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POINTS CLES L’obesite est une maladie chronique complexe dans laquelle la graisse corporelle anormale ou excessive (adiposite) nuit a la sante, augmente le risque de complications medicales a long terme et reduit la duree de vie[1][1]. Les etudes epidemiologiques definissent l’obe

KEY POINTS Obesity is a complex chronic disease in which abnormal or excess body fat (adiposity) impairs health, increases the risk of long-term medical complications and reduces lifespan.[1][1] Epidemiologic studies define obesity using the body mass index (BMI; weight/height2), which can stratify

Background Obesity is a chronic problem in Canada and although the Canadian Medical Association recognizes obesity as a disease, health care professionals (HCPs) are not necessarily proactively managing it as one. This study aimed to assess current obesity management knowledge and practices of Canadian family physicians (FPs) and evaluate the feasibility of an online self-directed learning platform, i-ACT™ in Obesity, in delivering learning and changing practice intentions to advance obesity management. Methods i-ACT™ in Obesity is an online self-directed learning program designed by Canadian obesity medicine experts to provide individualized learning curricula to participants. One hundred FPs, with an interest in weight management and managing patients with obesity, were recruited across Canada to participate in a pilot study. FP education was delivered in a stepwise manner. Each participant completed a practice profile assessment to determine knowledge gaps and educational needs. Learners then watched didactic videos across disciplines on topics assigned to their curriculum by the program algorithm based on the relative difference between indicated and desired current knowledge. FPs also completed 10 retrospective patient assessments to assess clinical management practices and planned behaviour change. Feasibility, acceptability, and satisfaction of the learning program were assessed to formulate the rationale for a more widespread deployment in the future. Survey responses and related data were analyzed using comparative measures and descriptive statistics. Results The program was piloted by ninety-one Canadian FPs, where 900 patients were assessed. FPs showed distinct differences between their current and desired levels of comfort in a variety of obesity-related topics. Participation was associated with an intention to use more obesity treatment interventions moving forward. The program received an overall satisfaction rating of 8.6 out of 10 and 100% of the evaluators indicated that they would recommend it to their colleagues. Conclusion The program was overall well received and successfully changed obesity management intentions among participating FPs, thus setting the stage for a larger more comprehensive study to examine the efficacy of i-ACT™ in Obesity in addressing knowledge gaps and advancing evidence-based, guidelines-aligned approach to obesity treatment.

Health research in Canada carries a history of exploitation and cultural insensitivity in its approaches, resulting in a deeply rooted mistrust among Indigenous Peoples. Communities are signalling the urgent need for health research to be conducted in a more conscientious way. To address these gaps, our team of three Elders and three researchers co-developed a series of workshops in the province of British Columbia, Canada, in 2019 to increase participants’ knowledge and skills for conducting culturally responsive health research. Workshops examined power and privilege; self-awareness/self-reflection; Indigenous and Western worldviews; cultural safety; allyship; and research principles and practices. Activities were experiential and privileged Indigenous knowledges. An Indigenous-informed evaluation captured participants’ experiences via online surveys. Participants described workshop learnings as deeply impacting ways they approach research practice. Thematic analysis of participant reflections revealed three overarching themes: bringing together the mind and the heart; self-reflection and initiating change; and understanding cultural safety as a lifelong journey. Lessons learned by facilitators included the importance of applying Indigenous ways of knowing to create safe spaces for healing and learning; empowering participants to critically self-reflect; and rooting the work in ceremony. The ethical responsibility to allow time and space for meaningful dialogue was crucial for aligning with Indigenous protocols of coming together. This project demonstrates that experiential workshops, co- facilitated by Elders and researchers, are an innovative, effective, and Indigenous-centred approach for providing education on how to engage in culturally safe and culturally resonant research.

Summary Obesity is a chronic disease with a significant and growing impact on Canadians. The “Awareness, Care and Treatment In Obesity MaNagement” (ACTION) Study investigated perceptions, attitudes and perceived barriers to obesity management among Canadian people with obesity (PwO), healthcare providers (HCPs) and employers. In this study adult PwO (body mass index ≥30 kg/m2, based on self‐reported height/weight), HCPs (physicians and allied HCPs managing PwO) and employers (≥20 employees; offering health insurance), completed online surveys between 3 August and 11 October 2017 in a cross‐sectional design. Survey respondents (N = 2545) included 2000 PwO, 395 HCPs and 150 employers. Obesity was viewed as a “chronic medical condition” by most PwO (60%), HCPs (94%) and employers (71%) and deemed to have a large impact on overall health (74%, 78%, 81%, respectively). Many PwO (74%) believed weight management was their own responsibility. While PwO (55%) reportedly knew how to manage their weight, only 10% reported maintaining ≥10% weight reduction for >1 year. Despite low success rates, the most commonly reported effective long‐term weight loss methods tried and/or recommended were “improvements in eating habits” (PwO 38%; HCP 63%) and “being more active” (PwO 39%; HCP 54%). PwO and HCPs reported very different perceptions of the quality and content of their interaction during obesity management discussions. These findings highlight the communication gaps and misunderstanding between PwO, HCPs and employers. This underscores the importance of, and need for, evidence‐based management of obesity and a collaborative approach and understanding of the complex nature of this chronic disease.

Major, complex, multi-casualty incidents occur with surprising regularity and previously, the command of these from a health perspective was often delegated to those with the most experience. Time served in the ambulance service was often the measure of one's ability to take command of such an event. The police and fire and rescue services have long established training programmes for their commanders. This training is in addition to their normal day job and is specific to incident command. Police and fire officers can only perform in that role if they have successfully completed the training required. The same cannot be said of health incident commanders.