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Elective Surgery After Bariatric Surgery

sharma-obesity-surgery14While we are now well aware of all the positive effects of bariatric surgery on metabolic, mental and functional health, one of the lesser discussed aspects is that, as a direct of the substantial weight loss and improvement in health, many elective procedures that could not be carried out prior to weight loss are now possible.

Thus, the recent report on bariatric surgery in Canada, released by the Canadian Institute of Health Information points out that (in Ontario),

“For example, compared with the three years before bariatric surgery, the number of knee and hip replacements increased by 139% and 275%, respectively, in the three years after surgery. Similarly, therapeutic interventions on the muscles of the chest and abdomen (including hernia repair) grew by 298% in the three years following surgery.’

Other elective procedures, however, become necessary as a direct consequence of the weight loss,

“For example, 137 removals of excess skin were performed during that time, compared with 7 in the three years preceding surgery.”

These procedures are often a reason why health care costs following bariatric surgery actually go up rather than down.

I, however, don’t see these as costs, but rather as important benefits of undergoing bariatric surgery.

I am sure, some of my readers who have undergone bariatric surgery will relate to this – happy to hear your story.

@DrSharma
Edmonton, AB

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Variation In Access To Bariatric Surgery in Canada

sharma-obesity-canadaBased on the recent report from the Canadian Institute of Health Information on bariatric surgery in Canada, it is evident that there is considerable (almost 800%) variation in access to bariatric surgery for people with severe obesity living across Canada.

While the overall rate of surgeries in 2012-2013 for all Canadians was 4.9/ 1000 individuals with a BMI>35 (2010), this number was as high as 7.9/1,000 in Quebec and as low as 1.1./1,000 in Nova Scotia.

The only other province that comes anywhere close to the rate of surgery in Quebec is Ontario with 6.0/1,000.

The middle field, ranging from 3.0 – 3.6/1,000, is held by Newfoundland and Labrador (3.0), New Brunswick (3.1) and Alberta (3.6).

The lowest numbers, ranging from 1.1 – 1.8/1,000, are in Nova Scotia (1.1), Saskatchewan (1.7), British Columbia (1,7) and Manitoba (1.8).

To catch up with the current rate of surgery in Quebec, Alberta would need to perform an additional 613 procedures a year, while BC would need an additional 649 and Nova Scotia an additional 383 per year.

Overall, bringing the rate of surgery across Canada to the current rate in Quebec, would require an additional 3,666 surgeries per year.

Remember, even in Quebec we are talking about only 7.9 patients out of 1,000 living with a BMI greater than 35 having surgery per year.

Thus, while the overall increase of over 400% for bariatric surgery in Canada sounds impressive, it is important to note that there is considerable inequity in access across jurisdictions.

If I was a Nova Scotian seeking bariatric surgery, I’d sure be moving to Quebec.

@DrSharma
Edmonton, AB

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Obesity Surgery In Canada Infographic

This is an infographic about bariatric surgery in Canada released by the Canadian Institute of Health Information:

CANADA_BARIATRIC_INFOGRAPHIC-CIHI

@DrSharma
Edmonton Canada

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Bariatric Surgery in Canada 2015

sharma-obesity-cihi-logoLast week the Canadian Institute of Health Information released a new study on the recent developments in Bariatric Surgery across Canada.

The following are the main findings:

  1. In 2012–2013, about 6,000 bariatric surgeries were performed in Canadian hospitals. This represents an almost four-fold increase over six years, due largely to increased capacity for bariatric surgery in Ontario.
  2. The typical bariatric surgery patient is a woman in her 40s who has obesity and other conditions such as diabetes, hypertension or sleep disorders. These characteristics have remained relatively consistent since 2006–2007.
  3. Overall, 5% of bariatric surgery patients experienced complications during their hospitalization for the surgery, and 6% were readmitted to hospital within 30 days of discharge. This study shows that complication and readmission rates have declined over time and are comparable to rates reported in other countries. As well, the readmission rate is similar to that for surgical patients overall in Canada (6.5%).
  4. Short-term increases in use of hospital care often follow bariatric surgery. Some patients have a noticeable change in their pattern of health care utilization after bariatric surgery. In some cases, this represents readmissions or follow-up care directly related to their surgery. In others, it may represent deferred procedures, such as joint replacements or hernia repairs, which could not be provided to patients at their starting weights. While this study examined only pre- and post-surgery hospital care, other studies have found that the surgery can reduce health care use and costs in other areas, such as prescribed medication.

The full report is available here

@DrSharma
Edmonton, AB

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Post-Weight Loss Fat Gain in US Rangers

army-rangersAnd finally, to conclude this week’s discussion of evidence to support the notion that weight cycling predicts weight (fat) gain especially in normal weight individuals, I turn back to the paper by Dulloo and colleagues published in Obesity Reviews, which quotes these interesting findings in US Rangers:

“…U.S. Army Ranger School where about 12% of weight loss was observed following 8–9 weeks of training in a multi-stressor environment that includes energy deficit. Nindl et al. reported that at week 5 in the post-training recovery phase, body weight had overshot by 5 kg, reflected primarily in large gains in fat mass, and that all the 10 subjects in that study had higher fat mass than before weight lost. Similarly, in another 8 weeks of U.S. Army Ranger training course that consisted of four repeated cycles of restricted energy intake and refeeding, Friedl et al. showed that more weight was regained than was lost after 5 weeks of recovery following training cessation, with substantial fat overshooting (∼4 kg on average) representing an absolute increase of 40% in body fat compared with pre-training levels. From the data obtained in a parallel group of subjects, they showed that hyperphagia peaked at ∼4 weeks post-training, thereby suggesting that hyperphagia was likely persisting over the last week of refeeding, during which body fat had already exceeded baseline levels.”

Obviously, association (even in a prospective cohort) does not prove causality or, for that matter, provide insights into the physiological mechanisms underlying this observation.

All we can conclude, is that these observations in US Rangers (and the other studies cited in Dulloo’s article) are consistent with the notion that weight loss in normal weight individuals can be followed by significant weight gain, often overshooting initial weight.

Incidentally, these findings are also consistent with observational studies in women recovering from anorexia nervosa, famine, cancer survivors and other situations resulting in significant weight loss in normal weight individuals.

Certainly enough evidence to consider a work of caution against “recreational” weight loss, especially in individuals of normal weight.

@DrSharma
Edmonton, AB

ResearchBlogging.orgDulloo AG, Jacquet J, Montani JP, & Schutz Y (2015). How dieting makes the lean fatter: from a perspective of body composition autoregulation through adipostats and proteinstats awaiting discovery. Obesity reviews : an official journal of the International Association for the Study of Obesity, 16 Suppl 1, 25-35 PMID: 25614201

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