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The Dangers of Medical Tourism for Bariatric Surgery

>> Sunday, April 25, 2010

There's no question that the waiting lists for weight loss surgery, or bariatric surgery as it's called, are unacceptably long. The wait list in Canada is well over 5 years, with this number varying across provinces and cities, depending on the availability of local facilities.

In desperation, some Canadians are turning to medical tourism for the answer.

Take the case of a woman who went to Tijuana, Mexico, for bariatric surgery, as per the recent story in the Calgary Herald. Due to leak from her stomach after a sleeve gastrectomy (which reduces the stomach's size), she returned to Canada to endure a prolonged hospital stay, at which point her stomach also had to be stretched out, as the bariatric surgeons in Mexico had made her stomach too small to sustain her.

This lady is not alone: due to the ease of accessibility and short wait times, many Canadians are turning to foreign coutries to have bariatric surgery performed. It costs $,6000 to $12,000, depending on the country (Costa Rica and India are other popular choices) and the procedure performed, which is cheaper than private pay facilities in Canada (eg BC, Ontario), where patients pay $16,000 to $18,000 for comprehensive care.

But remember - you get what you pay for. Medical tourism outfits may not take the same great care in selecting the appropriate patient for bariatric surgery, nor do they take the time to prepare patients adequately for the dramatic and permanent lifestyle change they are about to undergo. Nor do they do much, if anything, in the way of follow up, which is downright dangerous: ongoing nutritional counseling is crucial, as is monitoring for nutritional deficiency, which occur particularly with gastric bypass surgery, and can be very serious if not managed properly.

Further, one can't help but be wary of an outfit who tries to sell their medical procedure with promises of free nights of hotel accomodation, travel planning, and sometimes with sightseeing opportunities thrown in!

As Canadians, the problem that we need to urgently address is the lack of availability of bariatric surgery within our borders. There are several centres in Canada where bariatric surgery is publicly funded and of no cost to the patient, though the wait times are long. An increase in government funding is desperately needed to improve accessibility to existing centres of excellence for bariatric care, and also to help establish new centres where there currently are none.

Dr. Sue © 2010


Should there be a Junk Food Tax?

>> Saturday, April 17, 2010

Despite the medical profession's best efforts, obesity rates are still staggeringly high around the globe. While there is some evidence to suggest that obesity rates are beginning to plateau in the US, there is no sign that obesity rates are declining, and in North America we still face a situation where the majority of adults are overweight.

As such, governments around the world are scrambling to find a way to help combat obesity. One tactic that is being discussed in many countries is whether or not to institute a tax on unhealthy foods, to encourage people to purchase healthier choices instead. A parallel is often drawn with anti-smoking campaigns, which have included increased taxation as one method to discourage people from lighting up, and have been very successful in that regard.

An interesting study from the Archives of Internal Medicine looked at the effect of changing food prices on consumption patterns and overall energy intake. Over the course of 20 years, the study found that an increase in food prices was associated with a decrease in energy intake from those foods. Thus, it seems that increasing taxes on unhealthy foods could encourage people to make healthier food choices instead. Unfortunately, this study also notes that the real price (inflated to 2006 US dollars) of soda and pizza decreased over those 20 years while the cost of milk increased - thus encouraging fast food and discouraging healthier alternatives!

If our governments are going to institute taxes on unhealthy foods, they must be careful to be placing this tax on the appropriate foods. In Denmark, for example, there is currently discussion for a tax to be placed on foods containing saturated fat. This would include foods such as dark chocolate, but some types of potato chips would not be caught under this umbrella because they are low in saturated fat. Dark chocolate has some known health benefits when consumed in moderation (eg, its antioxidant properties), and it would be inappropriate to promote potato chips as a healthier alternative.

Given the staggering rates of obesity that we face, it is high time that our governments get more involved to institute policies that promote a healthier society. A comprehensive approach which includes promotion of healthier eating and an active life style are long overdue, and a plan that rewards us financially for making healthy food choices is a good idea. Ideally, this reward would come in the form of tax breaks on healthy food, but in reality, higher price tags on unhealthy food may be the more likely plan of action.

Dr. Sue © 2010


Bon Appetit, Parisienne Style!

>> Saturday, April 10, 2010

For anyone who has ever walked the streets of Paris or ever enjoyed a french restaurant, you'll appreciate it when I say that French cuisine is one of the richest in the world. Thick sauces and high fat cheeses abound, and desserts are richly irresistible.

However, as one takes a moment to people watch in that restaurant or cafe in France, one can't help but be amazed by how thin most people are. How can they eat such rich cuisine without packing on the pounds?

There are many contributors to this phenomenon, but amongst these, one element rings crystal clear: the French take time to enjoy their food. As it turns out, eating slowly is a stronger stimulus to tell your brain and body that you are full than noshing your food in a rush.

There are several hormones involved in the sensation of hunger and fullness. There is one predominant hunger hormone called ghrelin; it is secreted by the stomach, and its release decreases in response to food. There are several hormones that act in the opposite fashion, to tell you that you are full; these hormone levels increase in response to food and include peptide YY (PYY), Glucagon-like-peptide-1 (GLP-1), and others. These hormones act on the hypothalamus in the brain to signal fullness, and also slow the forward movement of food through the intestine so that food stays longer in the stomach and takes longer to move through the intestine.

Taken together, these hormones act in a very complex fashion, and their levels vary depending on many different factors, including the content of the meal and the speed with which it's eaten. As far as time frames go, the satiety hormones take 10-15 minutes to start to kick in; recent studies have shown that taking 30 minutes to eat a meal results in higher concentrations of satiety hormones than taking 5 minutes to eat the same meal.

Back in our Parisienne cafe, then, we can see that the thin couple who are enjoying their rich meal are taking their time to do so, with the result that they feel full and satisfied with a smaller portion. This phenomenon is well known by the chefs in the restaurant, who have been sure to serve up a small portion, knowing that a large portion is likely to be wasted.

So next time you find yourself ravenous or in a hurry and about to inhale your meal, set aside 15-30 minutes and allow yourself to enjoy it. Give those natural satiety hormones time to kick in and allow you to feel satisfied with a smaller portion!

Dr. Sue © 2010


Molson 67 - What's the Catch?

>> Sunday, April 4, 2010

I've been asked so many times lately as to whether the new Molson 67 low calorie beer is a better choice than regular beer, that I thought I'd better write a post about it.

It is true that Molson 67 is a lower calorie beer - it contains only 67 cal per bottle, about half the calories of a regular beer, which contains 120-150 calories.

It should also be noted that Molson 67 contains 3% alcohol, whereas most regular beers contain around 4.5%. The lower alcohol content makes this a better option than a regular beer as well.

However, there is potential for misinterpretation or misuse here (as there is for any alcohol product). In particular, because of Molson 67's lower alcohol content, one may not find a singular beer quite as satisfying if you are looking for that little bit of relaxation that you may otherwise find with a regular beer. My concern is that the result may be that you may find yourself reaching for a second beer to do the trick. This can be a slippery slope, as it may engender a pattern of increasing volume of beer consumption.

So, if you stick to one beer, then yes, Molson 67 is a better option than a regular beer to cut calories and alcohol - just don't compensate for either of these factors by increasing the number of beers that you drink.

Remember that Canadian guidelines recommend maximum 9 drinks per week for a woman and 14 per week for a man (with no more than 2 per day). The bottom line is that if you choose a lower calorie beer without increasing your alcoholic beverage consumption and while staying within these guidelines, then you are doing yourself a favor; but if you increase the volume of consumption, good marketing is beating you out.

Also remember that if you are diabetic and taking medication for your diabetes, it may be advisable to avoid alcohol completely, as alcohol can have many negative interactions with certain diabetes medications and insulin. Be sure to discuss with your physician.

Dr. Sue © 2010



I am excited that you have arrived at my site, and I hope you are too - consider this the first step towards a Healthier New You!! As a medical doctor, Endocrinologist, and obesity specialist, I am absolutely passionate about helping people with weight management. Though there is certainly no magic cure for obesity, there IS a successful treatment plan out there for you - it is all about understanding the elements that contribute to your personal weight struggle, and then finding the treatment plan that suits your needs and your lifestyle. The way to finding your personal solution is to learn as much as you can about obesity: how our toxic environment has shaped us into an overweight society; the diversity of contributors to obesity; and what the treatment options out there are really all about. Knowledge Is Power!!

Are you ready to change your life? Let's begin our journey together, towards a healthier, happier you!!

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