Canada's obesity care guidelines are globally renowned, yet many Canadians still face long wait times for treatment. Despite the country's leadership in shaping this global shift, progress at home remains slow and uneven. The World Health Organization (WHO) has recently released its first-ever guideline on anti-obesity medications, reinforcing a chronic disease model of care that Canadian experts have championed for years. This mirrors the Canadian framework laid out in 2020 clinical guidelines, which emphasizes that obesity is a chronic, relapsing disease requiring comprehensive, lifelong care. However, despite Canada's investment in obesity research and development of forward-thinking, science-backed approaches, system-wide implementation remains painfully slow. The paradox lies in the fact that while the world begins to follow Canada's lead on paper, most Canadians living with obesity still cannot access the level of care these very guidelines envision. Public coverage for anti-obesity medications remains limited and inconsistent across provinces, and private coverage reaches only a minority. Training gaps compound these access issues, and bariatric surgery capacity has been sharply constrained. To improve the system, more provinces need to recognize obesity as a chronic disease nationwide, and a coordinated federal-provincial-territorial framework should be implemented to ensure the guidelines are applied in practice. Ultimately, before we can improve the lives of our people, we need to improve the system that is supposed to care for them.
