JANUARY 30, 2005

Bariatric surgery is the best option for the morbidly obese

Experts caution that the fat is in the fire if the Feds
don't get behind this treatment


Overweight = BMI 25-29.9
Obese = BMI over 30
Severely obese = BMI 35-39.9
Morbidly obese = BMI over 40

Source: Statistics Canada

Patrick Deuel, a Nebraska native, recently made headlines as the 'half-ton man' who dropped 207kg (457 pounds) following bariatric surgery. The media circus immediately picked up on his unusual case, proving that sensationalist stories like Mr Deuel's are still hot news. Morbid obesity like Mr Deuel's is becoming more and more common — recent statistics show that it affects close to 3% of the population. Awareness of this huge health problem is at an all-time high yet there's little consensus on how it should be treated.

Experts say that bariatric surgery is a viable option for morbidly obese patients. Unfortunately for these olks, there just isn't enough awareness among primary care physicians about this option. "Surgery is currently the only reliable way to achieve longterm weight loss in morbidly obese patients," says Dr Laz Klein, a general and laparoscopic surgeon at Humber River Regional Hospital in Toronto who performs bariatric surgery. Nowadays, more patients are lining up for this invasive treatment option. But as the number of obese patients increases so do the resources required to manage this condition, not to mention the length of waiting times.



  • if the patient's body weight is more than 45 kg or 100% above ideal weight
  • if the patient's BMI is greater than 40
  • if the patient's BMI is greater than 35 with medical comorbidities
  • failure to reduce weight using nonsurgical methods and/or an absence of endocrine disorders that can cause morbid obesity

Source: www.weightlosssurgery.ca

In the last three years, the bariatric surgery section at the Royal Victoria Hospital in Montreal has seen a 300% increase in the number of patients requesting consultation for the procedure, explains Dr Nicolas Christou, head of the division of general surgery. "Not only are we seeing more patients," he says, "the body mass index has increased. The patients I see today are heavier." The significant rise in applicants has also meant longer waiting times — on average patients wait between three and five years for surgery.

Another problem facing candidates of bariatric surgery is access. Dr Christou explains that there are only three hospitals in Canada that perform more than 100 surgeries annually and another five to seven hospitals that do fewer than 50 per year. "We need more resources to service these patients," he warns.

"I believe the underlying sentiment amongst those who make the spending decisions is that bariatric surgery isn't as important," says Dr Klein, "and it's the patient's own fault that they're so fat." He believes that this social attitude is unique towards fat people. "People have no problem spending millions treating lung cancer, emphysema, heart disease, drug addiction and many others," adds Dr Klein.

Dr Christou agrees, stating that one of the big problems is that health administrators aren't willing to invest in bariatric surgery. An article, which he co-authored, published in the August 2004 issue of Obesity and Surgery looked at the cost incentive of bariatric surgery. "Our study has shown that the 'investment' made by the healthcare system to have a patient operated on is recouped in 3.6 years from the money saved due to the reduction in comorbidity and the need to visit physicians or hospitals," he explains. "It makes sense that the treatment of morbid obesity should be given priority," adds Dr Christou

Who's overweight? Who's obese?
Men: 44% Men: 13%
Women: 24% Women: 11%
Boys: 38% Boys: 19%
Girls: 35% Girls: 17%

(3% of Canadians morbidly obese)

Source: Statistics Canada

Another big blow to bariatrics is that the US is poaching surgeons from Canada. "Gastric bypass is probably the single most common operation in the US," says Dr Klein. There's a big demand for well-trained surgeons in the US and higher pay lures many of these specialists across the border. Dr Christou is the only fulltime bariatric surgeon in the country and only a handful of others do the procedure part-time.

"Here in Canada bariatrics is paid very poorly especially considering that these patients are very high risk and the most demanding patients in my practice," says Dr Klein. "I would be much better financially if I stopped bariatrics and spent more time doing much easier surgery."

Dr Christou believes that hospitals should be paying bariatric surgeons competitive fees, giving them sufficient OR time and providing the resources they need to deal with the increased demand.



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