Tuesday, January 14, 2014

Bariatric Care: How Sick is Big?

weight scale helpYesterday, I posted about the recent paper by Padwal and colleagues on the weight loss outcomes in a publicly funded multi-disciplinary tertiary care bariatric program, published in Medical Care.

Before going into details of the outcomes, I thought it prudent to first describe the patient population seen in this program.

Thus, the typical patient in the APPLES study is a Caucasian (92%) woman (88%) in her early forties (43 y), weighing 132 kg (BMI 47.9), nonsmoker (90%), married or in a common-law relationship (58%), with some or completed post-secondary education (71%), currently in full-time employment (60%), with a household income greater than $50,000 per year (66%).

She is also likely to have depression (62%) and/or anxiety (46%), hypertension (65%), type 2 diabetes (44%), dyslipidemia (60%), gastro-esophagial reflux (38%), osteoarthritis (29%) and sleep apnea (29%).

Although not reported in this paper, we also know that individuals in this BMI category have markedly impaired quality of life (comparable to that of patients with coronary artery disease and marginally better than those living with chronic obstructive lung disease).

We have also previously reported that many of these patients (20%) report a previous history of sexual trauma.

Thus, the vast majority of individuals seen in the APPLES study are not only severely obese but also present with a wide range of physical and mental health problems.

What stands out to me from these baseline demographics are the following:

1) We are not reaching the men – given that there is little difference in obesity prevalence between the sexes, once can only assume that the men are either less concerned about their weight or (even if concerned) far less likely to consider seeking bariatric care.

2) Two-thirds of the patients have at least some post-secondary education – well above the 53% average of Canadians who have trade certificates, college diplomas or university degrees – suggesting that better educated individuals may be better able to access the clinic.

3) Two-thirds of patients have a household income of more than $50,000 a year – while this may seem much, it is important to note that the average household income in Alberta is currently around $85,000 a year. This suggests that, despite the rather high degree of post-secondary education, bariatric patients may be making less in their jobs than their normal-weight peers.

In tomorrow’s post, I will discuss what happens to weight and health status in these patients as they linger on the waiting list to be seen in the program.

@DrSharma
Edmonton, AB

ResearchBlogging.orgPadwal RS, Rueda-Clausen CF, Sharma AM, Agborsangaya CB, Klarenbach S, Birch DW, Karmali S, McCargar L, & Majumdar SR (2013). Weight Loss and Outcomes in Wait-listed, Medically Managed, and Surgically Treated Patients Enrolled in a Population-based Bariatric Program: Prospective Cohort Study. Medical care PMID: 24374423

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3 Responses to “Bariatric Care: How Sick is Big?”

  1. Melinda says:

    Women are accessing the service because the societal costs of obesity are much higher. Think Rob Ford and Chris Christie. A woman that large would never be elected. Compare them to the criticism that Angela Merkel recieves or the focus on Christine Legrande’s health and fitness regime.

  2. Sandy says:

    My experience with the clinic is that they discourage people with lower incomes due to a concern that they will not be able to afford to eat properly after surgery, nor the necessary supplements not to mention the changes of wardrobes that massive weight loss requires. Not unlike many other health issues, the system works best for those with adequate income.

  3. Allen says:

    I fit the categorization with the following exceptions:
    -I am male.
    -I was not obese until after age 47 and was too ill to work when I became obese(‘drug resistant’ depression and undiagnosed sleep apnea). The various Dr.s that I saw never considered my obesity to need treatment. Bariatric surgery was never considered for me until I found the Weight Wise program myself. By then the waiting period was long. I used a known weightloss program to lose 53 lbs and then regained it while waiting. When I finally did get examined, I was discouraged from considering the surgery from my initial interview forward. I was 59 years old and 375 lbs at that time which may have been a factor. It seemed to me that lighter, younger, women received higher priority. There were no recommendations or referrals when I did not qualify for the surgery and I was “shown the door”.

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In The News

Diabetics in most need of bariatric surgery, university study finds

Oct. 18, 2013 – Ottawa Citizen: "Encouraging more men to consider bariatric surgery is also important, since it's the best treatment and can stop diabetic patients from needing insulin, said Dr. Arya Sharma, chair in obesity research and management at the University of Alberta." Read article

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