Why Is it Taking So Long for us to Embrace Bariatric Surgery?

For years, we’ve been guided by the basic principle that diet and exercise staves off obesity, and that eating sugar and living a sedentary lifestyle makes us fat. However, studies have shown that this just isn’t true…at least, it’s not that simple. Despite our endless gym memberships and extreme diets, our waist sizes are increasing. In Canada, 28% of the population is obese. In a recent  Globe and Mail article, this question is put forward: why aren’t more obese patients getting sleeve gastrectomies?

The Simplicity and Effectiveness of the Sleeve Gastrectomy

A sleeve gastrectomy has been characterized as a straightforward procedure. Unlike diet and exercise, the procedure not only shrinks the size of the stomach but also reduces the body’s ghrelin levels, the hormone that stimulates hunger sensations. The procedure involves the removal of 60–85% of the stomach pouch, thus restricting the amount of food the patient now needs to feel full. The whole procedure takes just under an hour, and patients can expect to return to work in as little as two weeks.

Why Is the Procedure Not More Common?

Quebec is ahead of other provinces in terms of weight loss surgery numbers. One in 90 obese people receive surgical treatment for their obesity, however, that is nothing if you consider that almost a third of our population would benefit from a procedure. So why isn’t more being done to help obese Canadians when “simple” diet and exercise isn’t enough? Cutting through the red tape and the haze of bureaucracy reveals the unfaltering and incorrect stigma that obese people are somehow to blame for their weight, which makes government-funded weight-loss surgery a politically and ethically charged subject on which nobody agrees.

More and more evidence is emerging that points the “blame” to something that not a single person on the planet can control: their genetic makeup. If you carry the gene variant called rs9939609, you share the same characteristic with every other obese person on the planet, which might be more to blame than unhealthy lifestyle choices.

If you think you qualify for bariatric surgery and diet and exercise have not helped, fill out of patient questionnaire to find out if surgical weight-loss treatment is right for you.

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Dr. Michel Gagner to Participate in AIS World Bariatric Series 2018

Along with three prominent bariatric surgeons, Dr. Michel Gagner will perform a live surgery as part of the AIS World Bariatric Surgery Series for the purposes of education and surgical training experience. The first part of the series is scheduled from April to July, while the second round begins again in September.

Joining Dr. Gagner are Dr. Camilo Boza, Medical Director of Clínica las Condes, Santiago, Chile; Bruno Dilleman, Director of the Center of Obesity Surgery at AZ Sint-Jan Hospital, Bruges, Belgium; and Robin Blackstone, Professor of Surgery at University of Arizona School of Medicine.

Series Schedule

Dr. Gagner will be performing a gastric sleeve to duodenal switch on June 13th, which can be viewed by registering for the series. The first part of the online training series will give learners the chance to participate in a bariatric revision surgery. Dr. Gagner and his associates will have the chance to discuss the surgery before performing it live. The second part of the AIS learning series will discuss the outcomes of the procedure, as well as any complications that arise.

What Can Participants Expect to Learn from the Series?

Anyone participating in the discussions and live surgeries will gain plenty of knowledge and experience from this series. Participants will have a deeper understanding of pre-surgery patient selection and preparation. They will have a chance to interact and discuss revisional surgery with industry-leading experts, as well as discuss other complex cases and the strategies for improving the outcomes of revisional surgery. Lastly, participants will have the chance to observe the use of safe and effective surgical technologies.

The next surgery is scheduled for May 24 and will be conducted by Dr. Bruno Dillemans. For more information about the AIS World Bariatric Series 2018 or to register, visit the official website. Registration is open to professionals as well as bariatric patients.

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Obesity Paradox Debunked by Researchers in UK

The Obesity Paradox is, to put it simply, a theory that obesity has more positive health effects on some populations. As the theory goes, body fat is thought to protect the body’s organs in the elderly and in people with certain diseases. This paradox has been largely criticized since its publication and has at last been debunked by researchers at the University of Glasgow.

Research Findings

The Scottish study that included almost 300,000 people revealed that the risk of stroke, heart attack and high blood pressure increased with body mass indexes higher than 23. It also determined that the risk was even higher for people who carried excess fat in their stomach. People with a BMI of 22–23 were at the lowest risk of heart disease.

Healthy Patients

The patients studied were all considered healthy, so it’s important to remember that this study did not research the effects of obesity in people with diseases. It is still believed that obesity protects people suffering from cancer, as the disease and treatment can cause significant weight loss.

Reverse Causation

The results of the Obesity Paradox test force us to question if whether its proponents have misdirected causation. In other words, people with lower BMIs may not have an increased risk of death, but rather, people who are sick or near death suffer from significant weight loss.

BMI and Weight Distribution

The study determined two important factors: that people who can maintain a BMI of 22–23 and keep excess weight away from their midsection have the lowest chance of heart attack, stroke, and high blood pressure.

If your body mass index is higher than 23, speak to your doctor or dietician who will help you develop a diet and weight-loss plan. Your doctor may also recommend weight loss surgery.

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A Decrease in Type 2 Diabetes Linked to Bariatric Surgery

A French study conducted between 2008 and 2009 showed that almost half of bariatric surgery patients stopped taking their anti-diabetes medication within six years of their surgery. Of the many bariatric surgeries studied, the biggest drop in anti-diabetes and insulin medication use was from patients who had undergone a gastric bypass procedure.

On an individual level, however, every patient will experience a varied mid- and long-term prognosis of obesity-related conditions. Patients who have only just started taking anti-diabetes medication are more likely to overcome their condition with bariatric surgery than patients who have been taking anti-diabetes medications including insulin for decades.

What is Gastric Bypass? 

Clinique Michel Gagner performs two variations of gastric bypass procedures: Mini Gastric Bypass and Laparoscopic Roux-en-Y Gastric Bypass.

The difference between a Mini Gastric Bypass and Gastric Bypass procedure is that the “mini” procedure involves only one connection or anastomosis of the stomach and intestine, whereas a Gastric Bypass involves two. This procedure combines two factors in achieving affective post-surgical weight-loss: intestinal malabsorption and gastric reduction. This is achieved through creating a gastric pouch near the esophageal sphincter, which is then attached to the first part of the intestine.

A Roux-en-Y Gastric Bypass procedure was developed by Dr. Gagner in 1996. As with the Mini Gastric Bypass, a Roux-en-Y Gastric Bypass also involves creating a gastric pouch, but with the first part of the intestine being cut into two sections and attached to the newly formed gastric pouch and further down the Roux limb.

Link Between Obesity, Diabetes, and Pharmaceutical Companies

In the article recently released about the French study, Dr. Michel Gagner posited that the number of patients examined represented only a small number of patients who have diabetes, and that the staggering number of money spent on anti-diabetes medication ($38.8 billion dollars in the United States alone) could afford to treat over a million people surgically.

Contact Clinique Michel Gagner today or fill out our patient questionnaire to start your weight loss journey.

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Dr. Michel Gagner Performs All-New Type of Surgery

Clinique Michel Gagner was recently featured in Le Journal de Montreal for performing the country’s first non-invasive bariatric surgery of its kind, called aspiration therapy. The surgery will be performed on Hélène Sénécal-Blanchet, a Quebecoise woman suffering from obesity and diabetes. Invented in the United States, aspiration therapy was first approved last year in Canada, but has been used in Europe since 2012.

The Difference Between Aspiration Therapy and Bariatric Surgery

Unlike other forms of bariatric surgery, aspiration therapy requires zero removal of the stomach. A laparoscopic sleeve gastrectomy, for example, involves the removal of up to 85% of the stomach pouch. After an LSG procedure, the patient will experience satiation sooner as their stomach volume is significantly reduced. While safe, LSG procedures do require general anesthesia and are not reversible.

Aspiration therapy, or AspireAssist, is a whole new approach to weight loss surgery. Instead of removing the patient’s stomach volume, a tube is inserted into the patient’s stomach and out the abdomen, where food can be disposed of in the toilet via a button that is attached to the patient’s skin. By disposing of the food before it is digested, the patient will not absorb as many calories, which can therefore lead to weight loss. Patients are required to replace their AspireAssist kit every year, and the treatment is completely reversible.

More About Aspiration Therapy

AspireAssist costs roughly $9,000 compared to the $13,000 to $20,000 price tag attached to other bariatric surgeries. So far, aspiration therapy is only available through the private sector. With such a long waiting list for obese patients to receive proper bariatric care in this country, therapies like AspireAssist could significantly reduce wait times for people in need.

If you’re interested in learning more about how weight loss surgery may be right for you, please fill out this patient questionnaire or contact us for more information.

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Bariatric Surgeries on the Rise; Sleeve Gastrectomy at Top

According to the American Society for Metabolic and Bariatric Surgery (ASMBS), bariatric surgeries in the US has risen by 10 percent since last year, with the sleeve gastrectomy continuing to be the main procedure with gastric bypass coming into second. Since 2011, sleeve gastrectomies only represented 17.8 percent of the procedures performed, but that number has been steadily rising over the years and now represents almost 60 percent of the weight loss surgeries performed in the US.

Laparoscopic Sleeve Gastrectomy

Dr. Michel Gagner perfected the sleeve gastrectomy in 2000 and it has been a popular choice for high-risk bariatric patients and patients with a low BMI ever since. There are many advantages to undergoing the sleeve gastrectomy compared to other procedures, mainly that the surgery preserves gastric emptying and mineral absorption, causes less dumping syndrome and hypoglycemia, and can easily be revised in the case of weight regain. Laparoscopic sleeve gastrectomy is generally the first step in weight-loss surgery for many patients, as it is typically less invasive (the laparoscopic camera allows for more precise use of long surgical instruments) than other procedures, and patients can return to work in as little as two weeks.

The laparoscopic sleeve gastrectomy is a procedure wherein 60–85% of the stomach pouch is removed, leaving a sleeve-like shape that is much smaller in volume. Because of the reduced size of the stomach, the patient will feel fuller sooner.

Bariatric Surgeries in the US

There is an estimated 24 million people in the United States who are eligible for bariatric surgery. In 2016, roughly 216,000 surgeries were performed or roughly one percent of the population who are eligible. Are you considering bariatric surgery as the next step in your weight loss journey? Fill out our Patient Questionnaire or contact Clinique Michel Gagner for more information.

 

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How Well Are We Treating Obesity in Canada: A Quick Overview

When it comes to access to bariatric surgery in Canada, our country’s report card could be better. The highest score we received was a C for waiting times between consultations and surgery, which doesn’t even apply to all provinces. Part of the reason for our low scores is that despite the fact of obesity in this country, not one province considers it a chronic disease, which has a major effect on how obesity patients receive health care.

Despite the Millions of Obese Patients in Canada, there are only 113 Bariatric Surgeons

Of the millions of obese patients in the country, every single one of them must rely on the training and expertise of a very low percentage of surgeons. That is not to say that these physicians are fairly spread out throughout the country. For instance, bariatric surgery is not even available in PEI or the territories. This is not reflective of the number of patients who are eligible for bariatric surgery. On average, bariatric surgery is only available to 0.54% of the population of Canadians who qualify.

Limited to No Access to Prescription Medication

There are only two approved anti-obesity medications in Canada. However, neither of these are offered by provincial drug benefit plans, and only less than 20% of Canadians with private insurance have access to these two drugs. Canada and the provinces/territories all scored an F on access to anti-obesity medications.

Access to Obesity Specialists

There are only 40 specialists in the country who are qualified and trained to provide obese patients with interdisciplinary care. The majority of these services entail dietetic services, while mental health support and cognitive behavioural therapy access is severely limited. Interdisciplinary treatment for obesity management is simply unavailable for the many people who need it, and Canadian physicians are just not seeking formal training in obesity management.

Clinique Michel Gagner is committed to providing our Canadian and international patients with superior service in bariatric surgery. Fill out this patient questionnaire or contact us today for more information.

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Constats sur la chirurgie bariatrique: Des résultats positifs dévoilés à la conférence FALS 2017

Du 6 au 8 octobre dernier, 180 chirurgiens bariatriques ont eu la chance de recevoir une formation dans le cadre d’un programme organisé par la Indian Association of Gastrointestinal Endosurgeons (IAGES) pour une deuxième édition à Mumbai. Lors de cet événement, plusieurs sujets comme l’avancement dans le domaine de la chirurgie bariatrique et des résultats de recherches concluantes à propos, par exemple, du bienfait des chirurgies bariatriques sur le diabète, l’obésité et d’autres maladies chroniques ainsi que sur l’importance de l’éthique dans le domaine. Le Dr Michel Gagner faisait partie des invités internationaux.

Les chirurgiens suivant cette formation de 3 jours ont pu en apprendre sur les bases de la chirurgie bariatrique, ses aspects techniques et les résultats possibles de celle-ci, sur les procédures postopératoires et la façon d’évaluer les patients pour ce type de chirurgie. Ils ont aussi pu assister à des discussions et le partage de résultats d’études menées sur le sujet.

 Des résultats positifs sur plusieurs maladies chroniques

Le Dr Phil Schauer de la clinique de Cleveland a dévoilé des résultats sur les bienfaits de la chirurgie bariatrique sur les patients souffrant de diabète type 2 au terme de l’étude Surgical Therapy and Medications Potentioally Eradicate Diabetes Efficiently (STAMPEDED), qui s’est étendue sur une période de cinq ans. Effectivement, l’étude a démontré que ces patients ont de meilleures chances de rémission qu’avec des traitements conventionnels incluant médications et mode de vie sain. «La chose la plus surprenante, spécialement pour les patients ayant subi un pontage gastrique, est de constater que presque un tiers ont connu une rémission complète du diabète.» A-t’il témoigné.

Zahabiya Khorakiwala, de l’Hopital Wockhardt a aussi partagé qu’au moins 3000 millions adultes souffrent d’obésité et que ce problème est associé à plusieurs maladies chroniques comme l’hypertension, crise cardiaque et plusieurs types de cancers. La perte de poids serait plus efficace lors de chirurgie bariatrique et il s’agit d’un traitement plus bénéfique que les thérapies et diètes conventionnelles.

 L’importance de l’éthique

Directeur du département de chirurgie bariatrique et métabolique à l’Hopital Wockhardt, le Dr Ramen Goel a souligné l’importance d’une pratique éthique sur le terrain. Avec plus de 17 ans d’expérience, il affirme qu’il ne s’agit pas de se demander quels patients opérer, mais bien de se questionner sur les patients à ne pas opérer, mentionnant qu’un docteur devrait avoir le courage de refuser une chirurgie si un patient est psychologiquement instable ou s’il souhaite une intervention chirurgicale pour des raisons d’apparence seulement.

L’honorable Bhikku Sanghasena, possible candidat au prix Nobel de la paix en 2017 a aussi pris la parole pour soulever un point important  en  faisant remarquer aux médecins qu’au-delà du partage de leur expertise, leurs connaissances, du diagnostic et de la sélection du bon traitement, la compassion fait une grande différence.

Cette formation, à laquelle le spécialiste Dr Michel Gagner assistait, a permis d’en savoir plus sur la chirurgie bariatrique, si vous souhaitez avoir plus d’informations sur ce type d’intervention, n’hésitez pas à contacter la clinique Michel Gagner, votre spécialiste dans le domaine.

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Obesity Linked to Greater Risk of Developing Certain Cancers

According to the American Centre of Disease Control (CDC) Newsroom, there is a strong link between being overweight or obese and cancer. In fact, these recent CDC findings link as many as 13 different types of cancer to obesity. While the rate of newly developed cancers has slowed down since the 1990s, obesity-related cancers are slowing down this rate.

Overweight and Obesity-Related Cancers

The main cancers associated with being overweight or obese are: meningioma, adenocarcinoma of the esophagus, multiple myeloma (blood cell cancer), and cancers of the thyroid, breast, liver, gallbladder, kidneys, ovaries, uterus, pancreas, colon and rectum, and upper stomach. The rate at which people are developing obesity-related cancers in the United States has risen by 7% since 2005.

Obesity in America

In 2014, over 600 thousand people were treated for overweight and obesity-related cancer in the United States. Two-thirds of these patients were between 50 and 74. Since two out of three Americans are considered overweight or obese (according to their body mass index), this has led to a global concern for the American people, especially since it seems as if not many Americans are aware that being overweight can pose a greater risk of developing cancer.

Lower Your Risk

From a healthcare perspective, more needs to be done to spread awareness about these types of cancers, to encourage patients to exercise and eat right, and to make healthy foods available to all demographics. Over half the cancer diagnoses in women and almost a quarter of the diagnoses in men were related to being overweight or obese. That staggering figure demonstrates the absolute need for overweight and obese people to make major life changes. Losing weight and reducing your BMI into a normal range will significantly lower your risk.

However, sometimes eating right and increasing your exercise is not enough to lose weight. If you’re morbidly obese, you may need more help. If you’re considering bariatric surgery, please feel free to fill out our patient questionnaire or to contact Clinique Michel Gagner for more information.

 

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Dr. Gagner to Debate at IBC World Congress at Oxford University

Between March 26th and 27th, Dr. Michel Gagner will take part in a debate with Dr. David Kerrigan over the motion that “staple line reinforcement with buttressing should be the standard of care in sleeve gastrectomy.” The debate is to take place at the first International Bariatric Club (IBC) World Congress at Oxford University, England. The theme of the congress is “Managing Obesity & Diabetes: From the Laboratory to Clinic to Operating Room to the World” (click here for more info or to register).

The International Bariatric Club
The IBC represents a group of bariatric surgeons from all over the world who discuss recent issues and industry news, provide support, share videos of surgeries, participate in live discussions, and host webinars. It is a closed member-only group and a global network for surgeons in this field. Dr. Michel Gagner is an IBC board member.

The IBC was established by three professors of surgery in Ohio: Dr. Tomasz Rogula, Dr. Raul Rosenthal, and Dr. Philip R. Schauer and began as a series of seminar broadcasts based in Cleveland. Of note, all three surgeons have received training in various degrees by Dr. Gagner. In 2010, the IBC opened a Facebook webpage and has since expanded its membership by promoting a sense of community where the world’s bariatric professionals can freely discuss issues related to their field.

Sleeve Gastrectomy

The topic of debate, that is, what should be considered the standard care in sleeve gastrectomy, will be interesting for Dr. Gagner to discuss, as he pioneered the procedure in 2000 and has been performing it ever since. Sleeve gastrectomy procedures have been a popular weight-loss surgery option for high-risk patients and as an alternative to gastric banding.

Check our news page for updates on recent publications, appearances, discussions, and interviews with Dr. Michel Gagner. If you’re interested in learning more about laparoscopic sleeve gastrectomy and how it can help improve your quality of life, please contact Clinique Michel Gagner today.

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