For some people, bariatric surgery is an option for obesity management. Bariatric surgeries either cause a reduction in the amount of food you are able to eat comfortably or a reduction in the absorption of calories from the food you eat, or both. While these surgeries can have major impacts on an individual’s weight and other health-related factors, continued success and improvements in overall health still depend on maintaining healthy behaviours.
With appropriate patient selection, education and follow up, bariatric surgery can offer sustainable weight loss (20% to 30% reduction) with substantial reductions in morbidity and mortality (40% to 89%, respectively) and significant improvements in mental health and quality of life.
As is the case with any surgery, bariatric surgery is also associated with some risks or complications. Complication rates associated with bariatric surgery are between 10% and 17%, reoperation rates are approximately 7% and the mortality rate is low (less than 1%).
According to the Canadian Institute for Health Information (which tracks statistics about healthcare funding, usage and outcomes in Canada), the three most common bariatric surgical approaches offered in Canada are:
Adjustable Gastric Banding – This reversible procedure uses an adjustable band wrapped around the top of the stomach, which creates a small pouch that holds about one half cup of food. Adjusting the band increases or decreases the size of the pouch, which in turn increases or decreases the amount of food you can eat. Since this procedure has poor long term results, most surgeons have stopped performing this procedure.
Sleeve Gastrectomy – Here, surgeons will remove most of the stomach, leaving only a banana-sized vertical “sleeve” of it in place.
Gastric Bypass – A small stomach pouch is created using surgical staples, which also allows food to bypass some of the small intestine.
Canadian Clinical Practice Guidelines recommend that adults with clinically severe obesity (BMI ≥ 40 kg/m2 or ≥ 35 kg/m2 with severe comorbid disease) may be considered for bariatric surgery when behavioural intervention is inadequate to achieve healthy weight goals. Eligibility criteria may vary from province to province. Most surgical programs require a referral from a primary care physician.
Ask your primary care physician about the availability of bariatric surgery in your province and whether or not it might help you. Not everyone who qualifies for bariatric surgery based on BMI and/or the presence of related disease may be eligible for it, depending on mental health status, whether or not someone has alcohol or drug dependencies and other factors.
Wait times for bariatric surgery in Canada are the longest of any surgically treatable condition, and vary significantly from province to province. A significant proportion of the wait time experienced by patients referred to bariatric surgery is between referral and consultation with a specialist. Patients in most provinces wait for two years or more, and the wait can be as long as four to five years. Typically, wait times between consultation with a specialist and surgery is six to 12 months.