model further. A pediatric guideline in Canadian Medical Association Journal emphasized multicomponent, family-centred support that addresses mental health, quality of life and cardiometabolic risk, while considering medications or surgery for selected adolescents through shared decision-making.
An adult pharmacotherapy update called for long-term, individualized use of modern anti-obesity medicines — including semaglutide and tirzepatide — and urged clinicians to focus on abdominal obesity and complications rather than BMI alone.
Access to care
Yet a paradox remains: while the world begins to follow Canada’s lead on paper, most Canadians living with obesity still cannot access the level of care these very guidelines envision. Public coverage for anti-obesity medications remains limited and inconsistent across provinces, and private coverage reaches only a minority.
Training gaps compound these access issues. Medical education in Canada has historically overlooked obesity care, leaving many clinicians unprepared to treat patients in line with the guidelines.
Bariatric surgery capacity has been sharply constrained, with reported wait times varying from 1.5 years to nearly nine years, and historic analyses documenting stark interprovincial inequalities. These bottlenecks make it almost impossible to deliver the very guidelines we’ve poured time and funds into.
So far, policy signals are mixed. In March 2025, Alberta became the first — and still only — province to formally recognize obesity as a chronic disease, a move that can unlock more comprehensive coverage and care options. The federal government is reviewing applications for generic GLP-1 drugs which could improve access down the road. But no pan-Canadian policy framework exists, leaving most patients navigating a patchwork system.
In Québec, more bariatric surgeries have been performed relative to need than most provinces but waits remain substantial and public drug coverage for anti-obesity medicines is limited.
Improving the system
Ultimately, before we can improve the lives of our people, we need to improve the system that is supposed to care for them.
The first crucial step would be for more provinces to follow suit with Alberta to recognize obesity as a chronic disease nationwide. Recognition is the gateway to coverage and comprehensive care.
A co-ordinated federal-provincial-territorial framework implementing our guidelines on behavioural/psychological support, pharmacotherapy and surgery should be applied for obesity care in Canada. Make quality of life, mental health, functional capacity and obesity-related complication reduction core performance indicators.
Finally, similar to diabetes care, public and private plans should cover anti-obesity medications where clinically indicated. The absence of coverage continues to hinder access as international guidance embraces modern, chronic-care models for obesity management.
Canada’s impact on modern obesity care is commendable, with countries like Ireland and Chile adapting our model. WHO now supports this same chronic-care approach with its stance on GLP-1 medicines. But if Canada’s own guidelines are not practically applied within our health-care systems, many lives will continue to be at stake, and obesity numbers will continue to climb, as they have for the last several decades.
Muhammad Ilyas Nadeem receives funding from Fonds de recherche du Québec (FRQ)-Santé.
Jessica Murphy has received funding from Fonds de recherche du Québec (FRQ)-Santé.
Sylvia Santosa receives funding from CIHR, NSERC, MITACS, CFDR.
Cristina Sanza does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.
– ref. Canada is a global leader in obesity care guidelines, so why are Canadians still waiting months for treatment at home? – https://theconversation.com/canada-is-a-global-leader-in-obesity-care-guidelines-so-why-are-canadians-still-waiting-months-for-treatment-at-home-273361