A version of this commentary appeared in EvidenceNetwork.ca, Toronto Star, iPolitics and the Hill Times
There’s a common catch phrase used by those championing efforts to prevent childhood obesity: “This may be the first generation of kids to not outlive their parents.” Sounds terrifying – except that so far, there is little evidence to support this idea.
Over the past several decades we have seen a remarkable increase in adult and childhood obesity, yet life expectancy has continued to increase and may well continue to do so.
This is not to say that obesity is not a major driver of health risks. Obese individuals are far more likely to develop diabetes, heart disease, arthritis, sleep apnea and even breast cancer. But survival of individuals with these conditions continues to increase. In fact, never have so many with these conditions lived to a ‘ripe old age.’
This ‘success’ poses important challenges to our health care system. No doubt obesity will drive some health conditions, but rather than translating into premature deaths, it is far more likely that today’s kids will live even longer — and live longer with chronic diseases — than their parents.
Thus the obesity epidemic’s real burden is an unprecedented increase in ‘chronic diseases of the young.’ This has implications for both our workforce and for our health care system.
For the workforce, this means that more employees will be living with obesity and the resulting increase in diabetes, hypertension sleep apnea, arthritis and other chronic health conditions. While these conditions can be managed, the resources and the delivery of health care cannot remain the same as it is today for the ‘chronic diseases of the elderly.’
While the retiring baby-boomers with these conditions can perhaps afford to sit around in waiting rooms for their clinic appointments, younger workers will be unable to leave their workplace as often as would be required for the management of their conditions. Indeed, success of managing chronic conditions is directly related to the number of visits with a health professional — the more frequent and regular these visits, the better the condition tends to be controlled.
So our health care system will need to develop and adapt to providing regular visits to a large proportion of the workforce, which can ill afford to take time off for lengthy day-time consultations.
There are essentially three ways to deal with this challenge, all of which must be considered: We need to open community chronic care clinics after hours; we need to relocate chronic care clinics to the workplace; and we need to use technology to deliver disease management programs to employees.
It is unlikely that the first option will acceptable to most health professionals. A far better approach would be to relocate chronic care clinics to our places of employment, making it possible for employees to consult with a health professional during the course of their work day. It is not the length but the frequency of such encounters that matter. Simply stepping on a scale, having your blood pressure taken or your glucose levels checked with a quick word of encouragement from a health professional is often enough to keep patients on track, and does not require a lengthy visit to the doctor’s office.
Finally, electronic communication including telehealth consultations that employees can participate in from their desk computer or handheld devices could replace frequent and expensive in-person visits to a health professional.
The sooner our governments and employers prepare for this obesity driven epidemic of ‘chronic diseases of the young,’ the more likely we will be able to avoid the expensive complications of these conditions — and save our health care system in the process.
This should, of course, not distract from obesity prevention efforts, but even the most optimistic forecasts do not foresee any significant reduction in the number of Canadians living with obesity and related health problems at least well into the middle of this century.
Not preparing for the expected consequences of the obesity epidemic will surely burden the health care system and negatively impact the productivity of our workforce. All of this can be avoided by changing how we deliver health care — taking chronic disease management directly to the community — and providing care at the workplace.