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.
Overweight = BMI 25-29.9
Obese = BMI over 30
Severely obese = BMI 35-39.9
Morbidly obese = BMI over 40
Source: Statistics Canada
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
WHO'S A CANDIDATE?
BODY WEIGHT CRITERIA:
- if the patient's body weight
is more than 45 kg or 100% above ideal weight
- if the patient's BMI is greater
- 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
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
|HOW DO CANADIANS
(3% of Canadians morbidly
are THE SURGEONS?
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.