Bariatric Care: How Sick is Big?

Yesterday, 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

Padwal 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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