Obese dying while waiting for weight-loss surgery
Reported July 05, 2009
Patients in Canada are dying while waiting their turn for obesity surgery, according to new research that says wait times for bariatric surgery are the longest of any surgically treated condition in the country.
In 2007, 6,783 patients were waiting for bariatric surgery in Canada. The wait time was just over five years, according to a report in the most recent issue of the Canadian Journal of Surgery.
At one Canadian centre the McGill University Health Centre in Montreal 12 patients died while on the waiting list. Researchers say the number of deaths underestimates the magnitude of the problem, because they were not actively looking to find them, and there was no formal callback of all 2,178 patients in the centre’s queue as of the end of 2008.
The average age of those who died was 46.
“It is not surprising that prolonged waits of more than five years for bariatric surgery lead to deaths among patients on the waiting list, given the devastating obesity-associated diseases that afflict these patients,” the McGill University researchers write. Those who died had underlying conditions such as diabetes, sleep apnea, heart disease, high blood pressure and deep vein thrombosis, or blood clots in the veins.
“Bariatric surgery cures or improves all these,” says lead author Dr. Nicolas Christou, a professor of surgery at McGill University and director of the bariatric surgery program at the McGill University Health Centre.
“Not having timely surgery to cure their obesity-associated diseases caused or contributed to their deaths.”
One 33-year-old woman died of multiple organ failure due to complications from diabetes. Others died of asthmatic attacks and cardiac arrest, blood clots in the lungs and heart attack. For five patients, the cause of death was unknown.
Christou says the wait times for obesity surgery are “inhumane.” But as Ontario, Quebec and other provinces look to expand access, he and others warn that the problem is bigger than just doing more surgery. Experts say no controls are in place to provide lifelong followup of patients.
“That’s more of a concern than the mortalities that are happening on the wait list,” says Christou. “You are exposing people to relatively major surgery . . . Who on earth is going to follow these people post-operatively?”
A common type of bariatric surgery is gastric bypass, which involves sectioning off a small portion of the stomach to create a pouch the size of a ping-pong ball. Also common is gastric banding, where a band-like device is placed around the stomach to divide it into two smaller compartments.
Gastric band patients “need to have a team of a dietitian, a psychologist and a bariatric physician specialist who will adjust the bands with them and make sure they stay on their diets,” says Christou.
Studies from France suggest as many as half of band patients “have to be re-operated because of no loss of weight whatsoever and worsening” of obesity-related health problems, Christou says. “If you happen to be the government, you’re paying double for the procedure without the proper followup.”
For gastric bypass patients, vitamin deficiencies such as B12 can lead to paralysis if not detected and treated.
“That doesn’t happen frequently, thank God,” Christou says. But iron-deficiency anemia is common. Other complications can include hernias, ulcers and staple leakage.
Christou is currently following 4,400 patients.
“I had about 100 people waiting in the office Monday, some of them waiting up to three hours to see me for post-operative followup five, six, seven years after their operation, because nobody else is trained to do it, or wants to do it, or is getting paid enough to do it.”
According to Christou’s study, a “conservative estimate” of the number of obese Canadians who might be eligible for surgery ranges from 600,000, to 1.2 million.
In total, 1,313 surgeries were performed in Canada in 2007.
Surgery can be life-saving for the right patient, says Dr. Arya Sharma, chair of obesity research and management at the University of Alberta in Edmonton. “The bottom line is that once you have severe obesity, diet and exercise is simply not going to do it.”
But only about one in four patients referred to the bariatric program in Edmonton is considered a good candidate for surgery, he says. Some have complex mental health problems, addictions or are considered too high a surgical risk. Others aren’t able to make the necessary lifestyle changes. “If your body is craving calories, you can be drinking those calories,” Sharma says. “You can still eat a gallon of ice cream when you’ve had surgery.”
Christou, who one day a week operates at his private clinic, says bariatric surgery is the only treatment that produces substantial and sustained long-term weight loss for the severely obese. The surgery can send type 2 diabetes into remission and lowers the risk of heart disease and cancer.
Joel Sopp, a 34-year-old father of two who weighs about 400 pounds, is scheduled for bariatric surgery on June 22. He has been waiting more than five years. He has been dealing with obesity since Grade 11, when he weighed 285 pounds. He suffers from sleep apnea, knee and back problems. He recently joined a city league basketball team in Regina to lose weight and ended up “almost blowing out one of my knees.
“It’s kind of ironic that I try and get more active to lose weight, and I end up hurting myself instead,” says Sopp, president of the Saskatchewan Bariatric Surgery Support Group.
“If the world operated like the Biggest Loser, where we could all leave work for the summer, the world would be an awful lot better. But that’s not reality.”
He says bariatric surgery “can make my life better, my family’s, and society’s, because it means I’ll be less of a burden on the health system.”
Source : Canwest News Service