While this is increasingly being appreciated in adults, data on childhood cancer survivors is rather sparse.
Thus, a study by Carmen Wilson and colleagues, published in Cancer, which follows the development of obesity in individuals treated for cancer as kids is of particular interest.
The study looks at 1996 cancer survivors who previously received treatment for cancer at a large Children’s Research Hospital, who survived ≥10 years from diagnosis (median age at diagnosis, 7.2 years; median age at follow-up, 32.4 years).
Interestingly, 47% of survivors, who received cranial radiation therapy developed obesity compared to only 30% of those who did not.
This risk was greatest in those who also received glucocorticoids or were the youngest at the time of treatment.
The researchers also found a significant modifying effect of genetic markers, some of which are known to be involved in neural growth, repair and connectivity.
Thus, this study shows that survivors of childhood cancer appear to be prone to developing obesity as adults particularly if they were treated with cranial radiation therapy and/or corticosteroids.
Clinicians should be aware of this increased risk and should consider measures to prevent excess weight gain in individuals with a history of childhood cancer.
Wilson CL, Liu W, Yang JJ, Kang G, Ojha RP, Neale GA, Srivastava DK, Gurney JG, Hudson MM, Robison LL, & Ness KK (2015). Genetic and clinical factors associated with obesity among adult survivors of childhood cancer: A report from the St. Jude Lifetime Cohort. Cancer PMID: 25963547
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:
Last 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:
- 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.
- 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.
- 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%).
- 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