Ontario broadens access for weight-busting bariatric surgery

TORONTO - Ontario is investing $75 million to significantly boost its capacity to perform bariatric surgery and reduce the number of patients who must be sent to the U.S. for the weight-loss operation, Health Minister David Caplan announced Monday.

Caplan said the expansion program will mean a 500 per cent increase in gastric bypass surgeries within the province, raising the number of patients who will receive the operation to 1,470 in 2011-12 from 244 this year.

The province is creating four centres of excellence for bariatric treatment, at St. Joseph's HealthCare Hamilton, Humber River Regional Hospital in Toronto, Guelph General Hospital and the Ottawa Hospital.

"It is part of Ontario's diabetes strategy that we are increasing bariatric surgery by some 500 per cent over the course of the next three years," Caplan said by phone from Hamilton.

Bariatric surgery - in this case, gastric bypass surgery - involves reconfiguring a patient's digestive system to limit the amount of food they can eat and digest. It is considered a medical last resort for people who have failed to lose weight or maintain weight loss through diet, increased physical activity, behaviour modification and anti-obesity drugs.

By helping overweight and obese people to shed excess pounds, the operation can prevent or resolve such conditions as Type 2 diabetes and high blood pressure.

"High levels of obesity are leading to dramatic rises in serious chronic illnesses like diabetes, heart disease, hypertension and some cancers," Caplan said. "Bariatric surgery will help offset the costs of treating these obesity-related conditions, while reducing ER visits and hospitalizations."

Ontario will spend about $51 million this year as part of its Out of Country program to send about 1,660 patients south of the border for the "much-needed" operation, "one of our fastest-growing expenditure lines in the health budget," he noted.

"And this put it in very stark terms for me, that for every surgery that we perform in Ontario as opposed to in the United States, it costs us $10,000 (per patient) less than we're currently funding."

But ramping up capacity is only one part of the equation.

Dr. Arya Sharma., president of the Canadian Association of Bariatric Physicians and Surgeons, said there are only about a dozen fully trained bariatric surgeons in Canada and lack of capacity has meant the specialty is not attracting more.

The average wait time country-wide for the weight-loss operation is more than five years.

"It's definitely a step in the right direction," Sharma said of Ontario's move. "Because obesity, if left untreated, is pretty much the root cause of a lot of the other chronic illnesses that you see."

Besides diabetes and high blood pressure, being overweight or obese can contribute to heart disease, sleep apnea, gastric reflux, joint problems and even some cancers.

"If you're not going to treat obesity, at some point you're going to end up spending a lot of money in treating all of these co-morbidities," Sharma, an obesity expert at the University of Alberta, said from Edmonton.

Caplan said it will take time to build teams of trained bariatric surgeons and related health providers at the four centres.

The hospitals will provide pre-and post-bariatric surgical care, counselling, referral, and weight-loss treatment delivered by a multi-disciplinary health-care team consisting of physicians, nurses, dietitians, social workers, kinesiologists and mental health workers.

"We are putting a focus on it to attract, to recruit, to retain and to train future practitioners," Caplan said.

Sharma said that when patients are sent outside the country for bariatric surgery, there is usually no followup by professionals trained to deal with obesity when they get home. And that followup is critical to ensure patients make lifestyle changes that help them get trim and stay that way.

In Alberta, there's only a handful of family doctors who have the expertise to look after patients who have had bariatric surgery, he said.

"And that I see as a much bigger problem than having the surgeons."