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Obesity Surgery is not Just About Surgery



Over the next little while, I will be taking a few days off and so I will be reposting some of my favourite past posts. The following article was first posted on Feb 2, 2008:

With the “sensational” results of obesity surgery being publicized in the media, it is not surprising that expansion of bariatric surgery is receiving increasing support. In every province, health plans are carefully looking at expanding access for their populations.

In light of these development it may be time for a word of caution.

Obesity surgery is not just about surgery. In fact, even the most enterprising bariatric surgeons will readily agree that the actual surgery is just a small (but important) technical piece in the overall treatment plan.

No doubt, good surgical outcomes require well-trained experienced surgical teams but we know that much of the long-term outcome depends on what happens before and after surgery.

Done in the wrong patients with no or little long-term follow up, what could be a life saving operation can become a disaster – and weight regain is perhaps the least that can go wrong. Much more severe and potentially devastating are the nutritional deficiencies and the psychological and social consequences that are not seldom after surgery.

For surgery to produce good long-term results it is absolutely essential that as access to surgery expands, so does the pre-surgical selection and education process as well as the access to life-long post-surgical monitoring.

Expansion of surgical programs does not just need more surgeons and OR time – it needs dietitians, psychologists, physicians, occupational therapists, social workers and other health professionals who are trained and qualified to prepare and follow-up surgical patients.

In the end it will be family doctors who have to look after the 1000s of patients who will be asking for and undergoing surgery. Given the numbers of eligible patients and the geographic distances in Canada, this task of preparing and following patients for life cannot be performed by a handful of Centres of Excellence. This is particularly true for the adjustable gastric band, which while offering a simpler and safer surgical procedure, does require regular and ongoing adjustments to be fully effective.

If we hope to see the spectacular results from the published studies on bariatric surgery replicated in daily practice, we must start bringing primary care providers up to speed on counseling, preparing and following their patients.

Ignoring this task will leave 1000s of Canadians stranded post-surgery with nowhere to go when things go wrong.

Obesity surgery is NOT just about surgery.

AMS

6 Comments

  1. I’m a 62 year old and I’m considering a roux ny gastric bypass surgery as I’m 265 lbs. and suffer from chronic osteoarthritis in my knees. I am having such a difficult time making up my mind to have the surgery. I was hoping the weight loss would help take away my osteoarthritis pain. Will it? I understand what you were saying it is life time change as who would take such drastic steps as this surgery.If you could tell me it is a good idea or not .Reapectfully Yours Candace Kane

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  2. I wish I could tell Candace Kane that no, weight loss will NOT take away the pain from arthritis, and I’m speaking from personal experience here. She really should consider having either the Vertical Sleeve Gastrectomy or the Duodenal Switch rather than the RNY gastric bypass, because she’s still going to be able to take NSAIDs for her arthritis.

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  3. Weight Loss Clinic will not accept clients age 60 and older. I know, I tried!

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  4. Is it, indeed, true that the Weight Wise Clinic (in Edmonton) only accepts patients below age 60? If the patient qualifies for the surgery, why is there an age restriction? Not all of us have been obese all our life. Some, like myself, developed diabetes later in life and the Roux N Y bypass seems the best solution for putting diabetes into remission. THIS is the greatest potential of bariatric surgery, for me. I see th slogan, “Healthy at any weight” posted everywhere. Why no also, “Healthy at any age”???

    Additionally, to be considered for bariatric surgery, the patient MUST be a non-smoker for at least 3 months prior to surgery. There are many people who use smoking in the same way others use food. To insist they quit smoking at a highly stressful time (prep for surgery) seems to only add stress, plus the fact that many patients will replace smoking with food. If the patient’s weight increases by 10 percent, the surgery may be delayed, too. No one has told them to quit drinking alcohol, until after surgery, and yet this is another ‘crutch’ may use to deal with underlying emotional issues. To deny surgery to people who really need it, based on these ‘rules’ seems cruel.

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Trackbacks/Pingbacks

  1. Dr. Sharma’s Obesity Notes » Blog Archive » Bariatric Surgery Guidelines - [...] As blogged before, obesity surgery is not just about surgery. [...]
  2. Dr. Sharma’s Obesity Notes » Blog Archive » Micronutrient Screening Before Obesity Surgery - [...] as I have often blogged before, obesity surgery is not just about the surgery. Indeed, nutritional management of these…
  3. Dr. Sharma’s Obesity Notes » Blog Archive » Have Diabetes? Find a Surgeon! - [...] before running aboard with this idea, a word of caution - as I have blogged before - bariatric surgery…

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