Bridging Medicine and Reconciliation Decolonizing Obesity Care and Expanding Access to GLP-1 Therapy for Indigenous Peoples in Canada

Abstract

ABSTRACT: Obesity is one of the most pressing health challenges in Canada, driving the rise of type 2 diabetes, cardiovascular disease, cancer, and premature mortality. While lifestyle interventions remain the cornerstone of obesity management, many individuals require pharmacotherapy and/or bariatric surgery to achieve sustained benefits. Among recent advances, glucagon-like peptide-1 (GLP-1) and dual glucagon-like peptide-1 and glucose-dependent insulinotropic polypeptide (GLP-1/GIP) receptor agonists have demonstrated unprecedented efficacy in weight reduction and cardiometabolic risk improvement.  

            For Indigenous peoples in Canada, the burden of obesity is not only medical but deeply rooted in colonial legacies. Systemic inequities, intergenerational trauma, disrupted food systems, and racism in healthcare have contributed to disproportionately high rates of obesity and related chronic illnesses. The authors evaluate the efficacy of GLP-1 pharmacotherapy, analyze policy and systemic barriers that constrain access, and highlight the essential role of primary care providers in delivering culturally safe, trauma-informed, and community-centred care. By situating biomedical advances within the context of reconciliation, the authors argue that equitable access and culturally grounded approaches are essential to achieving meaningful improvements in obesity care for Indigenous peoples in British Columbia (BC) and across Canada.   

This policy review employed a multi-faceted approach to examine the intersection of obesity management and health equity among Indigenous populations in Canada. The objectives were to identify available and publicly funded obesity treatments in BC and to explore the root causes of obesity and related health inequities among Indigenous peoples. First, an environmental scan of the BC health landscape was conducted, including an analysis of the BC Guidelines for Obesity Management and coverage available under the Medical Services Plan (MSP) and PharmaCare. Second, a literature review synthesized findings from scoping reviews and white papers addressing Indigenous health disparities. Finally, a focused literature review evaluated the clinical outcomes of GLP-1 pharmacotherapy for weight management in non-diabetic populations, with the specific search strategies and methods outlined within this paper.   

Key Themes  

The authors found several key themes in review of the literature, including: the enduring legacy of colonization and its impact on Indigenous health outcomes, systemic barriers to GLP-1/GIP access for Indigenous populations, culturally safe and trauma-informed approaches to obesity care, and recommendations for equitable access and culturally safe care. The authors conclude with a call to action to change policies on GLP-1/GIP medication coverages for First Nations that align with the social determinants of health.