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Charter Health Crowd

The wait is killing the obese


By Sharon Kirkey

Patients in Canada are dying while waiting their turn for obesity surgery, according to new research that says wait times for bariatric surgery are the longest of any surgically treated condition in the country.

In 2007, 6,783 patients were waiting for bariatric surgery in Canada. The wait time was just over five years, according to a report in the most recent issue of the Canadian Journal of Surgery.

At one Canadian centre -- the McGill University Health Centre in Montreal -- 12 patients died while on the waiting list. Researchers say the number of deaths underestimates the magnitude of the problem, because they were not actively looking to find them, and there was no formal callback of all 2,178 patients in the centre's queue as of the end of 2008.

The average age of those who died was 46.

"It is not surprising that prolonged waits of more than five years for bariatric surgery lead to deaths among patients on the waiting list, given the devastating obesity-associated diseases that afflict these patients," the McGill University researchers write. Those who died had underlying conditions such as diabetes, sleep apnea, heart disease, high blood pressure and deep vein thrombosis, or blood clots in the veins.

"Bariatric surgery cures or improves all these," says lead author Dr. Nicolas Christou, a professor of surgery at McGill University and director of the bariatric surgery program at the McGill University Health Centre. "Not having timely surgery to cure their obesity-associated diseases caused or contributed to their deaths."

One 33-year-old woman died of multiple organ failure due to complications from diabetes. Others died of asthmatic attacks and cardiac arrest, blood clots in the lungs and heart attack. For five patients, the cause of death was unknown.

A common type of bariatric surgery is gastric bypass, which involves sectioning off a small portion of the stomach to create a pouch the size of a ping-pong ball. Also common is gastric banding, where a band-like device is placed around the stomach to divide it into two smaller compartments.

Gastric band patients "need to have a team of a dietitian, a psychologist and a bariatric physician specialist who will adjust the bands with them and make sure they stay on their diets," says Christou.

Studies from France suggest as many as half of band patients "have to be re-operated because of no loss of weight whatsoever and worsening" of obesity-related health problems, Christou says. "If you happen to be the government, you're paying double for the procedure without the proper followup."

According to Christou's study, a "conservative estimate" of the number of obese Canadians who might be eligible for surgery ranges from 600,000, to 1.2 million. In total, 1,313 surgeries were performed in Canada in 2007.

Surgery can be life-saving for the right patient, says Dr. Arya Sharma, chair of obesity research and management at the University of Alberta in Edmonton. "The bottom line is that once you have severe obesity, diet and exercise is simply not going to do it."

But only about one in four patients referred to the bariatric program in Edmonton is considered a good candidate for surgery, he says. Some have complex mental health problems, addictions or are considered too high a surgical risk.

Others aren't able to make the necessary lifestyle changes.


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