Inequalities in Access To Bariatric Surgery in Canada

Despite a substantial recent increase in bariatric surgery in Canada, there are still substantial differences in access to this treatment across the country.

As I discuss in an editorial published this week in CMAJ, annual access to bariatric surgery (2012-13) per 1,000 individuals living with a BMI >= 35 kg/m2 (2007-2010 prevalence) in Canada is around 5.4, however, this number ranges from as high as 9.6 in Quebec to as low as 1.1 in Nova Scotia – an almost 10-fold difference  (bariatric surgery is not available in Prince Edward Island or the Territories).

To catch up with the current rate of surgery in Quebec, Alberta would need to perform an additional 813 procedures a year, while BC would need an additional 805 and Nova Scotia an additional 463 per year.

Overall, bringing the rate of surgery across Canada to the current rate in Quebec, would require an additional 5,129 surgeries per year.

However,, even bringing the rate of bariatric surgery across Canada to the current rate in Quebec may not be enough to significantly reduce the burden of severe obesity across Canada.

This, must not be an argument against further increasing access to surgery – there is no doubt that the vast majority of the 1000s, who currently do manage to get surgery benefit significantly from this intervention.

While it is important to acknowledge that obesity competes for scarce resources in strapped health care systems and that choices must be made about what services/treatments to provide, we must remember that bariatric surgery is currently the only effective long-term treatment for people living with severe obesity.

Despite all the risks inherent in any surgical procedure, and the fact that the occasional patient may struggle to lose weight or end up putting it back on, surgery currently remains the best treatment we have.

Nevertheless, as I point out in the editorial,

“Even as provinces work to increase access to bariatric surgery, other aspects of bariatric care cannot be ignored.  For one, efforts at secondary prevention, to reduce and limit weight gain in individuals already carrying excess weight must be increased. Given the over 6 million Canadian adults and children living with obesity, these services must be provided at the primary care level rather than at specialized centres. Secondly, these services need to apply the established tenets of chronic disease management to obesity, which include patient education, self-management and ongoing follow-up and support. These principles are embedded in the 5As of Obesity Management framework developed by the Canadian Obesity Network. Thirdly, education on the complex etiology and evidence-based management of obesity needs to be integrated into every level of professional education for physicians and allied health professionals.” 

As increasingly safe and effective medical treatments for obesity become available, these must be made accessible to patients who stand to benefit from such treatments.

In the meantime, the least we can expect from provincial health systems is that patients who need bariatric surgery have the same level of access across the country.

@DrSharma
Toronto, ON