Viewpoint

When Advice Ignores Reality: Weight Management Inequities in Canada

by Rebecca Smythe

Graphic design by Athena Li

When thinking about weight loss advice, some common phrases may come to mind from “eat better and move more” to “make the change today”. Everyday tips for weight management often seem intuitive, however these recommendations are simply not feasible for many. Although weight management in Canada tends to be framed as an individual’s responsibility, we must recognize that weight is shaped and limited by social, structural, and institutional inequities. Lack of healthy food options, juggling responsibilities, weight stigma, and inaccessible healthcare all affect one’s ability to adhere to recommendations. 

Food Insecurity and the Illusion of Choice 

Common weight management guidance assumes an availability of abundant healthy food options; however, for one in four Canadians who are food insecure, this is not the case.1 Household food insecurity, understood as inadequate access to food due to financial constraints, is a significant public health concern that increases one’s risk for adverse health outcomes, worse overall health, and increased emergency department use.2 Studies have shown that lower income households are at higher risk of obesity, as low household income can disrupt the consistency of healthy meals and eating patterns.2 

One determinant of eating patterns is accessibility to high quality and nutrient dense foods. For example, protein content in food helps reduce calorie consumption, whereby foods higher in protein keep you satiated for longer.3 Unsurprisingly, quality foods with higher protein content end up costing more than processed foods high in fat and carbohydrates.3 Purchasing foods adhering to the Canadian guidelines for “healthy eating” results in a 9% increase of cost, translating into nearly an additional $400 CAD per adult, per year.4 

Unfortunately, many Canadians have no choice but to opt for cheaper, calorie-dense foods. This is not an individual decision but is driven by inflation and the increasing cost of living. When access to food is unstable, the “healthy balance” that many care providers recommend becomes an unattainable ideal and not an appropriate weight management intervention. 

Time Poverty, Precarious Work, and the Cost of Consistency 

Often, weight management recommendations require time devoted to being active or meal planning. Many individuals say they know how to lose weight, but cannot remain consistent due to competing responsibilities and uneven time distribution.5. Time poverty can be understood as lack of time for leisure and personal activities due to over-commitment to other requirements.7 Time is an important determinant of health, where many individuals may be limited by working multiple jobs, having long commutes, or taking on a caregiving role for a loved one.6 Common weight management recommendations such as meal preparation, calorie tracking, and regular exercise may become difficult to adhere to with such rigid time constraints. Individuals experiencing time poverty are more likely to purchase food away from home and eat sporadically, which can make it more difficult to lose weight.7 Coupled with the psychological consequences of prolonged time stress and possible sleep deprivation, multiple factors intersect making common weight loss strategies ineffective. People who have the least amount of time are often harshly criticized for “non-adherence” to weight-loss programs and being “too lazy” to contribute to their wellbeing, when this cannot be further from the case.

Weight Stigma in Healthcare and Inequitable Care Experiences  

When weight management challenges bring individuals into the clinic or hospital, health care settings can entrench inequities rather than resolve them. When enacting weight centric approaches, body mass index (BMI) is often used despite being an inaccurate indicator of metabolic health.8 BMI, initially developed in the 1830s with the goal to establish the “average man”, used samples of height and weight from exclusively Caucasian, Belgian men.9 This limits the transferability of findings, particularly in people of color and women. Moreover, BMI’s failure to consider body composition and fat distribution restricts its use as a proxy for health.8,9 Despite this, BMI continues to be used and perpetuates clinical weight stigma, emphasizing weight management as a primary health outcome.8 Through this lens, symptoms can be dismissed as “weight complications” resulting in delayed diagnosis and shame during clinical encounters. 

While trust between healthcare providers and their patients is crucial, this relationship may be weakened by weight stigma.9 Providers may judge patients for their size, and in these cases, patients have been found to receive less respect from their providers, receive less explanation about interventions, and experience decreased involvement in care, ultimately making the patients less adherent to weight loss initiatives.9 Stigma disproportionately affects women, marginalized individuals, people with disabilities, and those in larger bodies,10 compounding existing barriers to care and resulting in worse short- and long-term health outcomes. 

Access to Care and Personal Responsibility Narratives  

Support for weight management in Canada is unfortunately fragmented and inaccessible. There is a severe lack of public health coverage for dietitians, nutritionists, and medications.5 These disparities extend to geographic distribution of care provisions, notably concentrated in urban settings compared to rural communities.5 Effective care is available, but is not widely accessible, which disproportionately impacts who receives best practice. 

The dominant cultural narrative around weight management and obesity surrounds personal irresponsibility, casting blame and shame on individuals living in larger bodies.5 Public health messaging often underscores behavior change as the key driver in weight management, which absolves institutions of their responsibility in the matter and further justifies underinvestment in social support. Weight management is a collective societal issue and when responsibility is individualized, inequities are silently amplified. 

Breaking Barriers in Weight Management 

We need to understand that weight is not the sole defining factor of health, and it is shaped by several intersecting factors such as income, social support networks, personal health practices, ethnicity, and ability.11 Intervention emphasis should be placed on upstream systemic and regulatory changes, through national initiatives, rather than individual fixes. Recent changes in Canada’s healthy eating strategy have showcased promising advancements through improving healthy eating information and nutrition quality, while protecting vulnerable populations, however this is still a work in progress.12 We need to consider food security policies, income supports, publicly funded multidisciplinary care, and stigma-informed training. Resolving this issue is not about abandoning weight management goals; rather it will involve breaking down barriers and changing societal discourse around weight management overall. 

References

  1. Food Banks Canada. Hunger by the Numbers. Food Banks Canada [Internet]. 2026 [Cited 2026 Feb 25]. Available from https://foodbankscanada.ca/hunger-in-canada/
  2. Fafard St-Germain AA, Hutchinson J, Tarasuk V. The relationship between household food insecurity or obesity among children and adults in Canada: a population-based, propensity score weighting analysis. Applied Physiology, Nutrition, and Metabolism. 2024;49(4):473-486. doi: 10.1139/apnm-2023-0302.
  3. Cabeza de Baca T, Piaggi P, Gluck ME, et al. Meal-to-meal and day-to-day macronutrient variation in an ad libitum vending food paradigm. Appetite. 2022; 171: 105944. doi: 10.1016/j.appet.2022.105944
  4. Rochefort G, Brassard D, Paqette MC, et al. Adhering to Canada’s food guide recommendations on healthy food choices increases the daily diet cost: insights from the PREDISE study. Nutrients. 2022;14(18):3818. doi: 10.3390/nu14183818
  5. Sharma AM, Belanger A, Carson V, et al. Perceptions of barriers to effective obesity management in Canada: Results from the ACTION study. Clinical Obesity. 2019;9(5):e12329. doi: 10.1111/cob.12329
  6. Oostenach LH, Lamb KE, Crawford D, et al. Influence of work hours and commute time on food practices: a longitudinal analysis of the household, income, and labour dynamics in Australia survey. BMJ Open. 2022;12(5):e056212. doi: 10.1136/bmjopen-2021-056212.
  7. Koomson I, Martey E, Temoso O. Employment-related time poverty, tim stress and food away from home behaviour: Panel evidence from Australia. Appetite. 2025;204. doi: 10.1016/j.appet.2024.107734.
  8. Levinson JA, Clifford D, Laing EM, et al. Weight-Inclusive Approaches to Nutrition and Dietetics: A Needed Paradigm Shift. Journal of Nutrition Education and Behavior. 2024;56(12):923-930. https://doi.org/10.1016/j.jneb.2024.07.007
  9. D’Arpino E, Kardong-Edgren S. From education to patient care: the impact of weight stigma in healthcare. Baylor University Medical Center Proceedings. 2025;38(5):769-778.  doi: 10.1080/08998280.2025.2528397
  10. Abrams Z. The burden of weight stigma. American Psychological Association [Internet]. 2022 [Cited 2026 Feb 8]. Available from https://www.apa.org/monitor/2022/03/news-weight-stigma
  11. Kasten G. Listen.. And Speak: A discussion of weight bias, its intersections with homophobia, racism, and misogyny, and their impacts on health. Canadian Journal of Dietetic Practice and Research. 2018;79(3):133-138. doi: 10.3148/cjdpr-2018-023.
  12. Government of Canada. Health Canada’s healthy eating strategy. Government of Canada [Internet]. 2026 [Cited 2026 Feb 15]. Available from https://www.canada.ca/en/health-canada/services/food-nutrition/healthy-eating-strategy.html