1) The author predicts that obesity rates, especially severe obesity, will increase in 2009 due to factors related to the economic downturn such as more sedentary behaviors and consumption of cheap calorie-dense foods. 2) Some public health attempts at obesity prevention through policies like taxes on sugary drinks and calorie labeling may occur but will not reduce obesity rates in the short-term. 3) Obesity will increasingly be recognized as a chronic condition, leading to more support for obesity treatments, especially for those with severe obesity. Exponential growth in demand for bariatric surgery is also predicted.

1. Obesity in 2009

2. I know I may be going out on a limb here but perhaps it would be a bit of fun to make a few predictions on what may happen with regard to obesity in 2009. Of course, at the end of the year, we can check to see how accurate my forecast was. So here I go:

3. The economic downturn will not lead to lower obesity rates If anything, I predict that obesity rates (especially severe obesity) will get worse. Lots of reasons for that – more people sitting at home in front of their TVs reaching for comfort food and drink (including more cheap alcohol). Restaurants will do all they can to retain increasingly cost-conscious customers with two-for-one, kids-eat-free, and all-you-can-eat “value” deals. Consumption of energy-dense fast foods will go up, more people with skip meals (only to overeat at supper), and some will have no choice but to save on fresh produce. Some may cancel gym and club memberships or save on sporting equipment and fees. For someone looking into an economic abyss, health and weight is unlikely to be top of mind.

4. There will be more public health attempts at prevention Canada or at least a few provinces may consider following some of the recent initiatives seen in the USA including taxation of sugary pop, calories on menus, and more restrictions on advertising and sale of junk and snack foods to kids. Will this reduce obesity rates - well, definitely not in the foreseeable future.

5. Obesity will be increasingly recognized as a chronic condition the “root cause” of the “chronic diseases of the young” (a term I use to describe the fact that we will continue to see more and more obesity-related chronic conditions (diabetes, hypertension, back pain, sleep apnea, reflux, etc.) in younger and younger adults – a trend virtually entirely due to the increase in obesity rates). I predict that this recognition will at long last lead to health systems and health professionals realising that obesity needs to be addressed within the same framework and with the same strategies as every other chronic disease. Various provinces will begin looking at and supporting obesity treatments – especially for individuals with severe obesity. (I may be too optimistic on this one!)

6. There will be an exponential growth in demand for bariatric surgery With the continuing expansion of the data on the remarkable outcomes and cost-effectiveness of modern obesity surgery, the public will demand more surgery and the health system will be seriously challenged to provide more access. As more patients benefit, nay-sayers within the health system will lose ground – more surgeons, but also more physicians and allied health professionals, will want to jump on the surgery bandwagon.

7. The use of pharmacological treatment for obesity will remain modest However those who treat obesity will use more “off-label” medications, those who have not prescribed anti-obesity drugs in the past may begin reaching for their prescription pads more often (especially with new data on older anti-obesity drugs expected this year). Lack of coverage and reimbursement for anti-obesity medications (an expression of weight-bias?) will continue to prove an important barrier.

8. Conclusion There may be a number of other obesity trends but none of these trends will be strong enough to make a significant dent in the problem. Increasing use of meal replacements and formula diets may be used for what I have called “rescue therapy”. The continuing increase in severe obesity will drive a notable demand for bariatric aids, equipment and support. The public-access discussion (I see last-year’s ruling on airline seats as just the beginning) will lead to a continuing and heated debate about whether or not obesity is a self-inflicted matter of choice (it is not!) or deserves the same consideration as “real” disabilities (it does!). The commercial weight-loss industry will continue raking in profits by largely selling products and services that don’t work (the only guaranteed outcome is weight regain!). Researchers (or rather the media) will continue proclaiming new genes and novel molecular targets that could lead to the ultimate obesity “cure”, but I do not expect any revolutionary breakthroughs that will quickly make treatment for the common “garden-variety” obesity more effective or widespread. We will however continue to be amazed by the complexity of the web of bio-psycho-social factors that affect body weight and makes obesity management one of the greatest health care challenge of our time.

9. About Dr. Arya M. Sharma Dr. Arya M. Sharma, MD/PhD, FRCPC is Professor of Medicine & Chair for Obesity Research and Management at the University of Alberta, Edmonton, Canada. He is also the Medical Director of the Edmonton Capital Health Region’s interdisciplinary Weight Wise Program. Dr. Sharma is also the Scientific Director of the Canadian Obesity Network funded through the federal "Networks of Centres"ofExcellence program. Dr. Sharma has authored and co-authored more than 250 scientific articles and has lectured widely on the etiology and management of obesity and related cardiovascular disorders. He sends his informative messages through his blog Dr. Sharma’s Obesity Notes. For more information on Obesity visit; http://www.drsharma.ca/