While 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.
Based 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.
This is an infographic about bariatric surgery in Canada released by the Canadian Institute of Health Information:
If you are planning to attend the 4th Canadian Obesity Summit in Toronto next week (and anyone else, who is interested), you can now download the program app on your mobile, tablet, laptop, desktop, eReader, or anywhere else – the app works on all major platforms and operating systems, even works offline.
You can access and download the app here.
(To watch a brief video on how to install this app on your device click here)
You can then create an individual profile (including photo) and a personalised day-by-day schedule.
Obviously, you can also search by speakers, topics, categories, and other criteria.
Hoping to see you at the Summit next week – have a great weekend!
Regular readers are well aware of the considerable evidence now supporting the notion that inter-generational transmission of obesity risk through epigenetic modification may well be a key factor in the recent global rise in obesity rates (over the past 100 years or so).
Now a brief review article by Susan Ozanne from the University of Cambridge, UK, published in the New England Journal of Medicine, describes how researchers have now identified a clear and conserved epigenetic signature that is associated with obesity across species (from the fruit fly all the way to humans).
The article discusses how the transmission of susceptibility to obesity can occur as a consequence of “developmental programming,” whereby environmental factors (e.g. a high-fat diet) encountered at the point of conception and during fetal and neonatal life can permanently influences the structure, function, and metabolism of key organs in the offsprin, thus leading to an increased risk of diseases such as obesity later in life.
There is now evidence that such intergenerational transmission of disease can occur through environmental manipulation of both the maternal and paternal lines – thus, this is not something that is just a matter of maternal environment.
Thus, as Ozanne points out,
“Epigenetic mechanisms that influence gene expression have been proposed to mediate the effects of both maternal and paternal dietary manipulation on disease susceptibility in the offspring (these mechanisms include alterations in DNA methylation, histone modifications, and the expression of microRNAs).”
Work in the fruit fly has linked the effect of paternal sugar-feeding on the chromatin structure at a specific region of the X chromosome and transcriptome analysis of embryos generated from fathers fed a high-sugar diet, revealed dysregulation of transcripts encoding two proteins (one of them is called Su(var)) known to change chromatin structure and gene regulation.
Subsequent analyses of microarray data sets from humans and mice likewise revealed a depletion of the Su(var) proteins in three data sets from humans and in two data sets from mice.
“This finding is consistent with the possibility that the depletion of the Su(var) pathway may be brought about by an environmental insult to the genome that is associated with obesity.”
Not only do these studies provide important insights into just how generational transmission of obesity may work but it may also lead to the development of early tests to determine the susceptibility of individuals to the future development of conditions like obesity or diabetes based on epigenetic signatures.
All of this may be far more relevant for clinical practice than most readers may think – indeed, a focus on maternal (and now paternal?) health as a target to reduce the risk of childhood (and adult) obesity is already underway.
This issue will certainly be a “hot topic” at the Canadian Obesity Summit in Toronto later this month.