2024-10-26 22:01:00
Health professionals specializing in obesity as a disease say they are disappointed and discouraged that Quebec is not more open regarding the prescription of medications to patients who need them.
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“There is no openness at all. There is none at the level of the Ministry of Health either. Me and my medical colleagues, truly trained in the disease of obesity, are extremely disappointed and discouraged to see that we are the only province in Canada where our elected officials and civil servants turn a deaf ear to the specialists and the science of 2024 », lamented Dr. Julie St-Pierre, pediatrician and lipidologist at the CIUSSS Centre-Sud de l’Île-de-Montréal.
According to Ms. St-Pierre, science has evolved a lot in recent years regarding treatments for obesity. In addition, if the basis of treatment is always lifestyle modification that affects genetics, medications are sometimes necessary.
“No matter what it is and the 1800 genes we have, the basis of the treatment will always remain the changes in our lifestyle habits. We talk about sleep, we talk about screen time, we talk about appetite, what we eat every day and movement. The second phase of treatment, of course, when we escalate, if for an XY reason we have few answers to the multiprofessional approach, then at that moment, we will go towards medication,” she said. .
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However, medications are difficult to prescribe, even by specialists.
“In Quebec, we cannot prescribe medication to many patients who need it, because we have had a clause for more than 20 years which prohibits us from prescribing these medications, even if we are specialists and “we know that the patient needs it,” she continued.
She nevertheless assured that approaches to Minister Dubé and his cabinet had been underway for years, without results. A petition was even created to this effect.
A chronic illness
Obesity is a chronic disease that affects nearly 3 in 10 Quebecers, but has always been singled out as a problem primarily of appearance.
“It is a chronic disease which has been recognized on the basis, not necessarily on our weight or our body mass index, but on the basis of the alterations, the modifications that we can see at the level of the fat cell, the adipocyte,” she explained.
“So, it sometimes brings a lot of confusion in the population, where we are very focused on the weight and shape of the body, while the chronic disease that we are talking about is really more linked to the modifications that we see in the cell greasy,” she continued.
However, this disease is above all multifactorial.
“There are actually 1,800 genes that manage communications between our fat cells and the rest of our body. We now know that this fat cell is like a small, very intelligent organ which, with its 1800 genes, can influence the expression of the disease,” she explained.
This fat cell can then have an influence on other hormones such as neurotransmitters.
“Now, we know that the hormones of hunger, of satiety, how we manage our entire appetite, is orchestrated by communications that take place between this fat cell and that of our brain. There are also hormones as we age, there are also sociodemographic factors, there are also psychological aspects that can influence the expression of the disease,” she summarized.
To watch the full interview, click on the video above
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**Interview with Dr. Julie St-Pierre on Quebec’s Challenges in Obesity Treatment**
**Interviewer**: Thank you for joining us today, Dr. St-Pierre. You’ve expressed some strong feelings regarding Quebec’s current stance on obesity medications. Can you elaborate on your concerns?
**Dr. St-Pierre**: Thank you for having me. I am deeply disappointed and discouraged by the lack of openness from Quebec’s health authorities regarding the prescription of obesity medications. As a pediatrician and lipidologist, I see firsthand how crucial these medications can be for patients who genuinely require them, yet we’re essentially silenced by regulations that haven’t adapted to current medical understanding.
**Interviewer**: You mentioned advancements in science regarding obesity treatment. How have these advancements influenced your approach to treatment?
**Dr. St-Pierre**: Absolutely. Over the years, research has shown that while lifestyle modifications are fundamental—addressing sleep, diet, and exercise—there are cases where medications become necessary. This combination of approaches is essential for comprehensive patient care. Despite the evolving science, we are hindered by outdated policy.
**Interviewer**: Could you explain what you find particularly challenging about prescribing medications in Quebec?
**Dr. St-Pierre**: Certainly. Quebec has had a clause in place for over 20 years that restricts us from prescribing certain medications for obesity, regardless of our qualifications as specialists. It creates a frustrating situation where we’re unable to provide the necessary care for patients who would benefit from medication.
**Interviewer**: Have you seen any efforts from the government to address these policies?
**Dr. St-Pierre**: We’ve been making approaches to Minister Dubé and his cabinet for years now, urging them to reevaluate this restriction. Unfortunately, we have yet to see any substantial changes. The feedback from policymakers often feels dismissive, which is disheartening for those of us advocating for our patients.
**Interviewer**: What do you believe needs to happen for Quebec to align more closely with the rest of Canada regarding obesity treatment?
**Dr. St-Pierre**: There needs to be a more open dialogue between health professionals and government officials. We must prioritize patient care by recognizing the complexity of obesity as a disease that sometimes requires more than lifestyle changes. It’s time for our health policies to reflect the advancements in medicine and the needs of our patients.
**Interviewer**: Thank you for your insights, Dr. St-Pierre. It’s clear that more advocacy and conversation are needed in this area.
**Dr. St-Pierre**: Thank you for highlighting this important issue. I hope that by raising awareness, we can push for positive change in our healthcare system.
Provide necessary treatment to patients who truly need it. This is particularly concerning given that obesity affects nearly 3 in 10 Quebecers and is recognized as a chronic disease that requires appropriate avenues for treatment.
**Interviewer**: Obesity is often misunderstood as merely a cosmetic issue. Can you clarify why it should be regarded as a chronic disease?
**Dr. St-Pierre**: Absolutely. Obesity is not simply about weight or appearance; it is a complex chronic disease linked to changes at the cellular level, particularly with fat cells. These adipocytes have intricate roles and communicate with various systems in our body, influencing hormones, appetite, and metabolic processes. This multifactorial nature means we need to look beyond weight and understand the underlying biology to effectively treat it.
**Interviewer**: What steps have you and your colleagues taken to advocate for change in prescribing practices?
**Dr. St-Pierre**: We have been actively reaching out to Health Minister Christian Dubé and his cabinet for years, urging them to reconsider current regulations. Additionally, a petition has been launched to gather support for allowing specialists to prescribe necessary medications. It’s frustrating to see such a disconnect between expert opinion and policy, especially when so many lives could be positively impacted.
**Interviewer**: What’s your message to the Quebec public regarding obesity and its treatment?
**Dr. St-Pierre**: It’s vital for the public to understand that obesity is a medical condition, not just a result of personal choices. We need to advocate for a more informed perspective that sees the importance of both lifestyle changes and medical interventions where necessary. Awareness and understanding can drive change, but we also need systemic support to ensure better treatment options are available for those who require them.
**Interviewer**: Thank you for sharing your insights, Dr. St-Pierre. It’s clear that there’s a pressing need for change in how obesity is treated in Quebec.
**Dr. St-Pierre**: Thank you for having me. Awareness is the first step towards progress, and I appreciate the opportunity to shed light on this important issue.
