Sharadh Sampath: B.C. budget should fund increase in bariatric surgeries

The obesity procedures would pay for themselves and shorten scandalously long wait lists

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      By Dr. Sharadh Sampath

      Finance Minister Carole James will bring down the province’s budget on February 20. The vast range of programs and services delivered by the provincial government must make the drafting of a budget an incredibly challenging task, balancing myriad needs with always limited resources.

      However, there is one thing the minister could include in her budget that would not only save money but would save and improve the lives of British Columbians too.

      Right now, the government of B.C. annually funds 400 bariatric-surgery procedures, far and away the most effective curative for obesity. It is also the only treatment option that can be curative for Type 2 diabetes. Each surgery—including pre-op conditioning and post-op supports—costs $13,000. That’s $5.2 million a year. By contrast, $1.4 billion is spent each year on the complications from obesity, including diabetes, hypertension, heart disease, osteoarthritis, and cancer.

      Of course, increasing the number of surgeries won’t eliminate all of that $1.4 billion—but it will pay for itself in every case where patients are costing the health-care system more money than the surgery costs.

      The wait list to enter a bariatric-surgery program now stands at 28 months—with another six to nine months before patients are ready for surgery. No other wait list in the province, surgical or medical, is that long. This kind of delay would never be tolerated for joint replacements, hernia surgery, cataract replacement, or any other condition. So why is it okay for a patient suffering from obesity?

      I have been performing bariatric surgeries for a number of years, and my experience tells me that people with obesity are blamed for their condition. Obesity may be our last acceptable prejudice.

      As a society, we have evolved so that people with mental illnesses are respected and treated with the same care as an individual with any other condition, not told to “cheer up” or blamed for not being “strong” enough to overcome their illness. So why would we tolerate the idea that people with obesity—a condition that disproportionately affects women, persons with disabilities, those in low socioeconomic strata, Indigenous people, and people with histories of abuse, mental-health disorders, and substance abuse—should be left to manage their struggles alone?

      In medicine, we have a term for it: weight bias. It’s a prejudice that allows doctors and others to dismiss the underlying physiological and psychological causes by throwing blame back on the patient. You’ve probably heard (or said, or thought) something along this line: Why couldn’t that person have a bit more self-control? Why couldn’t they eat a little less and walk a little more? Some of us may even have thought that obesity is a result of laziness, gluttony or weakness.

      I can tell you there’s nothing lazy or weak about my patients. Most have tried every diet under the sun. They’ve lost and regained the same 100 pounds more times than they can count. They struggle against a complex interplay of gut-hormones acting on centres in the brain with social stressors such as abuse, poverty and discrimination piling on. All these forces pull us back to our metabolic set point—which in patients who are obese is a dangerous weight that leads to additional medical conditions that can debilitate or kill them—and cost the health-care system enormously in the process.

      We British Columbians pride ourselves on being the most inclusive and accepting province in a country that is known as being pretty nice, overall. But the fact is, we are inclusive and tolerant until we aren’t. Because although we won’t tolerate bigotry and discrimination on the basis of race, religion, gender, or sexual orientation, we’re still not great when it comes to people who suffer from obesity.

      The provincial budget process must be incredibly intricate, a puzzle the complexity of which I cannot imagine. I do know, though, that funding more bariatric surgeries is one of those win-win options that can save lives and money at the same time. Other provinces recognize the false economy inherent in severely limiting the number of procedures. Per capita, Alberta funds twice as many bariatric procedures as B.C., Ontario triple the number, and Quebec five times as many.

      As the finance minister, the health minister, the premier, and others in the budget process complete their work in the next few weeks, I hope that they will consider what is a comparatively small budget item for more bariatric surgeries—an expenditure that will pay for itself while saving the lives of my patients.

      Sharadh Sampath, MD FRCSC, is president of the B.C. Obesity Society, head of general surgery at Richmond Hospital, director of the Richmond metabolic and bariatric surgery program, and clinical assistant professor at UBC.