Breaking The Stigma: A Candid Conversation About Obesity In Canada

A recent survey highlights a troubling reality: Canadians living with obesity face widespread stigma and discrimination, despite growing awareness that obesity is a chronic disease influenced by factors beyond personal control. With 88% of those affected experiencing shame and guilt, and half reporting negative impacts on mental health, it’s clear that change is overdue. In this Q&A, Chef Rodney Bowers, Novo Nordisk’s Rob Farina, and Dr. Sean Wharton discuss the science behind obesity, the urgent need for empathy, and how we can transform judgment into understanding. —Noa Nichol

Chef and TV Personality Rodney Bowers

What inspired you to share your personal journey with obesity and advocate for changing the narrative around this chronic disease?

I know how hard the struggle is. I live it. I know the impact that obesity has had on my life, and I feel there’s a lot of people out there that can relate. New data from a Leger survey sponsored by Novo Nordisk Canada found more than three-quarters (77%) of Canadians who are overweight or living with obesity have experienced stigma, bias or discrimination because of their weight. Society is not on the side of obesity and at times it can be a very hard disease to deal with. It can be very lonely and tough on a person’s mental health. I just want people out there to know that they’re not alone, obesity is not a lifestyle choice or character flaw, and there are lots of resources to help educate people and help them deal with the struggle.

How has the stigma surrounding obesity impacted your life, both personally and professionally?

Well, society is very fat phobic period. I’ve personally been made fun of and bullied as a kid, but also as you get older, the looks, stares and finger pointing never really go away – so it’s always been part of my life and sometimes it’s overwhelming and sometimes I’m able to shrug it off. Personally, I’ve learned to deal with it better as I get older. Professionally I’ve been told on more than one occasion that I was too fat for a couple tv programs and that I had to lose weight to be more accepted. Those moments sting for obvious reasons.

What are some of the most common misconceptions about living with obesity, and how can we challenge these assumptions in our everyday lives?

I think some of the common misconceptions are that obesity is a choice, and that all people living with obesity do is sit around and eat junk food when they should have some will power to eat less and go to the gym. A person is often viewed as less than, or that they are very lazy. Often times their work ethic or integrity is challenged. Obesity is complicated, and there’s no one-size-fits-all solution. Addressing these misconceptions by bringing awareness to them and talking about it more is essential to fostering empathy, reducing stigma, and supporting more effective public health initiatives.

What role do you believe storytelling and public advocacy play in fostering empathy and understanding about obesity?

Advocacy through storytelling can illuminate the multifaceted nature of obesity. And stories humanize the experience. They help put faces and voices to the statistics, which start to break down the stigma that is obesity. Personal narratives challenge harmful misconceptions, because hearing about how obesity is impacted by individual factors like genetics or emotional health, or even environmental barriers can dismantle biases and foster compassion and empathy.

What advice would you give to someone currently struggling with the stigma or mental health challenges associated with obesity?

I want people who are living with obesity to look around and try listening to others in the obesity community because hearing similar stories can reduce your feelings of isolation and shame. For me, my advocacy creates a sense of community and validates my experience, and all I can do is help bring awareness that you’re not alone and to encourage people to seek support. I’d encourage people who want to learn more to check out obesityoutloud.ca. 

Dr. Wharton

What is the scientific basis for classifying obesity as a chronic disease, and why is this understanding crucial for effective treatment?

There’s been a shift to understanding that obesity is not an acute problem that’s just inferred by a person’s lack of willpower, but is a chronic disease associated with biology and physiology.

What’s the biology of obesity? The biology of obesity is complex and still being researched. Weight regulation is based in the neurohormonal system that dictates energy balance. This weight regulation system is primarily controlled by our genetics but is also influenced by the environment and other factors that are still to be determined. We are aware of a number of the genes involved in determining weight regulation, and we know many of the hormones that act on the brain to regulate energy balance. Understanding this biology helps us to move away from the simplistic thought that obesity is due to a lack of willpower.

Genetics play a major role here and we know this because of some of the twin studies that have been done. If you raise identical twins in different settings, they will have almost identical weights and body types as adults. This tells us that a significant determinant of weight is under genetic control.

There are also environmental factors that trigger these genetic phenotypes, and this is called the epigenetic phenomenon.

How do genetics, environment, and psychological factors contribute to the development of obesity, and how can these factors be addressed in patient care?

Genetics are a major factor in weight determination and regulation, but there is still variability and the ability to influence each person’s phenotype in terms of weight. Environmental and psychological factors also play a role in the development of obesity and the ability to decrease weight and maintain it. Each person has to find the balance of understanding how to use medical intervention and lifestyle modification as effective treatment.

How can you, in the development of treatment, understand genetics? Let each patient know that the development of obesity is not their fault. That it’s not a lack of willpower. That it’s not a character flaw. There are predetermined aspects to weight that are similar to the genetics of eye color. You don’t apologize for your eye color, or say it’s a character flaw, because it is clearly genetics. Somehow, we tend to not understand the shape of our bodies and that our weight is genetically controlled as well. The more that we understand that, the more compassion we can have towards those living with obesity.

Understanding the environment – the environment pulls the trigger in an epigenetic fashion. What does that mean? It means that if we look at weight a few centuries ago, weight was not as high. The genes haven’t changed in these past few hundred years, so what has caused the increase in weight? The environment has changed. The environment does induce the weight to be higher. Let’s use the analogy of a dry sponge. If you have a dry sponge 500 years ago, and there’s just a little bit of water, it’ll just soak up that little bit of water. If you have a dry sponge today and there’s an ocean of water, it soaks it all up. You can’t stop the dry sponge from soaking up the vast amount water. The genetics are the sponge, and the water is the obesogenic society. 

For psychological factors, of course things like cognitive behavioural therapy and understanding that you’re loved and cared for help you to understand what you can do to impact your own health. You may not be able to change your weight, but you can improve your health and your understanding of your own body. That’s the psychological aspect. We can all take care of ourselves better if we understand that we’re loved and cared for.

What impact does the stigma surrounding obesity have on the mental and physical health of patients, and how can healthcare providers help combat it?

How can we deal with stigma? We can do our best to remind ourselves that we’re biased and that we are exposed to stigmatizing images and situations against people living with obesity. We can make a conscious effort to not engage in stigmatizing behaviours and to not discriminate against people living with obesity.

What advancements or innovations in obesity care are you most excited about, and how can they improve outcomes for patients?

Understanding the biological principles have allowed us to attach science to our treatments. So the hormones, the regulators – if we can block the bad ones and enhance the good ones, then we’re in a position where we can help people with the food noise in their head and with their frustrations of their genetics controlling what their brain and body does when they would prefer a different outcome.

Allowing for that control is what the science has actually done, as we have pharmacological treatment for obesity that is scalable, that can go across the entire world and help people in this obesogenic world of calorie-dense foods and no or low activity. I’m also excited about the fact that we understand bias and stigma more than we did before, and that we can have more love and compassion that is infused into treatments. Not everybody living with obesity will have access to pharmacotherapy, bariatric surgery or cognitive behavioural therapy, but everybody deserves compassion in regards to their medical condition, and they deserve to have autonomy and choice.

What steps can individuals and communities take to foster a more supportive and empathetic environment for those living with obesity?

I think the most important message the community can send is one of respect. Respecting individuals at a greater level. To be able to understand choice, to understand that there are medical interventions and to choose appropriately. Individuals can also choose not to have medical intervention, but they need autonomy.

It’s also important for us to have the compassion to know that that as healthcare providers, our viewpoint is not the only viewpoint that we can engage in. We need to work as a team with the patient as opposed to saying it, but not actually doing it. A lot of healthcare providers state that they do patient centered care, but they don’t do patient centered care. They often do paternalistic care that lacks compassion. We can do better by letting go some of our ego and allowing patients to derive the care that is best for them.

Individuals can take the responsibility of seeking out the best care for themselves and working with care providers that allow them to be part of the team. It is not easy to find the right providers, but patients should believe in the fact that they deserve the best care possible.

Rob Farina, PharmD, Interim VP Clinical, Medical and Regulatory, Novo Nordisk Canada

Can you share more about Novo Nordisk Canada’s mission and its commitment to supporting Canadians living with obesity?

Obesity impacts over 800 million adults globally, a number predicted to rise to 1.5 billion by 2030. As leaders in the science of obesity, Novo Nordisk is working to make obesity a healthcare priority, defeat stigma and support better access to evidence-based care. We aim to be the leading force in the science behind obesity.

In Canada, there are more 8 million adults living with obesity, and many require support to effectively manage their condition.  At Novo Nordisk Canda, we are dedicated to making obesity a healthcare priority. We are committed to helping improve the lives of people with obesity by changing how the world sees, prevents and treats obesity. We work both independently and with our partners to advance medical management through education, advocacy, patient support and improved access to care.

Why is it essential to address obesity as a chronic disease rather than just a lifestyle issue?

Obesity is much more than just excess weight. It is a chronic condition associated with over 200 complications affecting an individual’s health, including hypertension, type 2 diabetes mellitus, heart disease, high blood pressure, certain types of cancer, as well as decreased life expectancy. Health behaviour modifications are the cornerstones of obesity management; however, health behaviour changes alone are often not sufficient for maintaining obesity management goals. Just like other chronic diseases, obesity requires long-term management and a customized approach for each individual.

The number of people living with obesity continues to rise, highlighting the need to provide medical professionals with evidence-based tools to tackle the growing global obesity epidemic effectively.

What is the significance of partnering with advocates like Rodney Bowers to raise awareness and reduce the stigma around obesity?

Novo Nordisk Canada wants to shift the conversation from one of shame and blame to empathy and support. A person’s weight does not define them, and people living with obesity deserve support to help them regain their health. People struggling with their weight may feel alone and insecure and are often on the receiving end of negativity, bias or bullying, whether at the grocery store or at work, in the media, and on social media. According to a Leger survey, sponsored by Novo Nordisk Canada, results showed more than three-quarters (77%) of Canadians who are overweight or living with obesity have experienced stigma, bias or discrimination because of their weight, despite widespread understanding that obesity is a chronic disease beyond many people’s control

Partnering with Rodney helps us educate the general public around obesity being a chronic disease, and we are hoping to encourage more people to speak with their healthcare practitioners about their obesity management care. We know that bias and stigma can get in the way of people with obesity getting the care that they need.

There is no “one size fits all” solution for people living with obesity. Exercise, diet and medications can all contribute to lower weight and better health outcomes. But this we know: stigma is the enemy of change because it instills a sense of shame and prevents people from believing they can change their lives. We know that’s not true, and it’s our job to spread that message of change and possibility.

How does Novo Nordisk work to educate both healthcare providers and the public about the science behind obesity?

Novo Nordisk has been dedicated to researching, understanding and developing medicines for obesity for more than 25 years. To understand obesity, we must understand what is going on in our brains. It seems our bodies are hard-wired to hang on to those extra calories, probably because for thousands of years, it was a basic survival mechanism. Therefore, people living with obesity struggle to lose weight. Their bodies programming works to get them back to their original starting weight. In the brain, it’s as if there is a switch that tweaks a person’s energy expenditure until they have regained the lost kilos.

We are trying to pinpoint where exactly in the brain such a switch could be located and exploring whether it is something we could address with a medicine. So that one day, we might be able to help people with obesity to ‘reset’ their weight to a new, healthier starting point. If we succeed, we could help millions of people living with obesity.

Science has shown that obesity is a serious chronic disease and not simply a matter of effort. At Novo Nordisk, driving change in obesity is our long-term commitment to improve the lives of people with obesity and change how the world sees, prevents and treats obesity. As part of this, we work to build healthier environments; foster empathy for people with obesity and champion for obesity to become a healthcare priority; and ensure people living with obesity have access to evidence-based care. By working closely with organizations such as Obesity Canada, we aim to help inform policy change, improve the patient experience, break down stigma and bias, and ultimately change the way the world sees, prevents, and treats obesity.

What are some of the key initiatives Novo Nordisk is implementing to make obesity care a healthcare priority in Canada?

In Canda, we have implemented several initiatives that drive awareness to obesity care. We are leaders in areas of tremendous unmet need, and not only is our goal to create better treatments, we are also working towards building healthier communities, with a focus on disease prevention.

We recently partnered with proud Canadian actor, Eugene Levy, to share prevention information about cardiovascular risk and ways that Canadians living with obesity and diabetes can improve their lives. We leaned into Eugene’s Canadian pride and his passion for the well-being of his fellow citizens. And we sent an impactful message and call-to-action: it’s time to have a heart-to-heart with your healthcare professional about your cardiovascular risk: Eugene Levy and Novo Nordisk Canada provide prevention tools

In 2024, we proudly sponsored the ParticipACTION Community Challenge, a nationwide initiative that inspires Canadians to get active together while making physical activity more accessible across the country—an essential way to build healthier communities. This year’s Challenge saw more than 590,000 participants and 6,200 events across the country. After a devastating year of evacuations due to wildfires, Hay River, Northwest Territories, rallied the community together and won Canada’s Most Active Community, earning $100,000 to expand local activity programs. Thanks to programs such as these, physical activity becomes more inclusive and attainable, showing Novo Nordisk’s commitment to improving health outcomes and defeating chronic disease—especially for underserved communities. You can learn more about ParticipACTION here.

Lastly, we’ve partnered with the Province of Nova Scotia to create The Lighthouse Project, a collaborative initiative dedicated to addressing childhood chronic illness and health challenges. We work with the province to help address underlying issues impacting the health of Nova Scotians—especially knowing that 68 per cent of Nova Scotians over the age of 12 live with a diagnosed chronic condition.

The Lighthouse Project is dedicated to preventing youth chronic illness, including obesity. Childhood obesity can lead to a wide range of critical health conditions. By addressing the complex causes of childhood obesity, The Lighthouse Project is an opportunity to work across multiple sectors, identifying innovative solution to reduce high healthcare costs in Nova Scotia. Both the Province of Nova Scotia and Novo Nordisk Canada have each contributed $1.5 million dollars to this endeavor.