Nova Scotians are waiting more than eight years for weight-loss surgery

Most of the patients on Dr. Jim Ellsmere's operating table received their referrals for bariatric surgery nine years ago — and the wait times for weight-loss surgery haven't changed in the intervening years, according to the Nova Scotia Health Authority.

A patient referred to the weight-loss surgical program in March would have received a letter stating that "unfortunately, wait times are long, now eight to 10+ years."

There are numerous reasons for this, but it comes down to supply and demand: there's funding for operating time to perform between 60-80 surgeries each year, according to the health authority.

There are about 1,800 people on the waiting list to be assessed for the bariatric surgical program right now.

If all of them were successful candidates for surgery — and both the health authority and the Nova Scotia Health Department caution that not all would be — it would take between 22 and 30 years to clear the backlog.

"There's competing surgeries: knees, hips, those sorts of things that you hear about in the news," said Dr. Thomas Ransom, the program's medical director.

"But it's just a shame that so many are waiting so long [for bariatric surgery] and some might wait too long and then they're too old."

An economic argument

Although he recognizes the competition for resources in a health budget that's already reached $4.6 billion, Ransom said getting patients the surgery more quickly will also save the province money. 

Obesity is a disease, he emphasizes, and one that leads to many complicating conditions that are expensive to treat including diabetes, hypertension, heart disease, fatty liver disease, hip and joint issues, infertility, obstructive sleep apnea and depression.

"So all the complications of obesity are immense and really taking up a significant percentage of the health-care budget," Ransom said.

"Interventions such as bariatric surgery have been shown time and time again to be cost effective both in preventing complications of obesity, ameliorating the complications … such as people coming off all the diabetic medications or potentially not needing a knee replacement."

Neither the authority nor the Health Department could provide a figure for the program's funding, but Ransom estimates that each surgery costs about $6,000, with more funding for the program's part-time psychologist, part-time dietitian and nurse practitioner. 

In other provinces

Access to surgical intervention for obesity fluctuates across the country. In 2009, Ontario committed an extra $75 million to create a provincial bariatric network, which performed 5,007 bariatric surgeries in its first three years, according to an independent review of the program published in 2016.

The province said at the time that it saved about $10,000 on each surgery by performing them locally instead of having to send emergent patients out of the province.

Nova Scotia, however, has no plans to increase funding to the program, a spokesperson for the Health Department said in a statement. 

In a statement, Andrew Preeper disputed the figures cited by the provincial health authority, saying that provincial figures show the median wait times for a bariatric surgical consult is about 425 days, with the median surgery wait time sitting at 47 days.

Preeper said that some of the disparity in wait times may be due to individual patients needing more time to prepare physically and psychologically for surgery. 

"This program has not been brought forward by NSHA to the department for additional resources or funding," Preeper said in a statement. "That said, NSHA is now in the process of collecting information, including ways the wait time can be reduced or other barriers addressed, for further discussion with the department."

One surgeon

Right now, Ellsmere is the only surgeon in Nova Scotia who performs the surgery, which removes about 80 per cent of the stomach — something that limits both the amount patients eat and the amount of ghrelin, a hunger-triggering hormone, that's released into the body.

It's a "life-changing" surgery for people, Ransom said. More than 90 per cent of surgical patients in Nova Scotia successfully lose weight after the operation and maintain that weight loss, he said.

Shelly Lynds had hoped to be one of those success stories.

She's been waiting for a kidney transplant for five years and, during that time, dialysis has further laid waste to her body. In order to be a successful transplant candidate, her doctor has suggested she lose weight — and referred her to the bariatric surgical program in March.

She said she can't imagine being on dialysis for eight more years as she waits for surgery.

Waiting

While waiting for a surgical consultation, patients are asked to reduce their calorie consumption and aim for a weight loss of 15 to 30 pounds. A nurse practitioner and a dietitian will meet with patients to try to support them as they wait — as they do the work necessary to prepare for the surgery, Ransom said.

He emphasized that obesity is a disease, one affected by hormones and other genetic factors and that he worries that misinformation and stigma around obesity affects the way it is approached by health-care professionals.

"It's not just that this is a money-saving initiative for the health-care system, but that it's just such an excellent intervention for a lot of patients," he said. "It's really life-changing and the patients really benefit greatly."