Empowerment, Advocacy & Media Training


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My name is Ximena and I’m the Managing Director of the Canadian Obesity Network in Edmonton, Alberta. And the reason why I’m here is because Dr. Sharma and I have been working with the Canadian Obesity Network’s Patient Engagement Committee to try to integrate the science of obesity into our advocacy efforts in Canada. So, what we want to make sure is that patients feel that they have the scientific knowledge and understanding of obesity plus their own lived experience of living with obesity when they go out and do advocacy, whether it is with a politician, whether it is they’re talking to the media, or they’re talking to somebody who wants to know more about obesity in general.

Like it could be your doctor, it could be anybody. But basically, what we found at the Canadian Obesity Network was that when patients learn more about what obesity is and what obesity isn’t, they feel better prepared to talk about, you know, the key messages that they’ve developed for themselves. So, what we did in Canada was that we had a two-day training workshop.

And the first day, it was all about learning about obesity. And Dr. Sharma did, you know, some training with patients talking about all the studies we have about obesity and the misconceptions about obesity and the bias and all of that. And then we had advocates from other communities, from HIV-AIDS and mental illness, who came in and taught us about what they had done to advocate for change in those areas.

And then, the second part was, the second day was where we did media training. So, Dr. Sharma and our Director of Communications then talked to the committee about how do you talk to the media and how do you convey those key messages. But before we got to that point, the committee worked for about a day to develop their own key messages.

As a committee, what are patients living with obesity advocating for in Canada? And so, we have about five key messages. And then the media training involved the incorporation of those key messages into the role-playing that Dr. Sharma did with them during the training. So, today, we wanted to do a mini version of this.

We have one hour. Basically, Dr. Sharma will speak briefly about obesity. And I know you all have your own lived experience with obesity.

But he will speak more from a clinical and scientific perspective. And then, he will introduce a role-playing exercise. How does that sound? Great.

Yes? Excellent. So, Dr. Sharma. Okay, all right.

So, I’m not the expert in obesity. You guys are the experts in obesity, right? Because you have personal experience. I don’t have that experience.

But what I do know, because I’ve been working in the field for a while, is that there are a few things that we want the public to understand. So, whenever you talk to the media, you’re talking to an audience, right? And so, the first thing you want to know is who is the reporter writing for? Who is the audience? Are you going to talk to a television audience that is very general and it’s the evening news and there’s a small news item, so a lot of people are going to be seeing this? Or are you talking to a more specialized audience? Is it a women’s magazine, so only women are going to be reading? Is it maybe a fitness magazine, so that’s only going to be read by people who already have an interest in fitness? So, you have to always kind of know who is the person writing for. That does not change the message.

That has been my experience. My experience has been that whether I’m speaking to my professional colleagues or whether I’m speaking to lay people, the message is always the same. The words I use are different and the language I use are different, but the messages are always the same.

Now, I don’t want to give you the key messages because we’ve done key messages. It takes a long time to think about it. But when I speak to reporters, what are the things that I like to convey? The first thing I like to convey is that obesity is much more than simply diet and exercise.

Diet and exercise is important, but it’s not, for most patients, especially the kind of patients that I see, it’s not diet and exercise that is the main problem. So, we want to move away from the simplistic thinking, oh, obesity is all just fast food and lazy people not moving or people who don’t know how to eat healthy, to making people understand that, no, this is actually much more complex, and every patient has their own story, right? And whether it’s a mental health problem, whether it’s the social determinants of health, it’s food insecurity, everybody has their own story. And we know that genetics is very important, and we know that there are many reasons.

So, that’s my first thing, is to get people to appreciate that obesity is not as simple as it’s just diet and exercise. We want to move away from that. So, that’s kind of the first topic that I always try to talk about.

The second topic that I feel very strongly about is that once you get obesity, and it doesn’t really matter why or how you got obesity, it generally becomes a lifelong problem, right? It’s not a condition we know how to cure. We can manage it, we can treat it, we can maybe even with bariatric surgery lose some weight, maybe keep the weight up, but it’s going to be a lifelong problem, so it’s really a chronic disease, right? So, what I’m trying to do there is move away from this acute intervention, how do I get fat people to lose weight, to say, no, it’s not about losing weight, it’s about managing a chronic disease pretty much forever, right? So, that is my second message, if you want. And my third message is that, yes, it is a lifelong chronic disease, but we are not doing a good job of managing it.

And there are many reasons for that. But overall, we are not doing, we don’t have the kind of treatments for obesity that I would love to have. When I compare the treatments we have for obesity to, say, the treatments that I have for someone who has diabetes, or the number of treatments I have for someone who has heart disease, or someone who has, you name any other chronic disease, we usually have more effective treatments, better treatments, safer treatments, and more accessible treatments than we have for obesity.

Okay? So, if I break this down for me, and I say, okay, what do I want people to understand? The first one, obesity is complex, multifactorial, it’s not a question of shame and blame and whose fault this is. The second one is, when you get obesity, for whatever reason, it generally becomes a lifelong problem, and it becomes a chronic disease, and so we have to think about obesity as a chronic disease. And my third point is, we need better treatments and better ways to manage obesity, because what we do right now for obesity is not working, not enough, not good enough.

Okay? Those are my three messages. Now, I can go on, and I can have four and five and six and seven messages, of course, but what I’ve learned from media training is you want to keep things very simple, and usually, when you do an interview, if you can just get one of these messages across, I consider that already to be a very successful interview. That’s my perspective.

In the many years that I’ve been doing media, does anybody work with the media here? Media people? Has anybody had formal media training? Okay, so you guys know what I’m talking about. The first thing you learn in media training is never answer the questions. Okay? Forget about the questions.

It does not matter what the question is. You have to know the answer that you’re going to give. And that takes training.

Right? So when I go into an interview, I don’t care what the question is. I don’t care what they want to know, but I go into an interview with what I want them to know. And there are teachable and learnable skills that you can use, and that’s what we’ll do in the workshop.

We’ll do that in a minute. Okay? So you have to know what you want to say, and then you go into the interview. Don’t go into an interview saying, you know, I don’t know what the interview is going to be.

We’ll see what questions he asks. Okay? It doesn’t matter. Don’t worry about the questions, and don’t waste time answering the questions.

Right? Do not waste time answering the questions. Give them what you want them to know. Okay? That’s the first thing that I would say anybody going into any media interview is ignore the question.

And you kind of know this. It is irritating. Because who are the people who do the greatest job of ignoring the question? Politicians.

Politicians. Why do they do that? Because they all have media training. They all have media training.

They ignore the audience anyway. Huh? They ignore the audience. Ignore the audience.

Ignore the reporter. You say what you have to say. Yeah.

Okay? That’s the first thing. The second one is, and I know a lot of people are very shy about this, you have to control the agenda. And the best way to control the agenda is live.

So when you have the opportunity, and here I’m talking largely about public media. So we’re talking about radio and television here. When you have the opportunity to go live on television, live on radio, always go live.

A lot of people don’t want to go live. They say, oh no, let’s free record it because then we can edit it and then if I say something wrong then I can say it again. Or I can prepare for it.

The problem with that is you don’t have control. The only time you have control over what actually gets broadcast is when you’re live on television. Otherwise they’ll record your statement and you don’t know which – how many of you have actually done media interviews, have been taped? Yeah, they spent 30 minutes of recording and then it’s seven seconds on television.

Right? You don’t know what seven seconds they’re going to take. And they usually take the seven seconds that are the least important or not the ones that I wanted. Okay? So by going live I have control.

But if he likes it or not he’s going to have to listen to what I have to say. And they can’t cut it out because it’s live. Okay? So always go for a live interview if you have the possibility of doing live.

Right? Always better than pre-recording. But in many situations pre-recording is what happens. In most pre-recordings you have to know that they will probably be editing it.

So when you have a pre-recorded interview and because you don’t know what they’re going to use from that interview you have to not give them choices. Which means if I have one message that I want to get across the interview, pre-recorded interview can be 20 minutes. But I will spend over 20 minutes, I will say exactly the same message over and over and over and over again.

So that the only thing that they can actually ever use is going to be that message. So it doesn’t matter which minute out of the 20 minutes they take. They will always get the same message.

That’s a bit harder to do but it can also be done without making it sound too stupid. And again we can practice that. So that is the trick around media interviewing is basically they are a very important channel.

Right? They’re multipliers. But it only works if you are using them rather than they using you. And so what I want to do for this exercise now is, we don’t have a lot of time but we can do it for a few people.

I want you to spend maybe two minutes and actually take out a pen and paper. And write down for yourself what is your most important message around obesity that you would like the generalist. So if you have the possibility of standing up on the street tomorrow and there’s 100 people standing around you.

And you could say one thing to them about obesity. What is that one thing that you think is going to change their perspective or get them to better understand obesity or something that you would like them to know? Just one sentence. It can be a long sentence but just one sentence.

Okay. So I want you to do that right now. No, don’t tell it to me.

Write it down. I don’t want to know what it is. Just write it down and prepare for that.

And I’ll give you three minutes to do it. Can I ask you to put your board down for me? You’ve got a fan going on. I might have to move that to you as well.

No, I’m good. As you come closer. Because you’re also far away.

Oh, it’s a thinking fan? Oh, good. Can I look at you? What kind of question is that? I want to say something. I’m looking at the cards.

I’m looking at the cards. I’m looking at the cards. I’m looking at the cards.

I’m looking at the cards. I’m looking at the cards. I’m looking at the cards.

I’m looking at the cards. I’m looking at the cards. I’m looking at the cards.

I’m looking at the cards. So, Samuel, have you worked as a reporter? As a reporter? I’m a PR person. I work as a PR person for a publishing house, and I do the reporting.

All right. But you should be doing the reporting, but that’s okay. We’ll do three minutes here.

Okay, are we ready? Okay. All right. So, here’s what we’re going to do.

So, Vicky, and a lot of you probably don’t know this. So, Vicky is a reporter, and she works for this lifestyle magazine where it’s all about healthy, active living and fitness and following the latest diet trend and doing all those things. And she works for that magazine, and she wants to interview me because she has heard that I am one of the important people in this field and wants to ask me about what is the importance of fitness and lifestyle and what is the best way to lose weight and what’s the best diet that people should be on, et cetera.

Those are the questions that you have for me because that’s what you want to talk about. And she has agreed to meet me and talk to me about these issues. Okay? All right.

So, Vicky, you’re going to do the interview. Okay. Ari, you are so very welcome.

It’s a pleasure to have you here today. I see in your latest issue that you have spoken an awful lot about your work that you did in the summit in Europe. Can you tell me more about that? So, my work is basically dealing with patients who have what you would consider severe obesity.

That’s my clinical work, and I’ve been doing this for the last 20 years or so. And I can tell you that when we see patients with obesity, we don’t have simple solutions. That’s what I’ve learned.

And it turns out that obesity is not only a chronic disease, it’s also a chronic disease that is very, very difficult to treat. And was this on your agenda in Europe? Is this what you went to speak about? Well, I went to Europe talking exactly about the issue that obesity, irrespective of how you get it, there are many different reasons why people can put on weight. The problem is once you’re put on the weight, it generally becomes a lifelong problem.

And unfortunately, we don’t have great solutions for helping patients manage their obesity. I see that Slimming World and Hair of a Life are one of your sponsors, your main sponsors. And how do you feel about that? So, I feel very enviable in it because I think that patients who have lived with obesity for a long time recognize that there’s no easy solution.

They should take Hair of a Life? No, and they’re desperate, right? And so they are trying to try whatever is out there. And unfortunately, in obesity, because we don’t have very effective treatments and because patients are very desperate, there is this huge industry that is trying to sell solutions, whether they’re shakes or powders or a new fat diet. Unfortunately, what we have learned is that once you have obesity, it really becomes a lifelong problem.

And these quick fixes and fat diets and things that cost a lot of money, they don’t really work in the long term very much. But you take their money as a sponsor? See, I take their money really to get the message out that what we need for obesity management is going to be more than what most people think. Because most people think you can fix obesity by losing the weight or by taking a supplement or going into some kind of exercise program.

Unfortunately, for most patients, that is not enough. And we really have to get serious about thinking of obesity as a chronic disease. And we desperately need better treatments.

On a personal note, I see that your marriage has recently broke up. And you are now with the latest model from the swimwear collection. And can you tell me a bit about that? Because fitness is a big part of our lifestyle magazine.

Yeah, so my wife left me because I was too skinny for her. Okay, all right. So you get the idea, right? So she had an agenda, which I was not interested in.

I always came back to my messages. My message is chronic disease, we need better treatments, we need better solutions. It’s complex, right? So I stayed on message.

I can tell you it’s very hard to do. And when you have someone as skilled as Vicky trying to get you to say something, and that’s actually what they do. And the reporters don’t do it because they’re trying to get you to do something.

It’s not that they have an agenda. Very often these are honest questions that they have. Because reporters, very often like everybody else, have the same ideas about obesity.

It’s self-inflicted, you just have to lose the weight, you’re not motivated enough, you’re not following the right diet. So these are innocent questions, but that doesn’t matter. You’re controlling the agenda.

Okay, so why don’t we do a couple of examples here, and then we’ll talk it. So I need a volunteer, somebody who’s written down a message who wants to talk about it. Don’t tell me your message.

Come right up here. Don’t tell me what your message is. Hopefully we’ll find out.

Sit down. Okay, Sven. And I’m just going to play the reporter kind of guy.

So Sven, thanks for coming in the interview. So I have a question about, and this is not a personal question, but I look at you. How important is healthy eating for preventing obesity? It’s as important for obesity as it is for any other disease and life in general.

It’s not more important or less important. But isn’t it that people who have a weight issue, that they’re not eating healthy, and if they ate better, they would probably not have the problem? See, if there was an element of choice in becoming obese, there’s no element of choice in being obese. You cannot choose to no longer be obese.

Once you are obese, the chronic disease is with you. Yeah, but wouldn’t eating healthier help you lose weight and be healthier? As for everybody else. It’s as valid for obese people as it is for anyone else.

Okay, so you’re saying that, so what are you saying? I’m saying healthy eating is a good idea. But it’s not a solution for obese people. Because there is no solution to obesity, there is no choice.

I’m choosing to eat healthy so I can no longer be obese. So what is your solution? My solution is to manage the chronic disease and to live healthy with it, just as everybody else should. So if you’re saying that diet is not so important, is what I’m hearing.

That’s not what I’m saying. I’m saying it’s important for everybody as for obese people. Okay, what about physical activity? I mean, can’t you exercise to lose the weight? You can exercise to lose weight, but you cannot exercise to lose the weight.

And you cannot exercise to become not obese. Okay, so exercise doesn’t burn calories and help people lose weight? Yes, and I could explain to you the biology and biochemistry of obesity. But the fact is that once you are obese, your body is different from normal people.

And exercise will not fix you. You should exercise if you can, you should exercise if you’re healthy enough to do it, and you should pick the exercises that won’t ruin your joints or your legs. Okay, all right, pause.

What was he trying to say? What was his message? It’s not a choice. Don’t tell us the message. It’s not a choice.

Obesity is not a choice. Does anybody hear anything else? It’s a chronic illness. He did say chronic illness, yes.

Well, while you should live as healthy as you can, that won’t fix your obesity. There’s no cure for obesity. Okay, that was implied there, yeah.

Tell us your message. I don’t remember what’s after this. So, no matter if someone had a choice in becoming obese, there’s no choice about living with obesity as a chronic disease.

And you said that. Yes, yes, yes. How did you, how difficult was it to stay on track? Not at all.

Not at all. Why, because you knew what you were going to say, but you knew what you were going to say, and you, and you, he did a pretty good job of staying on message. Yeah.

Although he did somewhat answer my questions, but. I’d like, I’d try to be polite while being, not being uncool. Yeah, don’t worry about being polite.

Don’t be rude. Don’t worry about staying on message. Be rude.

Nice job. Let’s get someone else. Let’s get someone else.

Who else wants to volunteer? I guess I can. Yeah, go ahead. And again, don’t tell us your message, okay? Don’t tell us what you want to have, but have a clear message that you want to talk about.

Okay, so Christina, so we, you know, I want to talk to you about this whole obesity problem, and I was, I was just reading that there are, that there are chemicals in the environment that can cause obesity, and that maybe the obesity epidemic is because of all these chemicals that are out there, and you as someone who has been living with obesity, what do you feel about that message? What do you feel about those, those findings? Well, it’s interesting how people are trying to find out, come up with findings that are totally irrelevant, but they sell papers. So, so you, you don’t think that there are chemicals in the environment that can promote weight gain? Well, there are chemicals in the environment that can promote just about anything and everything if you want them to. So, so what do you think is the, is, is causing obesity? I mean, why are we seeing so many more people who have obesity today than, than before? It’s more a question of how the whole society are dealing with food, and how do we relate to, to it, and what we… Okay, so for you, obesity, you would say is, the food is more important than the, than the, than the chemicals.

The general living is more important. Okay. And that includes the chemical things, but that affects everybody.

Okay, so, so you think it’s food, so, so, so people gain weight because they eat too much, is that, is that the message, or? No, I think the food is, because everybody eats too much today. Okay. It’s, food is too accessible, and it’s so much lifted up as important thing to have.

You relate to people with… Okay, so we could fix the obesity problem by, by what, teaching people to eat healthy, or what, what, what, what is the solution? I think it actually is the, trying to get to the self-confidence of the person to live in the place where they are at the time. Okay, so people with obesity, they have low self-confidence, and if I make them more confident, they eat better, or what’s the relationship? The relationship is very much that people are stigmatized, they are held back the whole time, they are not allowed to be a good person as is, because they are always confronted with, it’s a bad thing to be obese. But could they not make better food choices and solve the problem? But that’s not the important thing.

So, so what do you think is important? To gain self-confidence as a person. And that doesn’t mean the result should be losing weight. It should be that you are a worthy person who can live in a society in a good way.

Okay, cut. What’s her message? Was there a clear message? Yeah. No? Yes.

Who thinks there was a clear message? At the end. So what was her, what was her theme or her message? Stigma. What are you going to take away from this? That each person is worthy of, each person is worthy.

You don’t have to be slim to be worthy. Okay, what were the words that we heard? We heard self-confidence. Self-confidence.

Stigma. We heard about stigma, what else did we hear about? Live a good life. Quality of life.

Quality of life, we heard about that, yes. Was there any other messages that you heard out of? Kristina, tell us your message. Self-confidence.

It was about self-confidence? Yeah, stigma and self-confidence. In what sense? I have a good illustration. I was working with people who were blind, kids.

Okay. And we trained them. One of the things that we did was train them to learn to drive a car.

Double commandos so that they wouldn’t go in. And the reason for doing that was to get them to have self-confidence. They knew something about what the rest of the world was doing.

So they had that insurance, you know. Well, I know how to drive a car. And that’s part of what a person should feel better.

So the self-confidence, the importance of self-confidence, that came out? She was trying to answer your question a little bit about the food. What? He got you to talk about the food. And his initial question was about the environment.

Yeah. But you didn’t answer that, which is good. Which is good.

You avoided the answer. You avoided answering that. Yes.

It’s good. Okay. All right.

Thank you. Thank you. Let’s take someone else who wants to answer.

I can try. Yeah. Come here.

I need to remember what I wrote down. Yeah. Read what you wrote down and why you stick on message, okay? My clear message.

Yeah. Don’t tell us. You might have to tell us later why you think that’s an important message.

Okay. All right. How are you doing? Doing good.

Okay. So I was hearing about stomach stapling, that stomach stapling can cure obesity. As someone living with obesity, how do you feel about that? I mean, going to a surgeon and having your stomach stapled so you cannot eat anymore, do you think that should be a treatment? I can’t say what I think should be a treatment because that’s up to the person to decide because the person living with obesity, it should be the person’s choice.

And I know there’s a lot of different alternatives that are presented. Yeah. That’s one of them.

Okay. So do you think that there’s a danger of, you know, getting people having bariatric surgery? And I hear also they have a lot of problems after bariatric surgery. So, you know, I know there are many doctors and surgeons who are lobbying for more surgery.

I mean, you think that is the solution or? I know there’s, like, a lot of, like, risk with it. But I think that the information and the risk should be accessible for the patient so they can make a decision if they want to do the surgery or not. But isn’t surgery, ultimately, isn’t surgery just taking the easy way out? I mean, you’re getting your stomach stapled so you cannot eat.

I think it’s still coming down to the person. I mean, that’s the person’s decision. It’s the person’s legume, obesity.

It should be the person’s call. And I think that, I mean, the information about all the risk and all the information about the treatment and follow-up, that is more important. And for the person with obesity, yeah, to take that call.

So do you think it is really—what country are you from? Sweden. Sweden. So in Sweden you have a public health system.

Do you think it is good use of public money in the health care system to pay for, you know, getting people’s stomach stapled? I mean, why are all those people going, you know, maybe we should be putting the money in healthy eating, on preventing obesity. So what is your opinion on that? My opinion, it still comes back to all the persons. I mean, if someone wants to do the stapling, that’s up to them.

I mean, I can’t really— Yeah, but should the public health care system, should my tax dollars pay for stapling someone’s stomach? Is that a good use of money in the health care system? I can’t really answer that. I don’t really think that you should, like, get all the money from the stapler to focus on one area. Because, I mean, not all the people are obese and see that that’s the problem, so they maybe don’t want to spend the money on that.

But as—if I want to do that, and yeah, then I pay taxes for it, then it would be up to me. I mean, still go back to that. Okay, thank you very much.

It should be enabled. Thank you very much. Okay, I got this.

Thank you. What was—what do you have in your piece of paper and read it to us? It didn’t go fast. Read us your paper.

What was your message? Yeah, it’s treat me like I’m a person, not a sickness. Okay. Was that what you heard out of his answers? No.

The decision is up to the person. That was very clear. That was very clear.

But you only managed to mix him up and you got into the money factor. Then he couldn’t respond and keep into that agenda. Yeah, he did a good job of answering my questions, which is a mistake.

Yeah, I’ll go for that, yeah. That’s only when you mentioned the money. Otherwise, it was fantastic.

He kept to the same message. Yeah, he kept to the message. Yeah, yeah, yeah.

Right. So, let’s adapt. So, what did you find challenging? No, it was more just like thinking about what everybody else should think.

Because I think this is my really important question. And just think that everybody should be treated the same. And I was thinking it should be my decision.

And that’s how important. And you said that several times. Yeah, yeah.

Okay. Because I don’t want to be treated like a sickness. Okay.

Good job. All right. Does anybody else want to try it? Anybody else has a message? Yeah, come on up.

You have to actually sit in that chair to experience this. Okay. All right.

So, who are you? I’m Janet. I’m Janet. Okay.

And you’re from Belgium? I live in Belgium. Okay. All right.

Do you have a big obesity problem in Belgium? Um… LAUGHTER Okay. Start again. Okay.

Um… Okay. So… Actually, it depends on how you want to define obesity. So, from our perspective in Belgium, there are many ways that you can become obese, but depending on if you follow the WHO definition or Dr. Sharpe’s definition, as I understand it, it’s going to be a difference between is obesity in terms of BMI affecting your life, or are you carrying on at which point you may or may not be considered to be obese.

But would you think, would you think, and I was looking at some statistics just before this conversation, and what I’m seeing here is that the obesity rates in Belgium have been going up for the last few years. So, is that all beer and French fries or Belgian fries, or what is driving this? Actually, as I said before, there are many different ways how people actually arrive at obesity. I think we need to take into consideration not only the food environment, but we also very much need to take into account mental factors and drivers, as well as sometimes medical, other comorbid medical conditions or epidemiology.

It may be allergies, it could be autoimmune, it could be anything. But there are different pathways to arrive at that physical outcome. Okay, so if you had to change the food environment in Belgium to prevent obesity, how should we change the food environment? Should we be taxing fast food, or what was your recommendation to the politicians? How can we reduce obesity in Belgium? Well, actually, I think you hit the nail on the head there, because food environment is something very important.

However, it’s not the full story. If I keep on having to emphasise that if someone, for instance, arrives at obesity because of a mental health complication, that’s not necessarily the food environment that kicks start it. So, the food environment, I would say, is part of the maintenance regime.

But when you think of how different people arrive at obesity, you need to start taking a more holistic look. And in fact, in the Belgian context, because of health outcomes-based healthcare approach that we’re now taking, and this is being integrated into the various Belgian health system reforms, there’s an excellent opportunity to go to different ministries and different stakeholders in the policy-making world, and actually make sure that we’re taking a holistic look. So, how would you address the fast food problem in Belgium? Would you increase taxes or ban advertising? How would you approach that as a solution for obesity? How do we get people to stop eating fast food? Well, again, it’s not a solution.

I don’t know how many times I have to repeat to you. So, you’re saying fast food is not part of the problem? That’s not what I said. What I said was, it is not the solution.

So, depending on, I think, again, you need to take into account a life cycle approach. Fast food comes into, could it have been a trigger as one of the pathways? Or, more to the point, once you’re there, how do you deal with it? How are the various influences around you actually supporting your management of a very long-term condition? But it’s not necessarily the trigger as to how you got there in the first place. So, I’m not an expert at this, but isn’t obesity just calories in, calories out? If you eat too much, your weight goes up? You know, once again, as I stated at the beginning of this interview, as I stated at the beginning, that’s one of the, if you like, the demonstrable factors in terms of weight gain or not.

But, again, some people have autoimmune conditions, some people have leptin, scientifically proven leptin resistance as well. And I hear that is very rare. Actually, it depends on what the co-factors will be.

And, again, depending on your other comorbidities, then that will affect positively, well, shall we say neutrally or negatively. And it’s just one of the other pathways to obesity. So what would your tip be for Belgians, how they can eat healthier? Actually, I’m going to take it away from the food.

Something which I personally do in order to manage my obesity is to meditate for 10 minutes every morning. I make sure I get in my… About what you have for lunch? No, not at all. Well… It’s actually, it’s a way of being mindful to be sure that actually I’m focusing on my day and centering myself so that food becomes fuel and actually it’s my mental capacity to be able to control or at least manage an ongoing, I would say, an ongoing multifaceted condition.

But you would agree that making fast food more expensive would also help? No, because once… If you have gone through that particular pathway to obesity, actually you won’t care. Will you say to a drug addict, for instance, if I up, as a drug dealer, if I up the price for your daily fix, you will still come to me? But that has worked with tobacco. They’ve increased the price of tobacco, of cigarettes, and so people are smoking less.

Well, actually what they’ve done is not only increase the price, they have done a whole slew of measures which took a holistic approach, targeted different audiences, had very clear campaign messaging, and in fact acknowledged that there are different pathways to people starting to smoke and continuing to smoke and what the different potential effects on their health and lifestyle and pockets can have. So it’s just part of a holistic campaign, which is what we should be doing and can do in the case of obesity as well. So banning fast food wouldn’t be a good start, right? That’s what you say.

APPLAUSE That was a really good message. That was a really good message. My message was there are many routes to obesity, both mental, physical, and epidemiological.

Oh, really? LAUGHTER That was my message. OK, did you hear the message? Yes! LAUGHTER I can be a bit of a pain. How did you feel in this situation? Was it realistic to you or not? Actually, it was the first time I wasn’t afraid, because I’m normally really, really afraid of journalists.

OK, why were you not afraid? Because it was something that I live every day, and it wasn’t just something that you have to learn for work or whatever. And I didn’t feel that… I actually felt genuine about it, so it was much easier. Did it help to have a message prepared? Very much so.

Very much so. And also the briefing that you gave before, to not care what they were going to ask me, but just keep going through it. Because before, I’d be like, but it’s impolite.

It is impolite. It’s very impolite to not answer our question. Yeah.

So it was… It actually… And because also it was in English, whereas… So that’s my first language. But if I had to do it in another language, then it would have been more challenging, for sure. Because I’ve got to do the nuancing in my brain as well at the same time.

Yeah. Very good. Nicely done.

APPLAUSE So maybe one more? Yes. LAUGHTER Yes! Carlos. Can I do an interview in Portuguese? No, sir.

Why not? I can do it in Brazilian. LAUGHTER OK, you can do it in Brazilian. Now we might be interviewing in Brazilian.

Sorry. So, Carlos, it’s very interesting that you’re here. So I’m hearing a lot about the obesity problem in Portugal, and I was reading about… And I was actually listening to a talk about that.

It is bacteria in the stomach which is making obesity. Is that your experience, or is that…? What do you think about that? I never heard nothing about bacteria in… For me, the obesity is a biological disease. It’s not a comportmental disease.

This is the main message that I want to tell you, and all the other people, because we know that 87% of the people with obesity has a resistance to leptin, and a little part don’t produce leptin, and they can solve this problem quickly. There are another part of people who produce not enough leptin to life, but can solve this problem too. But the biggest part has a resistance, and they can’t solve yet this problem.

So we need increased research about this. About leptin? About, not leptin, but about how can you… How do you say? Control? Control, yeah. Go around this resistance.

Okay, okay. That is the main problem that you have in obesity in this moment. Okay, so does eating a healthier diet, will that not help? Eating is only one of the way to control the obesity, not for the treatment.

What about exercise? Exercise is the other way to control. We talk about control, but when we talk about control, we talk about eating, exercise, surgery, some medicines that we have now to help us. Yeah, but medicines are very dangerous.

But we talk about control only. Treatment, you only have in research in this moment, and you have three centers, four centers working in this area. One is Portuguese, is the Gulbenkian Science Center.

The other one is Rockefeller in New York, the University of Cambridge, and an Australian university, I don’t remember the name of this one. But let me ask you, so I understand. Research is very interesting.

But we have results now. But isn’t obesity ultimately just, to be honest, is eating too much and not moving enough, right? No, because that is the problem that you have with the disease. Biological disease, if leptin don’t arrive to the brain, what you do if the meter from gasoline of your car is stopping here, and you need to drive, what you do? You go several times to the gas station, even with gas in the car, and you don’t drive so much because you don’t know if you have sufficient gas in the tank.

This is the main reason of obesity. If the signal said to you that you have the sufficient energy in your body to live, don’t arrive to the brain, what brain said? You need to eat, and don’t use because you don’t have energy, don’t exercise because you don’t have energy. Okay, but I’m slightly confused because if I eat too much, my weight goes up.

Yes. That isn’t the best way to lose weight if I stop eating or eat less, then my weight goes down. No.

So, why? No, you must control, but you are talking about control. You don’t talk about the treatment. So, control.

So, you’re saying is more willpower. More? Willpower. People have to have more willpower for eating, controlling their food intake.

No. Control obesity, you can control obesity from several ways, but my message is not about control obesity because all people talk about control obesity. Okay.

My message is we need research to the treatment of obesity. It’s different. Okay, but we can start by eating less.

We can start? No. All right. My message is this one.

Obesity is a biological disease and not a comportmental disease. Okay, all right. So, and when you were saying control versus treatment, are you saying that we need a cure? No.

We say that in this moment, we can make really treatment for some people who don’t produce leptin or produce leptin in not enough quantity. Right. But we need to improve the research in all these centers, these international centers, because what they discover is there are neurons in the sympathetic tissue outside the brain that connect to the… You’ve already lost me.

Like I… He’s lost you in the interview already. What they find, they find out neurons in the sympathetic tissue connect to the fat cells. Yeah.

They can be activated without coming to the brain. And they can do the same work that if leptin arrives to the brain and control the energy you have in your body. Yeah.

Okay, good job. All right. So, I’m going to do something else.

I’ll put you guys in the hot seat, which is unfair. Yeah. I want to put myself in the hot seat.

So, I’m going to ask the lady here, the professional, to come and interview me about obesity, whatever it is that you want to talk about, you can just come over and I’m the… English is not my first language, so… Huh? English is not my first language. It’s quite challenging for me now. Well, that’s okay.

So, you’re the journalist. I’m the obesity expert. I work in a very limited field of obesity, but that doesn’t matter.

So, ask me some of your questions. Dr. Shango, let me welcome you here. Yes.

How are you today? I’m very good. How are you? Oh, fine. Thank you.

So, you are here in Vienna at the Obstetrics and Gynecology conference right now. I heard your lecture yesterday. It was really interesting.

But, as I’m not a scientist, I will need your help now, as our viewers will as well. So, would you be so kind and tell us, tell the audience, what is a way to treat obesity today? Because obesity, it’s called a new epidemic, the epidemic of the 21st century. So, it’s clear that we need some cure, we need some treatment.

So, what’s the way to treat obesity? So, treating obesity is interesting, but really, I think we have to focus on prevention. I think our focus has to be, I mean, there is a reason why in the last 20 or 30 years we are seeing so much more obesity. And so, our talk about obesity has to talk about prevention.

And we have to think about what is it that we can do to prevent obesity. And I think that is much more important than going from fine to fine, which diet, etc. Because if we can prevent obesity, then we don’t need treatment.

Yes, of course, you are totally right. If you can prevent the illness, then you don’t have to treat it. Exactly.

I agree. But, we have a lot of people who need that treatment already. Because we didn’t do enough of prevention for them, so now we need a treatment.

What do you do with this? What can you offer? I think that if you focus on prevention, and we improve the food environment, and we improve the physical activity and mental health, I think everybody will benefit. Also, people who have obesity will benefit. So, I think we have to really go upstream and focus on the social determinants of health.

We have to improve the nutrition of the population. And that will help everybody. But I think that is where our focus has to be.

Yes, sure, I totally agree again. But, you are not answering my question. I asked, what can you do to people who are living with obesity? There is a prevention, there is information, of course.

But they need a treatment right now. So, is there anything you can offer to them? Well, I mean, there are lots of benefits. If we make good food cheaper and easier to access, and if we make physical activity the social norm, I think everybody benefits.

Also, people who have obesity will benefit. And I really think that there is a lot of opportunity of, you know, changing the food environment and changing the activity environment. That is going to benefit everybody.

Of course, of course. But how do you offer those things, those changes, to people who need a change and they need treatment? Oh, absolutely. And I think we should be starting with children.

This is a good point. If you prevent the development of obesity of children. But how do you teach children to live differently if their parents are living with obesity and they need treatment? That is where I think some of the policies we can discuss for prevention will be very helpful.

We can start with the sugar tax. Because we know that taxing changes behavior. We have seen it for tobacco, and I think we have reduced the tobacco smoking.

We can reduce obesity. But we have to focus on public policies. Let me stop you for a moment.

It works for tobacco industry, of course. Because you don’t have to smoke, but you have to eat. And if you are a person living with obesity and you need some treatment, you still have to eat.

So the taxes are not the answer. Yeah, but we can change the kind of food that people eat. If you make fast food more expensive and healthy food cheaper, then we can change what people eat.

How do you change it? How do you change it? Because how do you persuade people to do it, to change their habits? Absolutely. That is the first thing. And my second question is, how do you help them to be treated so they can change their life and then work on the prevention not to get back to what they got? I think, as you agreed, we have to start very early in childhood.

Because if we can prevent obesity, for me, that is the only solution I see. Okay. Sure.

Okay, sorry. She’s very good. We’re talking about different things.

All right, so what we wanted to do, so thank you very much. So what we wanted to do was just give you a taste for how easy it is to fall into the trap of answering questions and how important it is to actually know what you want to say before you go into an interview, right? This does not mean you should be shy of interviews. No, you have to welcome interviews.

You have to welcome. You have to look at every media contact as an opportunity to get your message out. But it has to be about the message that you want to get out there.

So you have to think very carefully about what is it that you want people to know about obesity, and then you can think. And then the more often you do it, the more fluent you become in your message, and the better you will get at it. But do not answer questions.

Okay, that’s the most important message here. So one of the things that we tried to do in Canada was to make sure that the messages that the patient engagement committee was releasing to the media were evidence-based. Yeah, absolutely.

And were strategic in terms of our advocacy goals. And so when this committee – I know that you have your strategic plan, and so you have strategic goals, and if those goals are aligned with your messages, I think if you’re representing this committee or talking about advocacy and what your goals are, then the messages are ready for you, right? Like we need whatever your goals are. Like the messages need to be around your goals.

And I think when they interview you, you can talk about your lived experience and your journey, but I think it has to match with what the overall goal is. Like what are we trying to get changed? And in Canada, we decided that the key first thing we need to do is get obesity recognized as a chronic disease. So every patient that is being interviewed in Canada right now will say obesity is a chronic disease in every single interview 20 times, right? Because we need to get that message in there.

So I think it would be helpful for all of you to talk about what are the key messages that EASO, the EASO Patient Council, wants to get out there. And then you contextualize that message with your personal experience. You know, like in my perspective, obesity is a chronic disease because I’ve lived with it for this long or I’ve tried this.

You can contextualize with whatever experience you have and you can answer the question that they’re asking you, but bringing that key message back. And I think that’s what the patient engagement committee in Canada liked about practicing this with you because you knew the key messages, but you didn’t know what the individual patient had selected for the role model, for their role play. But we all worked very hard for like hours to make sure that everybody could actually get their key message out.

And by the end of it, they got very good at it. And now they’re all practicing out there. Like they’re all doing media interviews.

And I think it’s helpful just for all of you to think about that. What is your key message from the EASO Patient Council perspective? Jimena, that was a two-day workshop, wasn’t it? We had a two-day workshop. So we need some time.

It takes time to actually. It does. It does.

But this is very, I mean, it was kind of like a teaser. Yeah, this was more like an introduction to some of the issues. But you can do it.

It’s more complex. You can record it. You can look at the recording.

You can analyze it and say, okay, what did you say there? And then, of course, there are other issues around body language and posture and how you speak. The kind of words that you use, the length of sentences, working with analogies. Those are all things that you can practice.

And they’re all very teachable, so it’s all learnable. If somebody tells you and you practice it, you can do it. There’s no rocket science.

It’s not magic. It doesn’t take a lot of complicated thinking. But somebody has to tell you and you have to practice it.

You have to practice it. Because that gets you better. Otherwise, you probably are not taking full advantage of the opportunities that you have to communicate your message and the issues that you want the public to understand.

So don’t depend on the reporter asking the right question. They don’t know what question to ask. No, that’s great.

They have their questions. They have their questions. But their questions, you can use their questions to get to what you want to talk about.

Do you have time for a few questions as well? I’m in no rush. All right. Well, thank you, everybody, for coming.

Well, I came, so you guys didn’t have to. Questions? But I’m happy to take questions. Yeah, sure.

Yes? When you were talking in the beginning and you mentioned your three messages, you also mentioned that when a person becomes obese, then the body changes and there’s going to be chronic life-long disease. Is that at any level of obesity that you were referring to, or is it at, for example, morbidity? No, it’s not even at any level of obesity. It’s at any level of body weight.

At my body weight, if I wanted to lose 5 kilos and keep them off, I would have as much of a problem as someone who has severe obesity who’s trying to lose 20 kilos and keep them off. This is not a problem of obesity. This is a problem of how the body regulates its body weight and defends its body weight.

We are all in a different set point. My set point is my current weight. But if I put on 30 kilos, then that becomes my new set point.

Right now, my body is defending this weight. This is not a special physiology of people who have obesity. You said it becomes a chronic life-long disease.

It becomes a chronic life-long disease. Yes, because what happens is that your body will then defend the higher weight. When you get to 120 kilos, your body is going to defend 120 kilos.

Your body will always try to defend 120 kilos, no matter what you do. When you try to lose weight, you go to diet, exercise, get your stomach stapled, take medication, do whatever you want. When you stop any of those things, your body will go back to 120 kilos.

That is what makes it a chronic disease. That’s why every single diet that we go on, it doesn’t matter. Everybody has lost weight over and over and over again.

They always end up at the same weight or they go even higher. The first thing that I tell my patients is, right now, what was your highest weight ever? They say it’s 130 kilos. I say, that’s good because you’re fighting 130 kilos.

You don’t want to fight 150 kilos or 170 kilos. You’re lucky. You’re only fighting 120 kilos.

Let us make sure that is the heaviest you’ll ever be. What we don’t want is this level going up because that’s going to make it more and more difficult. Unfortunately, I cannot change the 120 kilos.

Your body is always going to want to be 120 kilos. We have to find some way of managing it. I use my rubber band example.

I often explain this. Your body wants to be here. You want to be down here.

You’re pulling on a rubber band. We have to find ways for you to pull on the rubber band. Whatever you do, it will always be a rubber band.

You can have bariatric surgery that’s pulling on the rubber band. What bariatric surgery does, really, if you think about it, is it loosens the tension in the rubber band. Now, it is easier to pull and it is easier to sustain the pull on that rubber band.

Even after bariatric surgery, it is still a rubber band. Which means even after bariatric surgery, if you’re not pulling, you go back to 120 kilos. Surgery doesn’t cure obesity.

It makes managing obesity easier because it removes the tension in the rubber band. That’s why you’re more successful. It’s always going to be a rubber band.

I cannot change the rubber band. It’s always going to be 120 kilos or whatever the high speed is. How long you would have to be at a particular weight? It probably depends on that.

We know that from very short-term weight changes. If you take somebody like Tom Hanks and he gains 20 kilos for a film role and they film the film in four weeks and then he loses the weight and comes off and he never has a problem. Maybe four weeks is not enough.

The question is how long do you have to be at a certain weight before that becomes your new weight. I think that there’s going to be a lot of variability. For some people, that can happen very quickly.

For some people, it happens very slowly. For some people, maybe it never happens. But generally speaking, we have to assume that the highest weight that you’ve ever been is probably the weight that your body would go back to if you did nothing.

How does this help people knowing there’s a point? It helps people in two ways, I think. First of all, it’s very depressing and it’s a shock and everybody says, oh my God, no hope. I don’t think that’s true.

I think the first thing it helps you is to understand why it is important to not get heavier. If your lifetime maximum was 120 kilos, then please don’t make it 130, 140 because that’s going to be. If you’re 35 years old, your highest weight was 120.

If at age 50 your highest weight was also only 120, you have been very, very successful in managing your weight. That much I can tell you. That’s the first thing I tell patients.

That’s what you get from here. If your set point is 120, let’s make sure that’s the highest you’ll ever be. The second thing that I think why the model is helpful is because it tells you that I’m going to need a long-term strategy here.

It’s not about how much can I pull for the next two months because what happens in the third month? In the third month, I start going back. What it really means is we’re going to have to find a strategy for you, and that is different for every person, on how much can you pull on the rubber band in a way that you can sustain the pull. If you cannot sustain the pull, then you’re pulling too much.

For some people, the only pull they can sustain is this much. Then that’s a four kilo weight loss. That’s what you’re going to get.

Thank you so much. That’s the conceptual idea. That’s how I explain why obesity is a chronic disease.

I don’t care how you got to 120. Once you are there, you’re going to be fighting 120 forever. Dr. Shum, do you have scientific references for this model? Yes and no.

If you look at all of the intervention studies, all of the lifestyle intervention studies, or any type of study, we know that weight regain happens. In every single study, when you stop the treatment or when you follow people over time, they tend to regain their weight. If you take the biggest loser study, those guys, they lost a ton of weight.

I know that study. Right? Not everybody. Almost everybody goes back to where they started.

That is the rule. That is all over. That is the rule.

The people who lose weight and can keep it off for a long time, the longer you go, the fewer and fewer people you will find who can actually do that. They are the exceptions. The rule is that whatever amount of weight you lose, the chances of relapse, which means the chances of putting the weight back on, is almost, I would say, 95% for most people.

That tends to be a lifelong problem. So if I say that whatever diet you go on should be something that you can sustain for the rest of your life? Yes. That is something that I can claim that is scientifically supported.

It is not just whatever diet it is. It is a lifelong. It also applies to medication.

It also applies to bariatric surgery. So that is why, for example, getting a gastric balloon, which you can only have for six months, is not going to cure obesity. You can put in a balloon.

You can lose the weight. And I take out the balloon. What happens? The weight goes right back up.

The same would happen for medication. If I start you on lerogatide, the injection, the GLP-1 hormone, it also loses the rubber band and you lose the weight. That is for the rest of your life.

But I stop. Of course, you go back. Right? So when you stop, and that is the definition of a chronic disease.

The definition of a chronic disease is a condition that I cannot cure, where if I stop the treatment, the condition comes back or becomes worse again. So whether you’re looking at diabetes or high blood pressure or whatever the chronic disease is that you look at, when the treatment stops, the disease comes back. Okay? And that is exactly how obesity behaves.

When you stop the treatment for obesity, it doesn’t matter. You can be running marathons for your obesity. I don’t care.

When you stop running the marathons, guess what happens? Right? You could be doing mindful eating. When you stop practicing mindful eating, guess what happens? Right? It doesn’t matter what the treatment is. The point is you have to do that treatment for life.

And the day you start doing that treatment, whatever that treatment is, your weight will start coming back. Ari, may I interrupt just for one sec? So I’m Mary Fortin. I work with the Canadian Obesity Network.

One of the things, and I’ve worked with Ari a long time, I’m not a medical doctor. So when I first started doing interviews, I tried to talk really technical to sound like I really knew what I was talking about. And what it did is it made my interviews really bad.

Because it wasn’t natural for me to try to pretend to talk really technical. So how Ari was just talking at the end, that it doesn’t matter what I do, I have to do it for lifelong because it’s a chronic disease. That’s as much detail as you need to put the pressure on yourself to be able to say.

Unless you have that background and you really understand the technicality of it. Because the more I try to use all the right medical terms and all the technical explanation, the worse my interview was. And I think, I’ve forgotten your name, when you said it’s very natural.

The interview was very comfortable because I talked about what I knew and what I was comfortable with. That was bang on. So I just want to bring the stress level down a little bit if it’s there to not feel obligated.

My first ones, Ari used to go, Mary, that was terrible. They were terrible. Yeah, it actually helps to say, sorry guys, I’m not the expert on this.

But the way that I look at it, or my personal experience, or what I see in my patients. I’m not the expert, but I see in my patients. Although it looks like false humility, but actually it’s a very effective speaking technique.

To say, you know what, I don’t know. Of course there might be somebody who can do it. But you know what, I look at my patients, they’re not going to do it.

I look at myself, I’m not going to do it. So you bring this down to a very personal level. That also makes for a better interview.

Because the one thing you want to do in an interview is you want to be relatable. When somebody’s watching the interview, you’re looking at the person who’s the interviewer. So if you’re using a lot of fancy language, then you’re not relatable.

They say, who’s this guy? I’m like, I don’t believe him. So there’s a little bit of an art. The more you can keep it personal, use your own language, and stay at the level of comfort.

I was going to mention what happened to Doug, one of our patients that was part of the training. Doug lives in Halifax, Nova Scotia, where there’s very little access to treatment. In fact, the clinic that he was a patient of was canceled about six months ago.

So he has no support in his city. So he came to this training. It was his first in-person meeting with the public engagement committee.

And he heard Arya’s talk. You spoke about two hours about the science of obesity that first day. You talked about the brain set point.

You talked about this Canadian Medical Association defining obesity as a chronic disease. And he had never heard this. And he came back to me after his presentation and he said, Ximena, nobody has ever told me that I have a chronic disease.

Nobody, my doctor didn’t tell me. I’ve been through an obesity management program, and nobody told me that I was living with a chronic disease. And he’s like, I need to absorb this.

I need to think about this, what this means. And then an hour later, he’s like, Ximena, I’m still thinking. I’m still processing this information.

Like, this is very difficult for me. And then the next day, he came back and he’s like, I know what I can do now. He’s like, I’m going to go and talk to my minister of health in Nova Scotia.

I’m going to say this is unacceptable. I have a chronic disease. The Canadian Medical Association declared a disease.

It’s 2015. Why is it that I don’t have access to the treatment that people with diabetes have? And so it became an empowerment for him to understand that this is a chronic disease, that it was not his fault, and that he’s not alone, and that he doesn’t need to manage this on his own, and that there are evidence-based treatments, because I already talked about the treatments as well, and that he has a voice. Now he can go back and say, I am a person, and I have a chronic disease, and I am a taxpayer, and as a taxpayer, I want access to evidence-based treatments.

So I think the hopelessness, it went over. It was immediate. Like, he felt, oh, my God, I’m going to have this forever.

I don’t know what to do. But then after a couple of hours, he processed that information, and then it became an empowering thing for him. I just want you to think about that, because when you say that to somebody, a friend who has obesity or somebody else, and they have never heard this before, they’re going to look at you and say, what? What do you mean there’s no cure? What do you mean? What do you mean I have to do this forever? And so that’s the opportunity.

We have to educate the media, the public, and everybody that, yes, you can live with obesity. It is manageable. It’s not entirely hopeless, but we do need evidence-based treatments.

And I think that’s why you come in, because you are living with it, and you are managing your disease, and you are healthy, and you have good quality of life. It’s possible to live with obesity, but you need support, and you need evidence-based support. Why is diabetes always mentioned? It’s by the medical profession.

It’s sexier. It’s difficult to live with diabetes, and there’s also prejudice, I guess, people that say I should live with type 2 diabetes, because it’s your fault. Yeah, one person told me that patients with type 1 diabetes will explicitly say to you, I have type 1 diabetes, because type 2 diabetes is so stigmatic.

Yeah, it’s okay to have type 1 diabetes, but that is real diabetes. You have type 2 diabetes, but you only fight and leave if you forget. That’s all people who get that, right? But it’s mentioned a lot.

I’ve heard it a lot in the talks. It’s not always as if diabetes is tackled worldwide in a wonderful, fantastic manner, and diabetic patients have no problems at all. No, they have a lot of problems.

They have a lot of problems. So yesterday I was at their World Health Organization, the meeting that they had there, and somebody said, you know, I’m not sure I’m comfortable calling obesity a disease, because I think it will increase stigma. And I said, when we declare cancer a chronic disease, does that increase stigma for people with cancer? But cancer was never declared a chronic disease.

It’s an NCD, it’s a non-criminal disease by WHO. Yes, it’s a chronic disease. It’s an NCD in Europe as well.

Yeah. So I have a question, because one of the biggest challenges that I’ve been facing, I mean, I’m new to advocacy for obesity, but a lot of people keep saying to me, well, including my husband, you’re not an obesity patient anymore, because you’ve lost the weight through bariatric surgery. So you will be an obesity patient for life, right? Exactly, yeah.

I mean, that is like telling someone who’s diabetes, who’s blood sugar is well-controlled, you no longer have diabetes. No. You’re still a diabetes patient who’s well-controlled.

So how do you counter that when you’re dealing with the media, who basically sees you as if you don’t look like you, right? No, but you tell them, because you’re not living like a normal person. You’re living like a person who had obesity who has lost weight. Right? You’re not living like a normal person.

If you went to live like me, you’d be twice your size. I’d be very ill and die of diabetes. Right, yeah.

Exactly, right? So you’re not pure, right? You have found a treatment that has helped you control the disease, but you’re not, you’re still a patient with obesity. You have treated obesity. And you still live with obesity.

And you still live with obesity. And you could go back to obesity tomorrow if you went back to your surgeon and asked him to unstable your stomach, right, or something else happens, right? But that’s because people think obesity is a sign. Yes.

Obesity is not a sign. So there are big people and there are people who have obesity. There are people who are big who don’t have obesity.

The mental scars of obesity stay with you. You still walk into a room and see, can I fit through that gap, even though you’re a thinner? You still judge the seats. You still immediately scan and think, what can I do here? Because obesity is still in here.

It doesn’t go. But there are people who live in bigger bodies who don’t have any health impairments because of their weight, which is what Aria talked about yesterday. So I think we need to distinguish between being a big person or having a big body.

See, being a big person is not a disease. But having obesity is a disease. But how do you decide? Well, the difference is whether or not your size is affecting your health.

When your size affects your health, you have obesity. When your size does not affect your health, you’re just a big person. You’re just a big person, right? So there’s nothing wrong.

Like I’m a small person or a short person. Size is not a disease. Size is not a disease.

Even the amount of body fat is not a disease because you can have people who have a lot of body fat, and they’re pretty healthy, and they don’t even feel bad about it. If you lived in a culture where, I mean, remember, a lot of the stigma and the uncomfortability that comes is because of the social construct. Yes.

You live in a fat-phobic society. Yes. Right? And because you live in a fat-phobic society, there’s a lot of pressure to be thin.

But if you live in a society where people look down upon the skinny people, and if you lived in Africa where they’ll actually send you as a bride, oh, my wedding is next year. I need to gain 20 pounds. Otherwise, you know, my wedding night, my husband is not going to touch me.

If you live in that kind of a society, well, then you’ve got the others. Now the skinny guys are running around trying to gain weight because they are not, right? So we are living in a fat-phobic society, and so you have to kind of differentiate between what is the fat-phobia stigma part of the problem and what are the actual health implications. Now, of course, the fat-phobia problem, the stigma, can lead to health implications in two ways.

First of all, there’s a huge mental health burden, so we talk about the mental health burden of being stigmatized. If you’re living constantly in every single situation, from the minute you wake up in the morning to when you go back to bed, you’re conscious of your size, you’re ashamed of your size, you’re not comfortable, you’re afraid to go out on the street because people are going to look at you, you have to get on a plane, you don’t know if you want to sit, you have to ask for the extender. That is a constant stress level, right? Your stress levels are over here constantly the whole day.

That cannot be healthy, right? And so even if you don’t have any health problems, you are going to get health problems just from the stress. And that is why the Canadian Obesity Network says we have to work against fat-phobia as number one problem to de-stigmatize the condition because although we are not changing people’s sizes, at least we are trying to reduce the amount of stress that comes with this condition, right? It will never go away completely because, you know. Like Susan was saying, even after you lose the weight, it’s still there.

It’s always going to be there. So my definition of obesity or the obesity definition that I like is that when your body fat, and it’s not the amount of body fat, but it’s when your body fat affects your health, it becomes a disease. If it’s not affecting your health, it’s not a disease.

It’s just too much fat, right? And that’s why there’s a difference between being fat and having obesity. Being fat is like being short or being tall or being blonde or being whatever. That’s a good explanation.

Right? Yes. Right? That’s being fat, right? Yeah, I’m fat, but I don’t have obesity. How can you decide? For example, yesterday I was attending one of the talks and you mentioned the Yale study.

Yeah. Is that a good route to take to try and do the questionnaire? Yeah, I mean, I ask my patients. My patients come to me in my clinic.

I mean, my average patient that comes to me in the clinic is BMI 50, right? They’re all big patients, right? So my question to them is also, so how is your size? I mean, have you always been big, et cetera? But how is your size affecting your health? I mean, tell me specifically. And it could be I cannot tie my shoes, I cannot cross my legs, I cannot get on the floor to play with my grandchildren. Or it could be I have diabetes or I can’t lie on my back because I can’t sleep or my legs swell up or I have reflex disease or whatever the problem is.

But you tell me. I don’t know what your problem is. You tell me what your problem is.

Right? And then sometimes the problem you’re telling me, you know what, this problem we cannot solve with weight loss because no amount of weight loss is going to fix that problem. Right? So somebody might have told you. And self-esteem is one of those issues, right? No amount of weight.

You know, if you have a significant body image issue, my experience has been that for most patients losing weight does not fix that. But they will not be happy with their body image until they disappear. Okay? So I can’t fix that.

You’re going to be very, very unhappy because you’re going to have bariatric surgery, you’re going to lose 60 kilos, and you will still be unhappy. Yeah. Right? So we have to also be realistic.

Is losing weight even going to fix that problem? Because if it’s not going to fix that problem, then maybe losing weight is not the solution here. And so, but I can’t decide that. I have to, you know, that’s why you have to have a conversation.

And that’s why I’m saying you cannot define obesity based on a chart or a table or a measuring tape or a scale. You have to get to know the patient. I have to do a physical exam.

I have to talk to the patient. I have to look at the laboratory values. And then I can decide, okay, is this affecting your health or is it not affecting you? So I don’t want to keep you guys here forever, but my, I say obesity is like having a big nose.

Have you ever thought about it? No. Okay, if you live in a society where everybody has a big nose, and a big nose is seen as being something that is very attractive, then everybody wants to have a big nose, and that’s a good thing. But now imagine if you live in a society, if you have a very big nose, and you live in a society where the good thing to have is a small nose, and people with big noses, they are looked down upon, and we don’t like people with big noses.

You could be very conscious about your nose, and now your nose is going to affect your ability to, your confidence is all built on, they’re not looking at me, they’re looking at my nose. So you get very conscious about your nose. So is that a medical problem? No.

But it can be a medical problem. If you’re so conscious about your nose, then you can no longer function in society. You’re no longer leaving your house.

You’re always wearing a mask. You have no friends because you don’t even put your picture on social media because you’re so conscious. It can become a medical problem in the sense that it is now impairing you.

Or it can be a real medical problem. If your nose is actually making it more difficult for you to breathe, or you’re always getting sinus infections because of the size of your nose, it can become a medical problem. So now the question is, when does the public health system pay for your nose job? When can you go in a public healthcare system, go to a plastic surgeon and get your nose corrected? Is that just, you know, I don’t feel comfortable, I prefer smaller noses so I want to get a nose job, or is there a medical reason for getting a nose job? So when does a big nose become a disease? When it starts impairing you.

When it’s impairing your health and functioning. Well, I would say, listening, I’m struggling with, I always struggle with this one. With the nose.

No, no, no, no, I’m struggling with the difference between, when you allude to, when you mention medical problems, actually you then give a list of physical problems. No, no, so medical, so I think very holistically. So my definition is health.

So mental and physical. Mental, physical, and social well-being. Okay, yeah.

Right? And social well-being is the hardest to fix. Right? The physical health I can fix, mental health you can do, you know, psychological counseling or whatever. Social health is very difficult, because social health I’m dealing with society, I can’t fix society.

Right? So that is the most difficult aspect of this to help, right? I mean, but that’s my definition of health. So when I say health, I’m not just talking about whether you have diabetes, I’m also talking about social functioning, you know, job opportunities, and, you know, can you find a partner? Right? That’s all part of health. So it’s a very broad definition of health.

Now, when does that become enough of a problem to warrant medical care and medical intervention? That’s a whole different problem, and that depends on resources and access to services, et cetera. Right? Let’s thank our guests and our participants. Thanks very much.

Thank you. Thank you. Thank you.

Thank you. Thank you. Thank you.

Thank you. Thank you.