Bariatric Care in Newfoundland and Labrador

Harbor light house St. John's NLYesterday, I spent all day learning about Eastern Health’s bariatric surgical program that started in St. John’s, Newfoundland in May of 2011 and provides bariatric services to all of Newfoundland and Labrador. The program has since performed about 150 operations, with the surgeons currently performing about three surgeries a week – a slow clip given a waiting list of over 500 eligible patients.

In addition to the bariatric surgeons, the individuals involved, consist of a nurse practitioner and a part-time dietitian – the team has recently been joined by an endocrinologist with interest in the field.

The biggest problem for the clinic is dedicated bariatric space for the clinic – the three hours of weekly clinic time dedicated to bariatric consults is simply not enough. This has the very dedicated and enthusiastic nurse practitioner, who runs the program, scrambling to “beg, borrow and steal” additional clinic time to see her patients.

Another major problem is the lack of dedicated psychological and psychiatric support – thus far these are not directly available within the program.

Despite these challenges, this fledgling program is working hard with what they have to provide much needed bariatric care in one of Canada’s “fattest” provinces.

Despite the small size of the program, there is a robust bariatric research program in place (we heard a moving presentation from patient #001, who generously described her own journey), which follows each patient practically from the time that they first enter the waiting list into their future (there is a special interest in understanding the long-term challenges and complications).

Looking at the demographics and disease burden of the patients that have made it into the program so far, they are virtually identical with the patients we see in Alberta (an probably at most public bariatric centres across Canada).

Apart from very limited resources, the clinic faces problems similar to those faced by other Canadian centres – geographic remoteness with patients having to travel incredibly long distances to visit the clinic. In addition, as in most of Canada, there is little local support for bariatric management within the often tiny communities. Given the chronic and life-long nature of this disorder, providing these services not just to patients undergoing surgery but to the tens of thousands people with obesity living across Newfoundland and Labrador is certainly a major challenge facing the provincial healthcare system.

I for one, was certainly most impressed by the efforts I saw both from the clinical team as well as the researchers – from the many research projects we reviewed, I cannot think of a better set up for integrating much needed bariatric care research with clinical practice.

St. John’s, Newfoundland