A new care centre in Thunder Bay is helping people who are struggling with obesity and also saving provincial health-care dollars.The Thunder Bay Regional Bariatric Care Centre opened its doors in July. Located beside Thunder Bay Regional, the centre is an integrated surgical assessment program for the care of obese and morbidly obese patients.
So far, it has received more than 300 referrals from across northwestern Ontario, already exceeding its original expectation of about 200 referrals annually. Referrals from primary care practitioners are sent to the Ontario Bariatric Registry and then forwarded to a bariatric care centre.
The Thunder Bay centre focuses on providing patient and family-centred care, high-quality pre-surgical assessment and post-surgical followup services for adults requiring weight loss surgery.
"We make sure that patients are appropriate for surgery, and prepare them for the implications of surgery," said Ron Turner, the centre's implementation co-ordinator. "We make sure they are making an informed decision and are physically fit for surgery."Northwestern Ontario has the highest obesity rate in the province - 33 per cent higher than the provincial average.
Savings
Before the program was initiated, patients had to have surgery outside of the country. Patients from the Thunder Bay area had gastric bypass surgery performed in Duluth. The government is saving about $10,000 for every case performed in Ontario rather than the United States.
"The Ministry (of Health) realized they could get more bang for their buck if they brought the service back into the province," said Turner. "The patients who went to Duluth were not really getting the followup care that we are providing here."
Bariatric surgery, also called gastric bypass surgery, involves reconfiguring a patient's digestive system to achieve significant weight loss. It is considered a last resort for patients who have tried unsuccessfully to lose weight in other ways, such as diets, increased physical activity, behaviour modification and anti-obesity drugs.
Bariatric surgery can help resolve several health conditions, including diabetes, hypertension and dyslipidemias, a condition that can lead to the hardening of artery walls and restrict blood flow to the heart. Gastric bypass surgery can also reduce other obesity-related conditions, such as high blood pressure, osteoarthritis, ischemic heart disease, stroke and some cancers.
Last year, the provincial government announced a plan to fund 1,470 additional bariatric surgeries a year as part of Ontario's $75-million plan to improve access to bariatric services.
By 2011 and 2012, Ontario expects to fund a minimum of 2,085 surgeries a year to be delivered at "centres of excellence" throughout the province.
The Ontario Bariatric Network consists of four centres of excellence located in Toronto, Hamilton, Guelph and Ottawa, as well as regional assessment and treatment centres in Thunder Bay and Windsor, and a paediatric regional assessment and treatment centre at the Hospital for Sick Children.
Team
The Thunder Bay bariatric care team collaborates with surgeons at St. Joseph's Healthcare in Hamilton, and with other Ontario bariatric surgery centres of excellence, where the gastric bypass surgery is performed. The local team consists of an endocrinologist, nurse practitioner, social worker, psychologist, kinesiologist and two registered dietitians, in addition to administrative clerks and a patient/family advisor.
While the surgery is not currently performed in northwestern Ontario, the province hopes to provide surgery in Thunder Bay within the next few years.
"We've got a proposal in with the ministry," said Brent Maranzan, director of surgical services at Thunder Bay Regional. "The goal is to do the surgery here as well."
A member of the Ontario Bariatric Network, the centre has telemedicine links throughout Northern Ontario to assist with assessment and followup in remote sites. This allows patients to be closer to home, travel less and still meet assessment goals.
Anyone thinking about having bariatric surgery must have a comprehensive assessment and screening completed before being accepted for surgery. To be eligible for surgery, a patient must have a body mass index (BMI) of at least 40, or a BMI above 35 if medical problems such as diabetes mellitus or high blood pressure exist. The patient must have also tried many diets, and must be motivated and willing to make eating and lifestyle changes. Besides being psychologically and medically fit for surgery, the individual must commit to five years of post-surgical followup.
"Bariatric surgery is the most successful care for obesity," said Turner. "It is an irreversible surgery, and we want to make sure that patients know what they are getting into."
Within the first two years after surgery, patients who stick to a strict set of guidelines can expect to lose up to 70 per cent of their excess body weight.
"When you get into the third, fourth and fifth years, that's when you see people start to regain weight, and that's what we're trying to focus our attention on," said Turner.
The decision to undergo bariatric surgery is one that permanently alters a patient's lifestyle.
Stomach
"The stomach goes from the size of a football down to the size of a tennis ball post-operatively," explained Turner. "The amount that people can eat changes, and the types of food that they eat changes."
Patient followup is a big focus of the care centre. In the first year after surgery, patients are required to attend between four and six appointments for a comprehensive followup to ensure they are on track. After that, patients are seen once annually for four more years.
"It is about support throughout the entire process," said Turner.
The care centre is part of a provincial government strategy designed to reduce the risk of diabetes and improve access to bariatric treatment.
In 2008, Ontario launched a $741-million diabetes strategy that aims to prevent, manage and treat diabetes care across the province. Complications caused by diabetes include heart disease, stroke, kidney disease and blindness, costing the health-care system more than $5 billion annually.
More than 50 per cent of Type II diabetes cases in Ontario can be attributed to obesity.
www.bariatricregistry.ca
Brigitte Petersen is a freelance journalist based in Thunder Bay.
