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The Regina-Qu’Appelle Bariatric Surgery Pilot Program: Preliminary Results

The Regina-Qu’Appelle Bariatric Surgery Pilot Program: Preliminary Results. Jillian Wilmot, Regan Shercliffe Ph.D., Ali Bell MA & Gordie Kaban MD. Acknowledgements. Regina Qu’Appelle Health Region Allied Health Centre & Health Pro Management Luther College at the University of Regina.

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The Regina-Qu’Appelle Bariatric Surgery Pilot Program: Preliminary Results

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  1. The Regina-Qu’Appelle Bariatric Surgery Pilot Program: Preliminary Results Jillian Wilmot, Regan Shercliffe Ph.D., Ali Bell MA & Gordie Kaban MD

  2. Acknowledgements • Regina Qu’Appelle Health Region • Allied Health Centre & Health Pro Management • Luther College at the University of Regina

  3. Definition of Obesity • Based on the World Health Guidelines for Body Mass Index (BMI) obesity is defined as: • Obesity I BMI 30.0 to 34.9 • Obesity II BMI 35.0 to 39.9 • Extreme Obesity BMI > 40 • Currently the rate of obesity in Canada is 22.9% for men and 23.2% in women • Rates of obesity in Saskatchewan are significantly higher than the national average at 32.9%

  4. Obesity in Canada

  5. Health Risks • Co morbidities associated with obesity include (but not limited to): • Cardiovascular Disease • Joint problems and pain • Diabetes • Kidney Disease • Sleep Apnea • Stroke

  6. Healthcare Costs • Direct costs associated with obesity and comorbidities associated with obesity in Canada: • 1.8 billion dollars or 2.4% of healthcare budget • Largest expenditures: • Hypertension • Type II Diabetes • Coronary Artery Disease • The costs associated with obesity are double in the United States compared to Canada • Other countries report similar costs to Canada • When indirect costs are considered the impact in terms of dollars to the overall economy is more than double

  7. Rationale for a Pre-surgical Program • While there are few studies that have systematically assessed the role of pre-surgical programs in predicting success following gastric bypass, the research thus far suggests: • Dietary non compliance and level of activity following surgery can impact amount of weight lost • Pre surgical weight loss of greater than 10% can result in increased weight loss following surgery • There is general agreement that lifestyle changes, i.e. monitoring caloric intake and regular exercise, are important to the long term success of the surgery defined as weight loss of at least 50% of excess body weight

  8. Background for the Current Study • Funding was received in 2008 to run a 15 month presurgical pilot program that involved – once patients complete the six month presurgical program they are then put on a waitlist for the Roux-en Y procedure • Comprehensive assessment and follow-up at 2, 4 and 6 months by a psychologist, nutritionist, physiotherapist an exercise therapist • Patients will be followed for two years post surgery • Study has received ethical approval form the RQHR Research Ethics Board

  9. Method • In order to be eligible patients must have a BMI between 40 and 60, patients with a BMI between 35 an 40 may be considered if they have 2 or more co-morbid conditions associated with their obesity • Patients were asked to complete a number of measures at initial assessment and at 2, 4, & 6 months. • Pre surgery • The measures assessed eating patterns, exercise and activity, mood and anxiety and other relevant factors. • Post surgery • Patients completed a comprehensive questionnaire package when they returned for follow-up with the nutritionist at 2 weeks, 1, 2, 3, 4 and 6 months post surgery. Patients will complete the same measures at 1 and 2 years (no patients thus have been 1 year post surgery)

  10. ResultsDemographics • To date 110 patients have been examined for research purposes • Patients are 83 females and 27 males • Patients are between the age of 21 and 65. • Mean age = 43.94 SD = 10.02 • Mean BMI = 51.35 SD = 7.43 • 57% of patients report having experienced problems with depression, anxiety or other emotions which disrupted their normal functioning • 89% have sought professional help in this respect • 29% of patients report previously being subjected to physical abuse • 31% report having been subjected to sexual abuse

  11. 33% of patients had scores of moderate to severe depression 55% of patients reported binge eating patterns on the WALI 18.5% of patients had scores of moderate to severe anxiety 12.5% of patients had scores of moderate to severe depression 13% of patients reported binge eating patterns on the WALI 2.8% of patients had scores of moderate to severe anxiety ResultsPre-surgical Initial Assessment 6 Month Follow Up

  12. Mean weight = 146.06 kg SD = 26.02 8.6% of patients engaged in more than 1 day of vigorous physical activity per week 46% of patients reported their activity levels were declining, 35% were maintaining and 19% were improving Mean weight = 142.11 kg SD = 22.80 49% of patients engaged in more than 1 day of vigorous physical activity per week 19% of patients reported their activity levels were declining, 29% were maintaining and 52% were improving At 6 month follow-up assessment 90% of patients had met the physical activity goals set by exercise therapist ResultsPre-surgical Initial Assessment 6 Month Follow Up

  13. ResultsPost surgery • Results are very preliminary • 28 patients have had surgery • On average 1 surgery per week is being performed • On average, second post surgery follow up is conducted 5.6 weeks following (N=21) • Mean weight = 115.61 kg SD = 14.37 • On average, fifth post surgery follow up is conducted 27 weeks following surgery (N=7) • Mean weight = 97.67 kg SD = 12.71

  14. ResultsPost surgery • The Bariatric Analysis and Reporting Outcome System (BAROS) evaluates the results of treatments for obesity by analyzing weight loss, changes in co-morbidities and quality of life. • A system used internationally since the late 1990’s to compare outcomes of bariatric treatments, the BAROS was updated in 2009. • 54% of patients reported good to very good quality of life scores at second post surgery follow-up • 100% of patients reported good to very good quality of life scores at fifth post surgery follow-up

  15. Conclusions • Pre-surgical program has been effective with respect to improving mood, increasing activity level and losing weight • This suggests that patients are engaging in positive lifestyle changes that will enhance post surgical success • Post surgical results are preliminary • The goal is to compare RQHR results with those of other studies using the BAROS and other measures • Eventually, once more patients have surgery we will be able to build prediction models that will add to the literature and also be useful with respect to practitioners considering establishing a bariatric pre-surgical program

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