Background

As regularly documented in the media, obesity is a growing health concern in Canada. Obesity leads to many co-morbidities, including type II diabetes, sleep apnea, hypertension, some forms of cancers and heart disease. Obese people see doctors more often, take more prescription drugs and are more likely to access mental health care services. And not only does the disease take its toll on the individuals suffering, but it is a tremendous cost to our health care system ($1.8 billion in 1997; this number continues to climb). In 1998, the Canadian Medical Association estimates there were 3.3 million obese Canadians, a number showing a steady increase since 1985. We know obesity is a growing problem. We know the medical consequences and cost of obesity. Yet, ironically, obesity remains one of the most difficult health problems to access treatment for.

According to the CMA, once a person reaches the rate of morbid obesity (approximately 100 pounds overweight), he or she has only a 2% chance of losing and keeping the excess weight off without surgical intervention. With surgical intervention, that success rate goes up to approximately 75%. But weight loss (bariatric) surgery, despite its tremendous demonstrated success (96% of co-morbidities improve or disappear), has a distressingly long wait time in Canada. In British Columbia, a patient, if referred to a surgeon today by his or her family doctor, could expect to wait around four years for surgery. During that time the patient often experiences deteriorating health (translating into extra costs to the system). Furthermore, obese people are more likely to be on disability or underemployed; lost productivity is not included in the $1.8 billion cost of obesity. And finally the patient faces the continued psychological pain of living as an obese person in a fat-phobic society, often suffering discrimination and taunting, as well as struggling with the limiting nature of obesity.

While bariatric surgery is not a magic bullet cure for obesity, right now it is the best treatment option available. And for those who decide it is an option for them and for whom a surgeon determines it is a viable treatment option, along with any other life-saving procedure, it should be reasonably accessible. Many Canadian jurisdictions, including Alberta, Ontario and Saskatchewan, have acknowledged the problem of obesity among their populations and since 2007 have added targeted funding to increase access to bariatric surgery. British Columbia, however, has not

Goal 1

Our first goal at the BCABA is to lobby for funding for increased access to bariatric surgery. Targeted funding for obesity surgery is first and foremost cost-effective for the long-term given the increased health of the patients and decreased risk for serious health concerns. Furthermore, it is compassionate given the life-altering experiences of the patients.

Goal 2

Our second goal is to see adjustable banding procedures covered in British Columbia. Right now these options are available only on a self-pay basis, meaning that patients are not necessarily choosing the best option for their health needs, but rather are choosing based on their bank account. It seems ludicrous that patients are forced by the Medical Services Plan to undergo a more invasive procedure (such as gastric bypass) when a less-invasive adjustable band would serve their needs, or to undergo a banding procedure with more post-op complications, such as the vertical banded gastroplasty. If the surgeon and the patient determine that an adjustable band is the most appropriate choice for a patient, that option should be covered by MSP.

Goal 3

 We are also advocating for better coverage for post-weight loss reconstructive surgery. Currently, there exists within MSP’s billing structure an allowance of $292.63, an amount designed to cover a panniculectomy, or removal of the triangular region of skin below the belly button. This is grossly inadequate in that it does not begin to address the amount of redundant skin most patients have. Furthermore, it does not allow for the tightening of the muscles-- which also become stretched in obese patients-- that are part of an abdominoplasty. And many patients require not only an abdominoplasty, but a belt lipectomy, which addresses the redundant skin all the way around the torso, including the hips and back. Patients requiring this procedure can expect to pay $10 000 to $15 000. Those without the means to pay must carry around the redundant skin, and can experience rashes, sores, infections and pain from the weight of the skin. Furthermore, the patient still psychologically feels fat and cannot move on and fully benefit from his or her new lease on life. MSP covers breast reconstruction following a mastectomy because of its importance to the patient’s psychological health and overall well-being. The same thinking ought to extend to the formerly obese patient whose body is even more disfigured than the mastectomy patient’s. The American Society of Plastic Surgeons distinguishes between cosmetic and reconstructive surgery: Cosmetic surgery is taking a normal body part and making it look better, whereas as reconstructive surgery is taking a deformed body part and making it look normal. Clearly a patient who has lost a massive amount of weight is in need of reconstructive surgery, rather than cosmetic. Unfortunately, MSP’s billing schedule does not reflect this reality. So those who have financial means are able to access treatment for their redundant skin. Those without financial means are not. This hardly seems compatible with the philosophy of universality underlying the Canadian health care system.

Goal 4

Our final goal at the BCABA is to act as educators. It is not an understatement to say that obesity remains the one form of discrimination in our society. We have (rightly) evolved beyond accepting racist jokes or jokes about the disabled. However, fat jokes are still perfectly acceptable. And obese people face discrimination and mistreatment on a daily basis. Like all other forms of discrimination, this mistreatment is rooted in a lack of understanding. And it is a far-reaching lack of understanding, one that unfortunately even permeates into the medical community. Many obese people report that they sometimes don’t seek medical attention because of the lack of respect and compassion they’ve been shown in the past. So it is our goal to increase people’s understanding of obesity and the problems facing those who suffer from it. All people in society have dignity and merit respect and compassion. Why should the obese be any different?