Addressing anti-Indigenous racism in Canadian health systems: multi-tiered approaches are required.

Interpersonal and structural racism is a significant contributor to pronounced and widespread health inequities affecting Indigenous peoples in Canada. Recent events surrounding the tragic death of Ms. Joyce Echaquan in Quebec have renewed attention to the devastating harms of Indigenous-specific racism. A recent series of meetings convened at the federal-provincial-territorial levels resulted in the identification of short- and long-term actions to eliminate anti-Indigenous racism. While these represent important starting points, we raise concerns about the shortcomings of these actions. In presenting our commentary, we highlight additional strategies and recommendations for embedding anti-racism into Canada's health sector, including a call to adopt anti-racism as a sixth pillar of the Canada Health Act. We contend that adding anti-racism to the Canada Health Act will prompt national dialogues, trigger the development of universal policies and programs to interrupt systemic and interpersonal racism in health systems, and be sustainable over time despite changes in governments and political ideologies. In taking this position, our aim in presenting this commentary is to intensify the dialogue in Canada regarding the need for multi-tiered, system-level efforts to address anti-Indigenous racism with the explicit aim of transforming healthcare cultures, policies, and practices in support of health equity and reconciliation.

RéSUMé: Le racisme interpersonnel et structurel au sein du système de santé est un contributeur important aux inégalités de santé prononcées et répandues chez les peuples autochtones du Canada. Les événements récents entourant la mort tragique de Mme Joyce Echaquan au Québec ont renouvelé l'attention sur les effets dévastateurs du racisme envers les Autochtones. Une récente série de réunions convoquées aux niveaux fédéral-provincial-territorial a permis d'identifier des mesures à court et à long terme pour éliminer le racisme anti-autochtone. Bien que ceux-ci représentent des points de départ importants, nous voulons soulever des inquiétudes quant aux lacunes de ces mesures. En présentant notre analyse, nous soulignons d'autres stratégies et recommandations visant à intégrer la lutte contre le racisme dans le secteur canadien de la santé, y compris un appel à adopter la lutte contre le racisme comme sixième pilier de la Loi canadienne sur la santé. Nous soutenons que l'ajout de la lutte contre le racisme à la Loi canadienne sur la santé suscitera des dialogues nationaux, déclenchera l'élaboration de politiques et de programmes universels pour interrompre le racisme systémique et interpersonnel dans les systèmes de santé et sera durable au fil du temps malgré les changements dans les gouvernements et les idéologies politiques. En prenant cette position, notre objectif en présentant ce commentaire est d'intensifier le dialogue au Canada sur la nécessité d'efforts à plusieurs niveaux au niveau du système pour lutter contre le racisme anti-autochtone dans le but explicite de transformer les cultures, les politiques et les pratiques de soins de santé à l'appui de l'équité et de la réconciliation en matière de santé.

Evaluation of Weigh Forward: A group intervention delivered by dietitians and psychologists within a National Health Service specialist weight management service.

There is limited evidence of the effectiveness of non-surgical interventions for severe obesity. Our aim was to evaluate a group intervention delivered by a National Health Service (NHS) specialist weight management service to contribute to the evidence base and inform the development of future services. Participants in this prospective cohort study were patients attending NHS Grampian Specialist Weight Management Services. The intervention was an interactive 12-session group programme based on evidence-based psychological model, with combined dietetic and psychological knowledge and support provided. The primary outcome was mean weight change at the end of the intervention and for 12-mo follow-up (including programme completers, baseline observation carried forward [BOCF], last observation carried forward). Secondary outcome measures included mood, anxiety, binge eating and quality of life. A total of 166 patients accepted a place on the group programme, mean body mass index was 48.9 kg/m2 . Mean weight loss at 6 mo was 5.6 kg and 35.2% of those who completed the group (n = 88) lost ≥5%. Using BOCF, 18.7% lost ≥5% at 6 mo. Those who remained in the programme maintained their weight loss 12 and 18 mo after the start of the intervention. Significant improvements were also found in psychological variables, including reduced depression, anxiety, binge eating and improved emotion regulation. This real-world evaluation of an NHS intervention for patients with severe obesity suggests that individuals who engage achieve a moderate weight loss, which most maintain a year later, although further research is needed to strengthen this conclusion.