Morbid Weights and Morbid Waits

This is the title of an article by Raj Padwal and myself appearing in this weeks edition of the Canadian Medical Association Journal.

Here are some key quotes from this article:

In 2004, 5.1% of Canadians were moderately obese and 2.7% were severely obese. Therefore, 5.8% (60% of 5.1%, plus 2.7%) of Canadians would have potentially been eligible for bariatric surgery. Assuming that 2000 surgeries were performed in 2004 (conservatively adjusted for the lack of data from Quebec and time increment from 2003) and an adult population of 20 million, demand for bariatric surgery would have outstripped the theoretical capacity by nearly 600-fold.

As of January 2008, in our regional population-based medical and surgical obesity program, 2470 patients were waiting for a clinic appointment for an initial assessment. This represents a wait time of 4.3 years and a 70% increase in the waiting period over 1 year.

Compared with the general population, surgical candidates are more likely to exhibit depression, anxiety and impaired self-esteem. Up to one-third have been victims of sexual abuse as children. In our program, 60% of patients approved for surgery have a history of mental illness and 11% are unemployed or receiving social assistance.

To optimally care for patients struggling with the immense burden associated with severe obesity, we must ensure that they are able to access state-of-the-art standards of care in a timely and equitable fashion.

For a free copy of the full paper published in the CMAJ click here

As blogged before, given the spectacular health benefits, improvements in quality of life, and cost savings associated with bariatric surgery, no health care system can afford not to substantially increase access to bariatric care in the foreseeable future.

But this will need far more than just hiring surgeons – these patients will need long-term access to multidisciplinary care that must include psychosocial support, nutrition, rehabilitation experts and medical care. It is of course much “cheaper” to not provide this follow-up care and then simply once again blame the patient for failure.

Edmonton, Alberta