Here at Winterberry our mission is to help patients live their best life and our Medical Director, Dr. Steven Zizzo, is our guide and visionary. Today we’re congratulating him on being honoured with prestigious awards from CFPC, OCFP and OntarioMD for his contributions toward COVID-19, obesity medicine and virtual care.

The College of Family Physicians of Canada (CFCP) Award of Excellence which recognizes an exceptional accomplishment or innovation achieved in the past 24 months in a specific area pertaining to the specialty of family medicine.

The Ontario College of Family Physicians (OCFP) Award of Excellence celebrates the outstanding skill, knowledge and dedication of family doctors across Ontario through the 2022 Awards program. The recipients showcase the vital work family doctors do to help keep Ontarians healthy.

The OntarioMD Luminary Award which is awarded to Dr. Steven Zizzo for having shown innovative use of certified electronic medical records (EMRs) and other digital and virtual care tools to enhance patient care.

These awards are given in recognition of Dr. Steven Zizzo’s medical excellence and vision as well as for leading the Winterberry Family Medicine team in inoculating 31,000 (and counting) Hamiltonians with COVID-19 vaccines.

Dr. Steven Zizzo attended the award ceremonies virtually and was excited to accept the honours on behalf of himself and the entire team of caring and skilled professionals at Winterberry Family Medicine.

To find out more about Dr. Steven Zizzo and Winterberry visit www.WinterberryMedical.ca

According to Dr. Sue Pederson, a medical doctor, Specialist in Endocrinology & Metabolism, and a Diplomate of the American Board of Obesity Medicine:

The American Diabetes Association (ADA), in conjunction with the European Association for the Study of Diabetes (EASD), have just released their joint Consensus Report at the EASD meeting in Stockholm, published simultanously in Diabetes Care.

This rich and beautiful Consensus Statement covers the gamut of treatment of type 2 diabetes, which is far beyond the scope of a single blog post.

What I want to focus on today is a true turning point in how we approach treatment of type 2 diabetes.   Until now, guidelines for which medications to recommend for type 2 diabetes focus on protection of the heart and kidneys, and blood sugar control.  While these remain extremely important goals of treatment, they are now joined by another primary target in treatment: weight management.

As the authors note, weight loss had previously been viewed mostly as a strategy to improve blood sugars and reduce the risk of other health complications associated with elevated weight.  With weight loss now identified as a primary treatment target in people with type 2 diabetes and elevated weight, they point out that:

  • the greater the weight loss, the greater the benefit
  • 5-10% weight loss confers metabolic improvement (eg sugars, cholesterol, blood pressure)
  • weight loss of 10-15% or more can result in remission of type 2 diabetes
  • weight loss can improve cardiometabolic risk factors and, importantly, can improve quality of life.

As far as how to lose weight, the consensus statement points out/advises:

  • There is no single ratio of carb:protein:fat intake that is optimal for every person.
  • Construct an overall healthy eating plan that results in less calories in than out.
  • The use of glucose-lowering medications that provide significant weight loss, particularly the GLP1 receptor agonists with high weight loss efficacy, should be considered, as they can provide 10-15% weight loss or more.
  • Weight loss medications, in addition to lifestyle change, can reduce weight and improve diabetes control.
  • Bariatric (metabolic) surgery should be considered for people who are appropriate candidates.  It is most effective early during diabetes.

In accordance with the triple priorities of heart/kidney protection, glucose control, and weight loss, the consensus statement no longer recommends metformin as the default first line treatmentas the benefits of GLP1 receptor agonists and SGLT2i inhibitors for all three treatment targets often make these medications more appropriate to use first (see figure 3, page 13).

Again, I emphasize that there are so many important aspects to this update, including particular focus on taking each person’s social circumstances into account, supporting patients in self management, physical behaviors through the 24-hour clock (including a brand new section on sleep!), a new section on fatty liver disease, and so much more!

Diabetes Canada was not part of this consensus statement, but I’m certain that it will be a hot topic of discussion at our upcoming Diabetes Canada professional conference.

Watch the video Dr.Sue shared on her site DrSue.ca

We’re excited that our new online appointment booking system is faster and easier to use than our previous system.

To make it as simple as possible for you to book your next appointment we’re sharing “The Oceans Patient Guide To Online Booking”. This Guide gives you information on our new booking system and clear, easy to understand instructions to read as well as a simple, 2 minute video to watch.

Visit this link:

Ready to book your next appointment using our new online booking system? Simply click here to get started.

If you have any questions about our new online booking system please call us to discuss and we will be happy to help you!

By Cara Murez
HealthDay Reporter

TUESDAY, July 5, 2022 (HealthDay News) — The obesity epidemic isn’t slowing down anytime soon, and new research delivers even worse news: Most American adults have not only gained more weight, but they gained most of it earlier in life.

The statistics were grim: More than half of Americans in the representative sample had gained 5% or more body weight during a 10-year period. More than one-third of Americans had gained 10% or more body weight. And nearly one-fifth had gained 20% or more body weight.

It got worse: People were gaining more substantial amounts of weight earlier in adulthood, thus carrying more of that extra weight for more years, researchers found.

This pattern was surprising, said study author Larry Tucker, a professor of exercise science at Brigham Young University in Salt Lake City, Utah. “What people don’t realize is that most of that weight, the actual gaining of weight, is highest at a younger age.”

In the study, his team culled data from the National Health and Nutrition Examination Survey (NHANES) on 10-year weight change patterns of more than 13,800 U.S. adults.

In 2000, about 30.5% of adult Americans were obese. By 2017-2018, the U.S. Centers for Disease Control and Prevention estimated that about 42.4% of adult Americans had reached that weight.

Those extra pounds were packed on in early adulthood: The average American gained about 17.6 pounds from their mid-20s to mid-30s, the study found. Meanwhile, the average person gained about 14.3 pounds between their 30s and 40s, 9.5 pounds between their 40s and 50s, and 4.6 pounds between their 50s and 60s.

Women gained twice as much weight as men, 12 pounds, on average, compared to about 6 pounds. Black women had the greatest average weight gain over 10 years, about 19.4 pounds.

Reasons for the nationwide increase vary, Tucker said. The environment people live and eat in is far different from what it was 50 or 100 years ago. Obesity rates didn’t start climbing until the late 1970s or early 1980s, he explained.

“That’s because very rapidly a few things happened,” Tucker said. “That’s when fast food became prevalent. Before, people were more in control of what they ate. People sat down and had meals. People planned ahead. ‘What are you going to eat? What are you having for supper tonight?'”

Picking up what is admittedly a tasty fast meal, but loaded with calories, makes it hard for a person to control what they’re eating, he said.

“It takes a very conscientious person to work around that. I do this for a living and I’m lean, but it’s because I’m very much aware of the situation,” Tucker said.

The findings were published recently in the Journal of Obesity .

Dr. Ethan Lazarus, president of the Obesity Medicine Association, said he had not seen the issue of obesity studied in this way before.

“It definitely points to the idea that obesity is not an equal opportunity employer. It’s unfortunately disproportionately affecting already marginalized groups with less access to care,” noted Lazarus, who was not part of the study.

One reason for the greater impact on women may be that they have experienced more environmental changes than men have in the last five decades, with greater numbers in the workforce and also caring for families, he said.

“I think you see a lot published these days about higher levels of stress and lower amounts of sleep, and more time sitting and more time staring at computer screens,” Lazarus said. “That’s become the normal American job is to sit in front of a computer all day and then we get home and we’re so tired all we can do is sit on the couch and play with the phone. It’s like we’re never unplugged.”

Lazarus also pointed to the foods Americans eat, coming from a box with high quantities of sugar and little nutritional value, as a factor.

“What we look at as a normal diet in America, I think is fueling this epidemic,” Lazarus said.

He suggested rethinking values of making money and working more hours and instead refocusing on personal health.

For those who are already living with obesity, the Obesity Medicine Association suggests healthy nutrition, counseling on physical activity and what it calls intensive lifestyle intervention, which addresses issues that lead to weight gain, such as stresssleep deprivation and social events. A variety of new medications can also target obesity, Lazarus said.

For people with more advanced or more complicated obesity, there are surgical options, Lazarus said.

Tucker said he would like to see more education based on well-established principles of healthy eating from a young age, including not rewarding young people with food and encouraging fruits and vegetables.

“I think knowing at a young age with the medical community involved, with schools involved, we don’t want people to become obsessed and think that their worth is in their weight,” Tucker noted.

“That’s not healthy, but at the same time, we want them to realize that it’s hard to be healthy,” he said. “It’s hard to prevent diabetes. It’s hard to prevent heart disease if people continue to gain weight and become obese.”

More information

The U.S. Centers for Disease Control and Prevention has more on overweight and obesity.

SOURCES: Larry Tucker, PhD, professor, exercise science, Brigham Young University, Provo, Utah; Ethan Lazarus, MD, president, Obesity Medicine Association, and physician, Clinical Nutrition Center, Greenwood Village, Colo.; Journal of Obesity, May 6, 2022

TORONTO — The Ontario government, in consultation with the Chief Medical Officer of Health, is expanding eligibility for second booster doses to Ontarians aged 18 and over in order to provide an extra layer of protection to those who may need it.

Starting on Thursday, July 14 at 8:00 a.m., eligible individuals can book an appointment through the COVID-19 vaccination portal or by calling the Provincial Vaccine Contact Centre at 1-833-943-3900. Eligible individuals can also book an appointment directly through public health units that use their own booking systems, through Indigenous-led vaccination clinics and participating pharmacies. Appointments are based on availability, which may vary by region.

“As we continue to manage COVID-19 for the long term, we’re expanding second booster doses and extending the availability of free rapid antigen tests to give people the tools they need to stay safe and to ensure Ontario stays open,” said Sylvia Jones, Deputy Premier and Minister of Health. “Vaccines continue to be our best defence against COVID-19 and protecting our hospital capacity for those who need it most.”

Second booster doses are being offered at an interval of five months after an individual receives their first booster dose. While most individuals aged 18 to 59 years old will continue to have strong protection more than six months after their first booster dose, expanding second booster dose eligibility will ensure that Ontarians can make an informed decision based on their personal circumstances. A new bivalent COVID-19 vaccine is anticipated to be approved by Health Canada this fall, which may offer more targeted protection against the Omicron variants. Ontarians are encouraged to speak with their health care provider about whether getting a second booster dose now is right for them.

High-risk individuals who should get their second booster dose as soon as possible and many of whom have been eligible to do so for months include:

  • Individuals aged 60 and over;
  • First Nation, Inuit and Métis individuals and their non-Indigenous household members aged 18 and over;
  • Residents of a long-term care home, retirement home, or Elder Care Lodge and older adults living in other congregate settings that provide assisted-living and health services; and
  • Individuals who are moderately to severely immunocompromised.

The Ontario government will also continue to provide free rapid antigen tests to the general public through existing channels like grocery stores and pharmacies, as well as to workplaces, schools, hospitals, long-term care and retirement homes and other congregate settings until December 31, 2022.

“Expanding eligibility to second booster doses and providing continued access to testing will empower Ontarians to make the best decisions for their circumstances and help keep our communities safe,” said Dr. Kieran Moore, Chief Medical Officer of Health. “Staying up to date on vaccination is the best protection against severe outcomes from COVID-19.”

As part of the province’s plan to stay open, Ontario is expanding Ontario’s health care workforce, shoring-up domestic production of critical supplies and investing more than $40 billion for over 50 major hospital projects that will bring over 3,000 new hospital beds. Since the start of the pandemic, the province has added over 8,600 health care professionals to the health care system with programs in place to recruit thousands more.


Quick Facts

  • Ontarians aged 60 and over, as well as First Nation, Inuit and Métis individuals and their non-Indigenous household members aged 18 and over have been eligible for second boosters since April 7, 2022.
  • As of July 11, 2022, Ontario has administered more than 33 million doses of the COVID-19 vaccine, with more than 93 per cent of Ontarians aged 12 and over having received at least one dose, more than 91 per cent having received a second dose and more than 57 per cent having received a booster.
  • If you have questions about your vaccine eligibility, please contact the Provincial Vaccine Contact Centre at 1-833-943-3900 (TTY for people who are deaf, hearing-impaired or speech-impaired: 1-866-797-0007), which is open seven days a week from 8 a.m. to 8 p.m. and capable of providing assistance in more than 300 languages.
  • As of July 8, 2022, Ontario has distributed more than 238 million free rapid antigen tests, with more than 140 million going to highest risk settings, schools and licensed child care, essential industries and small and medium-sized businesses. More than 98 million free rapid antigen tests have been distributed to the public through participating grocery and pharmacy retailers and targeted distribution to high priority communities that have been disproportionately impacted by the virus.
  • Publicly-funded PCR testing remains accessible for high-risk individuals including as a qualifier for accessing treatment such as antivirals. Learn more about COVID-19 treatments and determine if you are eligible by using Ontario’s antiviral screener tool or calling 811.

Press Release link: https://www.cbc.ca/news/canada/toronto/ontario-covid-update-rapid-tests-moore-1.6519060

The Ministry of Health for Ontario is encouraging those who have not yet received their third dose of the COVID-19 vaccine, and are eligible, to do so.

All COVID-19 vaccines approved by Health Canada are safe and can reduce your chance of being infected by COVID-19. However, if you do become infected, the vaccine can reduce the risk of serious illness, hospitalization and death. Receiving all recommended doses of the vaccine, including booster doses, provides the greatest protection against COVID-19 and its variants.

If you would like to learn more about Ontario’s COVID-19 vaccination program, vaccine safety, and where and how to get vaccinated, you can visit https://covid-19.ontario.ca/covid-19-vaccines-ontario or if you have any further questions, please contact the Provincial Vaccine Contact Centre at 1-833-943-3900.

Find a list of cooling places at hamilton.ca/heat.

“Cooling places” provide ‘vulnerable’ Hamiltonians with a space to chill during heat events.

According to an article in The Spectator in the spring of 2022, the city encourages people needing respite from the sun to drop into public libraries, recreation centres and service offices, for a blast of air conditioning during heat advisories. The consequences of not giving “vulnerable” populations a place to cool off would be dire, said Janet Robinson, the coordinator of the city’s heat response program. “We’d be very worried about our community. We’d be very worried about people who have health issues and about people who might not know how to care for themselves in these heat situations.”

During heat events the city will be activating its “cooling place”, each marked by signs that say “Cool Down Here.” Also, open swims at city pools will be free. Find a list of cooling sites at hamilton.ca/heat.

“Extreme heat affects everyone,” Environment Canada says, but risk is greater for young children, pregnant women, older adults, people with chronic illnesses and people working or exercising outdoors.

The most important advice to staying safe in extreme heat? Drink plenty of water and stay in a cool place.

For the most up-to-date weather information, go to weather.gc.ca/warnings.

Many insurance companies refuse to cover new weight loss drugs that their doctors deem medically necessary.

Gina Kolata
  • May 31, 2022

Maya Cohen’s entree into the world of obesity medicine came as a shock.

In despair over her weight, she saw Dr. Caroline Apovian, an obesity specialist at Brigham and Women’s Hospital, who prescribed Saxenda, a recently approved weight-loss drug. Ms. Cohen, who is 55 and lives in Cape Elizabeth, Maine, hastened to get it filled.

Then she saw the price her pharmacy was charging: $1,500 a month. Her insurer classified it as a “vanity drug” and would not cover it.

“I’m being treated for obesity,” she complained to her insurer, but to no avail.

While Ms. Cohen was stunned by her insurer’s denial, Dr. Apovian was not. She says it is an all too common response from insurers when she prescribes weight-loss drugs and the universal response from Medicare drug plans.

Obesity specialists despair but hope that with the advent of highly effective drugs, the situation will change.

Novo-Nordisk, the maker of the medicine Dr. Apovian prescribed, and patient advocacy groups have been aggressively lobbying insurers to pay for weight-loss drugs. They also have been lobbying Congress to pass a bill that has languished through three administrations that would require Medicare to pay for the drugs.

But for now, the status quo has not budged.

No one disputes the problem — more than 40 percent of Americans have obesity, and most have tried repeatedly to lose weight and keep it off, only to fail. Many suffer from medical conditions that are linked to obesity, including diabetes, joint and back pain and heart disease, and those conditions often improve with weight loss.

“The evidence is now overwhelming that there are physical changes in weight regulating pathways that make it difficult for people to lose weight and maintain their weight loss,” said Dr. Louis Aronne, an obesity medicine specialist who directs the comprehensive weight control center at Weill Cornell Medicine. “It’s not that they don’t have willpower. Something physical is holding them back.”

Ms. Cohen in 2016.

Dr. Aronne and other obesity medicine specialists emphasize that obesity is a chronic disease that should be treated as intensively as heart disease, diabetes, high blood pressure or any other chronic illness are. But, they say, that rarely happens.

“Access to medicines for the treatment of obesity is dismal in this country,” said Dr. Fatima Cody Stanford, an obesity medicine specialist at Massachusetts General Hospital and Harvard Medical School.

But even if a patient’s insurer will cover weight loss drugs, most doctors do not suggest the drugs and most patients do not ask for them, as they fail to realize there are good treatment options, said Dr. Scott Kahan, an obesity medicine specialist in Washington, D.C. And, he added, even if doctors and patients know there are F.D.A. approved drugs, many think they are “unsafe or not well studied and that everyone regains their weight.”

The medical system bears much of the blame, Dr. Stanford said. Just 1 percent of doctors in the United States are trained in obesity medicine. “It’s the biggest chronic disease of our time, and no one is learning anything about it,” she said.

Data on medication use by patients predate the newer, more effective and safe drugs made by Novo Nordisk and Eli Lilly. Still, obesity medicine doctors say, they doubt that the number has changed much from the earlier studies that found that less than 1 percent who are eligible obtained one of these drugs. That is about the same percentage as those who get bariatric surgery, which most insurers, including Medicare, pay for.

“The perception is, ‘If you are heavy, pull yourself up from your bootstraps and try harder,’” Dr. Kahan said.

And that, he adds, is a perception many patients, as well as doctors, share, making them reluctant to seek medical help or prescription medications.

Then there is the problem Ms. Cohen ran into: Insurers that do not cover weight-loss drugs.

But some obesity specialists have found a strange workaround to get an effective but expensive Novo Nordisk drug for patients with obesity whose insurers will not pay.

Ozempic, or semaglutide, is often covered by insurance companies as a diabetes drug.
Ozempic, or semaglutide, is often covered by insurance companies as a diabetes drug.
Credit…Ryan David Brown for The New York Times
Ms. Cohen took a mix of prescription weight-loss pills.

The workaround exploits quirks in the way Novo Nordisk markets its drugs. The company sells a drug, semaglutide, for both diabetes and for obesity. As a diabetes drug, it is called Ozempic and has a list price of $892 for four weeks. It is easily available at pharmacies, and insurance companies cover it for people with diabetes.

Novo Nordisk sells two weight loss drugs that are of the same class in two doses — liraglutide as Saxenda, and semaglutide at a higher and more effective dose as Wegovy. The list price — the suggested retail price — for both is about $1,350 a month. That means the same drug costs 51 percent more if it is used to treat obesity than if it is used for diabetes.

But as an obesity drug, it is hard to get.

Not only do most U.S. insurers decline to pay for Saxenda or Wegovy because they are weight-loss drugs, but Wegovy supplies are so limited that the company has asked doctors not to start new patients on it.

Eli Lilly has a similar and seemingly more powerful weight-loss drug, tirzepatide, which it hopes to get approved for people with obesity. It was recently approved to treat diabetes under the name Mounjaro. As a diabetes drug, its retail price is $974 a month.

Douglas Langa, an executive vice president at Novo Nordisk, said the Wegovy supply problem was caused by a manufacturing issue that should be resolved later this year.

He also said that diabetes and obesity were “separate categories, separate marketplaces” to explain the difference in price between the companies’ two drugs that were based on the same medicine, semaglutide. He said Wegovy’s price “reflects efficacy and clinical value in this area of unmet need.”

Dr. Stanford was appalled.

“It’s unbelievable,” she said, adding that it was a gross inequity to charge people more for the same drug because of their obesity. She finds herself in an untenable situation: getting excited when her patients with obesity also have diabetes because their insurers pay for the drug.

Dr. Apovian says she too finds herself rejoicing when patients have high blood sugar levels — and that was what ultimately resolved Ms. Cohen’s problem.

Her insurance company would cover Ozempic, but it would not cover Saxenda. So she started taking Ozempic, with a $70 a month copay.

Ms. Cohen — who measured at five feet tall and weighed 192 pounds when she saw Dr. Apovian — had a dramatic response to Ozempic. She has lost 54 pounds and now weighs 138 pounds. Her waist size, which was 46 inches, is now 33 inches. She has more energy and her joints do not hurt.

“It has absolutely changed my life,” Ms. Cohen said.

Gina Kolata writes about science and medicine. She has twice been a Pulitzer Prize finalist and is the author of six books, including “Mercies in Disguise: A Story of Hope, a Family’s Genetic Destiny, and The Science That Saved Them.” @ginakolata • Facebook

A version of this article appears in print on June 1, 2022, Section A, Page 17 of the New York edition with the headline: Many Insurers Won’t Cover New Weight Loss Drugs. Order Reprints | Today’s Paper | Subscribe

According to the Canadian Mental Health Association (CMHA) mental health is not only the avoidance of serious mental illness. Your mental health is affected by numerous factors from your daily life, including the stress of balancing work with your health and relationships. In this section you will find resources to help you stay mentally fit and healthy.

At Winterberry our goal is to help our patients live their best lives and this means offering easy-to-access mental health services with caring, highly trained professionals. 

It’s easy to book an appointment with one of our Mental Health counsellors by discussing your concern during an appointment with a Nurse Practitioner or a Family Physician. They will take it from there and make the connection for you. You’ll receive a call from our clinic letting you know when you’re appointment is. 

Knowing you need help and asking for it is important – and understandable. There is no stigma to asking for help with mental health concerns. Our two Mental Health Counsellors, Kelly and Susanna are here to help. We know you will feel welcome, supported and understood under their care. 

As part of Mental Health Week 2022 we’d like to introduce you to our Mental Health team and find out a little about the best part of their day at Winterberry and also why they choose to become mental health care providers. 

Kelly Nancekivell, Mental Health Counsellor 

The best part of my day is being able to connect with patients of the clinic and provide a safe space for them to talk about their concerns. I love seeing their progress over time and their ability to use their own strengths to identify solutions to some of their problems. I appreciate the relationships I get to make with the people I serve at Winterberry, and I truly value the opportunity to provide easier access to mental health help and resources. 

I chose to be a Mental Health Counsellor at Winterberry because I love the collaborative components and the ability to work within a multidisciplinary team. I love that there is wrap-around support for patients concerns because they have access to so many different professionals who can help them navigate their path to mental and physical wellness. Since mental and physical health are very much interconnected, I feel this approach is very beneficial and meets the needs of the people we work with. I am grateful to be a part of the compassionate, caring team at WFM, and am proud to empower the patients at the clinic to reach their mental health goals. 

Susana Cadavid, Mental Health Counsellor

The best part of my day is being able to call each patient and spend the session supporting them. Meeting them wherever they may be on that day, supporting their needs that day, and hearing the sense of relief as the call comes to an end. Being able to make a difference in someone’s life makes every day a dream come true. Knowing that I am helping people is my favourite part of my day. 

Becoming a Mental Health Counsellor was an easy choice for me. Having experienced struggles with mental health myself, I can appreciate how crucial it is to have someone who will listen non judgmentally, support objectively, and provide resources. Being a Mental Health Counsellor allows me to do this and more for the patients we see at Winterberry. Patient centred and multidisciplinary care are two things I am very proud to be part of here. 

To book an appointment with one of our mental health care providers, talked to a Nurse Practitioner or Family Physician and share your concerns. They will work with our administrators to book you an appointment as soon as possible.

Benefits of large weight loss were observed in patients with various overweight- or obesity-related complications, including improvements in comorbidities such as type 2 diabetes and hypertension.

Improvements in glucose metabolism and cardiovascular risk factors were observed in patients who achieved large weight loss through lifestyle interventions or pharmacotherapy (phentermine/topiramate 15/92 mg once daily or subcutaneous semaglutide 2.4 mg once weekly).

Other benefits associated with large weight loss included reduced cancer risk and improvements in knee osteoarthritis, sleep apnea, fertility-related end points, and health-related quality of life.

While costly, bariatric surgery is currently the most cost-effective intervention, although most weight-management programs are deemed cost-effective.

Conclusions: Overall, large weight loss has a major beneficial impact on overweight- and obesity-related complications. Large weight loss should be the main treatment target when modest weight loss has had insufficient effects on obesity-related complications and for patients with severe obesity.

Citation: Tahrani AA, Morton J. Benefits of weight loss of 10% or more in patients with overweight or obesity: A review. Obesity (Silver Spring). 2022 Apr;30(4):802-840. doi: 10.1002/oby.23371. PMID: 35333446.