One of the things Sheryl Rasband learned as part of her recovery from anorexia was that she shouldn’t actively try to lose weight. That’s why she was a little taken aback when her psychiatrist suggested she might want to try Ozempic.
“I want to give him the benefit of the doubt because I was expressing my anxiety about my weight…. However, he knows my history,” she said.
The 40-year-old nurse and mother who lives in Utah County, Utah, has struggled with an eating disorder since she was 16, and said her weight has gone up and down since then.
When she was at her lowest point she had to be hospitalized and even temporarily lost custody of her children as a result, she said.
Now, after going through extensive treatment, Rasband said she feels much better mentally, even though she is technically obese according to her Body Mass Index. (BMI is a measurement that some doctors use to determine healthy weight, though it has been challenged as an indicator of health.)
Sheryl Rasband’s psychiatrist prescribed her a number of weight loss drugs including Ozempic which she didn’t take out of fear it would trigger her anorexia. (Shelby Winterton)
“I feel like I am more healthy, more functional, more everything at this weight versus when I’m at a lower weight and I’m in and out of treatment and I am suicidal.”
People who work in the field of eating disorder treatment in Canada say what Rasband has experienced is happening in this country, too, and they are raising the alarm that their patients are being prescribed weight loss drugs without proper screening or counselling.
Risks for people with eating disorders
Anita Federici, a clinical psychologist adjunct professor at York University, has noticed this trend.
“My grave concern is a movement that I’m seeing where physicians are prescribing drugs like Ozempic to people with eating disorders, and … providing false education, that these are front-line treatments for things like binge-eating disorder or bulimia nervosa, which they are absolutely not,” said Federici, who has a PhD in psychology and is also a fellow of the Academy for Eating Disorders.
Clinical psychologist Anita Federici says doctors in Canada are prescribing Ozempic to people with eating disorders. (Paul Howard)
While there are no data to show how many of the 3.5 million Ozempic prescriptions written in Canada last year went to people who have history of eating disorders, Federici said that a number of her patients are on Ozempic and that she’s worried, not just about their mental well-being, but also their physical health.
Of particular concern are patients who have what is sometimes called “atypical anorexia,” she said, because although they might have a BMI that puts them in the category of overweight or obese, they are in fact starving themselves a lot of the time and are at risk of becoming malnourished if they use a weight loss drug.
“You’re medically compromised. And now the danger is that the person with, quote unquote, atypical anorexia or binge-eating disorder walks into the physician’s office and is increasingly being prescribed Ozempic,” said Federici.
An Ozempic billboard, seen in London, Ont., outside a skincare clinic in the city’s northwest end. (Kate Dubinski/CBC News)
‘Doctor-supervised starvation’
This is something that concerns clinical psychologist Jennifer Mills as well.
She’s a professor who studies eating disorders in the Department of Psychology at York University.
Mills said that a drug like Ozempic could even trigger an eating disorder in someone “who is predisposed to having that kind of reaction,” and that patients need to be carefully monitored during what is “almost like doctor-supervised starvation.”
She said there have been some documented cases where people who have had weight-loss surgery or taken weight loss drugs, where it’s triggered “an anorexia nervosa-like reaction.”
“Sometimes when people lose weight drastically, they can develop a distorted sense of what their bodies look like. It’s almost as if their brain has a hard time catching up to the physical weight loss, and … perhaps an excessive fear of gaining the weight back or not being thin enough,” said Mills, who has a PhD in psychology.
Jennifer Mills, a professor who studies eating disorders in the Department of Psychology at York University, says Ozempic could induce an anorexia-like reaction in some patients. (Horst Herget Photography)
One issue, she said, is that doctors and psychologists don’t always agree on the best approach to weight loss.
For example, Mills says she believes that people can be healthy at any size and encourages her clients to adopt that perspective, too.
“I preach that to my patients and yet it is at odds with this kind of buzz and hysteria around a drug that makes it really easy to lose weight.”
A ‘valuable’ drug for some
But for doctors of patients with diabetes, weight loss can be a desired byproduct of using Ozempic.
“We have an obesity epidemic…. That’s why we have a diabetes epidemic,” said Dr. Stewart Harris.
He’s a professor in the Department of Family Medicine at Western University’s Schulich School of Medicine and Dentistry, and medical director of the primary care diabetes support program at Saint Joseph’s Health Care in London, Ont.
“From a purely clinical diabetes perspective [Ozempic] is a very valuable drug in … our toolbox.”
Dr. Stewart Harris says drugs like Ozempic are extremely important in the treatment of diabetes and can be prescribed safely to someone with an eating disorder if done with proper precautions. (Western University)
And, he said, Ozempic can even be safely prescribed to someone with an eating disorder if the proper precautions are taken.
“If I know … somebody has a binge-eating history or has mental health issues, I’m going to be much more judicious and careful as to whether I even initiate this therapeutic option, or how I’m going to do it or how I’m going to monitor them,” said Harris.
“I’m very selective and careful in all people that I put this therapy on, but especially in people that I’m concerned about where there may be more adverse outcomes associated with people’s eating disorders.”
He said he doesn’t want to point fingers but he knows not every doctor does this.
“You [can] just pop into a health promotion clinic that’s selling diets and other lifestyle and things … and they just off-the-cuff give you a prescription without knowing who you are and what your clinical history is…. Then I think that’s where people are running into trouble,” he said.
Sad and scared
Sheryl Rasband said she still isn’t sure whether she’s going to try Ozempic like her psychiatrist suggested.
Although she’s much happier living without an eating disorder, she’s not certain it won’t return with the pressure she feels to take weight-loss medication.
“It’s just so sad that it’s catching me after all of these things that my eating disorder has done, and it’s bringing it back.”
She’s also afraid that she is not the only one struggling with this difficult decision.
“If it has me questioning, and it has all these other people who are like me questioning what their values are and what their priorities are for this publicly pushed weight loss medication, I feel scared for the population at large.”
The Canadian government says it will donate up to 200,000 vaccine doses to fight the mpox outbreak in Congo and other African countries.
It says the donated doses of Imvamune will come from Canada’s existing supply and will not affect the country’s preparedness for mpox cases in this country.
Minister of Health Mark Holland says the donation “will help to protect those in the most affected regions of Africa and will help prevent further spread of the virus.”
Dr. Madhukar Pai, Canada research chair in epidemiology and global health, says although the donation is welcome, it is a very small portion of the estimated 10 million vaccine doses needed to control the outbreak.
Vaccine donations from wealthier countries have only recently started arriving in Africa, almost a month after the World Health Organization declared the mpox outbreak a public health emergency of international concern.
A few days after the declaration in August, Global Affairs Canada announced a contribution of $1 million for mpox surveillance, diagnostic tools, research and community awareness in Africa.
On Thursday, the Africa Centres for Disease Control and Prevention said mpox is still on the rise and that testing rates are “insufficient” across the continent.
Jason Kindrachuk, Canada research chair in emerging viruses at the University of Manitoba, said donating vaccines, in addition to supporting surveillance and diagnostic tests, is “massively important.”
But Kindrachuk, who has worked on the ground in Congo during the epidemic, also said that the international response to the mpox outbreak is “better late than never (but) better never late.”
“It would have been fantastic for us globally to not be in this position by having provided doses a much, much longer time prior than when we are,” he said, noting that the outbreak of clade I mpox in Congo started in early 2023.
Clade II mpox, endemic in regions of West Africa, came to the world’s attention even earlier — in 2022 — as that strain of virus spread to other countries, including Canada.
Two doses are recommended for mpox vaccination, so the donation may only benefit 100,000 people, Pai said.
Pai questioned whether Canada is contributing enough, as the federal government hasn’t said what percentage of its mpox vaccine stockpile it is donating.
“Small donations are simply not going to help end this crisis. We need to show greater solidarity and support,” he said in an email.
“That is the biggest lesson from the COVID-19 pandemic — our collective safety is tied with that of other nations.”
This report by The Canadian Press was first published Sept. 13, 2024.
Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.
HALIFAX – The Nova Scotia government says it could be months before it reveals how many people are on the wait-list for a family doctor.
The head of the province’s health authority told reporters Wednesday that the government won’t release updated data until the 160,000 people who were on the wait-list in June are contacted to verify whether they still need primary care.
Karen Oldfield said Nova Scotia Health is working on validating the primary care wait-list data before posting new numbers, and that work may take a matter of months. The most recent public wait-list figures are from June 1, when 160,234 people, or about 16 per cent of the population, were on it.
“It’s going to take time to make 160,000 calls,” Oldfield said. “We are not talking weeks, we are talking months.”
The interim CEO and president of Nova Scotia Health said people on the list are being asked where they live, whether they still need a family doctor, and to give an update on their health.
A spokesperson with the province’s Health Department says the government and its health authority are “working hard” to turn the wait-list registry into a useful tool, adding that the data will be shared once it is validated.
Nova Scotia’s NDP are calling on Premier Tim Houston to immediately release statistics on how many people are looking for a family doctor. On Tuesday, the NDP introduced a bill that would require the health minister to make the number public every month.
“It is unacceptable for the list to be more than three months out of date,” NDP Leader Claudia Chender said Tuesday.
Chender said releasing this data regularly is vital so Nova Scotians can track the government’s progress on its main 2021 campaign promise: fixing health care.
The number of people in need of a family doctor has more than doubled between the 2021 summer election campaign and June 2024. Since September 2021 about 300 doctors have been added to the provincial health system, the Health Department said.
“We’ll know if Tim Houston is keeping his 2021 election promise to fix health care when Nova Scotians are attached to primary care,” Chender said.
This report by The Canadian Press was first published Sept. 11, 2024.
ST. JOHN’S, N.L. – Newfoundland and Labrador‘s chief medical officer is monitoring the rise of whooping cough infections across the province as cases of the highly contagious disease continue to grow across Canada.
Dr. Janice Fitzgerald says that so far this year, the province has recorded 230 confirmed cases of the vaccine-preventable respiratory tract infection, also known as pertussis.
Late last month, Quebec reported more than 11,000 cases during the same time period, while Ontario counted 470 cases, well above the five-year average of 98. In Quebec, the majority of patients are between the ages of 10 and 14.
Meanwhile, New Brunswick has declared a whooping cough outbreak across the province. A total of 141 cases were reported by last month, exceeding the five-year average of 34.
The disease can lead to severe complications among vulnerable populations including infants, who are at the highest risk of suffering from complications like pneumonia and seizures. Symptoms may start with a runny nose, mild fever and cough, then progress to severe coughing accompanied by a distinctive “whooping” sound during inhalation.
“The public, especially pregnant people and those in close contact with infants, are encouraged to be aware of symptoms related to pertussis and to ensure vaccinations are up to date,” Newfoundland and Labrador’s Health Department said in a statement.
Whooping cough can be treated with antibiotics, but vaccination is the most effective way to control the spread of the disease. As a result, the province has expanded immunization efforts this school year. While booster doses are already offered in Grade 9, the vaccine is now being offered to Grade 8 students as well.
Public health officials say whooping cough is a cyclical disease that increases every two to five or six years.
Meanwhile, New Brunswick’s acting chief medical officer of health expects the current case count to get worse before tapering off.
A rise in whooping cough cases has also been reported in the United States and elsewhere. The Pan American Health Organization issued an alert in July encouraging countries to ramp up their surveillance and vaccination coverage.
This report by The Canadian Press was first published Sept. 10, 2024.
