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The Bariatric Medical Program provides comprehensive medical care led by an interdisciplinary team. The focus of this program is the non-surgical treatment of obesity and obesity-related health conditions, safe weight management, and healthy lifestyle changes. 

In order to be referred to the Medical Program, patients will require a physician's referral.  

Patients who meet the eligibility criteria are assigned to a Bariatric Centre of Excellence (BCoE) or Regional Assessment and Treatment Centre (RATC). 

Eligible patients will be contacted directly by their assigned bariatric centre to attend an orientation session, followed by comprehensive screening and assessment by the interdisciplinary bariatric team to assess their appropriateness for a treatment plan. Intensive education and nutritional counselling are provided. Following the completion of the medical treatment plan, patients are monitored and scheduled for routine follow-ups for a period of 1 year. 

Eligibility: 

  • 18 years of age and older (allow referrals at age >=17.5 years) 
  • BMI greater than, or equal to 35 
  • BMI greater than or equal to 30, but less than 35. With at least one of the following comorbidities (as determined by your physician):  
  • Complicated Type II diabetes mellitus 
  • Idiopathic intracranial hypertension 
  • Poorly controlled hypertension 

Ineligibility (not limited to): 

  • Current drug or alcohol dependency (within 6 months of referral) 
  • Recent major cancer (life threatening, within last 2 years) with active treatment where caloric restriction might exacerbate the condition 
  • Untreated or inadequately treated psychiatric illness 

Types of Medical Programs

There are three types of Medical Programs that may be offered to patients through the OBN. For all Medical Programs, the focus is to help patients achieve medically acceptable weight loss in order to improve their co-morbidities and quality of life. The programs focus on helping patients achieve a healthier state of wellness by providing knowledge and life skills to change their eating and coping behaviours, and develop alternative lifestyles that promote healthy eating, physical activity, and healthy living.

The appropriate treatment option for the patient is determined by the interdisciplinary team of bariatric experts at each centre. Program duration varies depending on the treatment plan, and centres follow patients for a period of 1 year.

Bariatric Medical Program is comprised of:

  • Meal Replacement/Behavioral Modification Program
  • One to One Program

Medical Program Features

The OBN has established standardized care paths based on current evidence and best practice that outline the minimal tests/assessments required for all Medical Program bariatric patients in Ontario. Assessments, appointments and treatment plans may vary from person to person, depending on the individual and their health care needs. 

  • Program Orientation (Group Session)  
  • Interdisciplinary Bariatric Team Assessments 
  • Routine blood work and additional diagnostic testing based on patients' individual medical needs 
  • Behavioural modification/education classes (up to 24 people) are closed groups for patients only and are facilitated by the clinic’s social worker, registered dietitian, psychologists and kinesiologist; as appropriate 
  • Patients may be on a low-calorie meal replacement at patients own expense for 6 to 12 weeks depending on BMI, after which time, patients are slowly reintegrated back onto food 
  • Your treatment plan could also include one-on-one intervention, based on individual needs 
  • Weight is measured each week 
  • Attendance is mandatory 
  • Follow up assessments at the following time intervals  
  • 6 months  
  • 1 year 
  • The program will incorporate use of telemedicine as appropriate 

Frequently Asked Questions

Overweight: 10% to 20% above the person's "desirable" body weight 
 
Obesity: 20% or more than the person’s "desirable” body weight. It is an increase in body weight beyond the limitation of skeletal and physical requirements, as the result of excessive accumulation of body fat. 

Super Obesity: 40% or more than the person’s "desirable” body weight. It is an excess of body fat, or weight of 45.4 kilograms (100 pounds) over ideal body weight, that increases the risk of developing cardiac and endocrine disturbances, including coronary artery disease and diabetes mellitus, as well as some kinds of cancer. 

Body Mass Index (BMI) is a measurement of weight in relation to height. BMI is calculated by dividing your weight in kilograms by the square of your height in meters. 

Excess Body Weight (EBW) is a measurement of current weight in relation the ideal weight which is based on age and height. The amount of weight in excess of one's ideal body weight is the calculated EBW. 

Bariatric surgery, also known as weight loss surgery, is a surgical procedure that serves as an option for some people who have not been able to lose weight through traditional means such as diet and exercise. There are several different kinds of bariatric surgery; the bariatric surgeries funded by the MOHLTC and offered through the OBN Surgical Program are outlined in the 'Types of Bariatric Surgery' section.  

Are You Eligible for the Surgical Program? 

Eligibility: 

  • 18 years of age and older 
  • BMI greater than or equal to 40 BMI greater than or equal to 35 but less than 40. With at least one of the following comorbidities (as determined by your physician):  
    • Coronary heart disease 
    • Type II Diabetes mellitus 
    • Hypertension 
    • Diagnosed sleep apnea 
    • Gastroesophageal Reflux Disease (GERD) 

Ineligibility (not limited to): 

  • Current drug or alcohol dependency (within 6 months of referral) 
  • Recent major cancer (life threatening, within last 2 years) 
  • Untreated or inadequately treated psychiatric illness 

You must be at least 18 years old to be considered for the Surgical Program. Please refer to the 'Surgical Program Eligibility' tab for more information. 

No, bariatric surgery is not the solution for everyone. The interdisciplinary bariatric team will help determine whether surgery is right for you after a complete evaluation and discussion with you. Bariatric surgery is a life-altering procedure and you need to be committed to making the lifestyle changes needed for successful outcomes. 

The OBN has established standardized care paths based on current evidence and best practice that outline the minimal tests/assessments required pre-operatively for all bariatric patients in Ontario. Additional pre-operative assessments may vary from person to person, depending on the individual and their health care needs to optimize health prior to surgery. 

This is a general list of tests that you may have before surgery. You may have some or all of these tests. Other tests may be needed as well. 
 
You may need to prepare for some tests; your bariatric team will explain these to you and tell you how to prepare for them. 

Abdominal Ultrasound 

Other names for this are ultrasound imagining, scanning or sonography. Abdominal ultrasound involves using high-frequency sound waves to produce pictures of the inside of your body. The pictures show the structure and movement of your body’s internal organs as well as the blood flowing through blood vessels.  

Upper Gastro-Intestinal Series (Upper G. I.) 

This is an x-ray of the esophagus, pharynx, stomach, and first part of the small intestine called the duodenum. For this test, you swallow a special liquid dye called barium; as the barium moves through your body pictures are taken.  

Cardiac Imaging 

Cardiac imaging tests check your heart, heart valves, blood vessels and other structures of the heart. They pick up previous heart attacks, heart disease, blocks from plaque build-up or other problems that you may have with your heart, as well as provide measurements of the heart, chambers and function. There are many kinds of cardiac imaging tests such as a cardiac stress test, cardiac magnetic resonance imaging, cardiac MIBI, and cardiac perfusion scan. 

Electrocardiogram (ECG or EKG) 

This is a test that records the electro activity of your heart. It is used to diagnose some heart problems. This test is non-invasive and requires a few minutes of relaxation. While laying down sticky pads are placed on your chest, stomach, arms and legs; these are attached to a machine by thin wires. The machine is then turned on and records your heart activity during rest. 

Sleep Apnea Studies 

This is also called Polysomnography (PSG); it is a test that may require a few visits to complete. Sleep apnea tests help identify a variety of sleeping disorders such as sleep apnea (when you stop breathing several times when sleeping), narcolepsy (when you fall asleep any time, anywhere), restless leg syndrome and other sleep problems.  
 
You will stay overnight for this sleep apnea testing. You are attached to a monitor and watched closely while you sleep. During the exam many body functions are monitored including, eye movement, brain waves, heart waves, muscle movement, snoring, breathing air flow and effort. 

Cardiac Stress Test 

A Cardiac Stress Test is also known as an Exercise Stress Test or a Treadmill Test. A Cardiac Stress Test helps the health care team find out how well your heart handles work. As your body works harder during the test, it needs more oxygen, so the heart pumps more blood.  
 
This test shows if the blood supply is reduced in the arteries that supply the heart. It also helps the health care team know the kind and level of exercise appropriate for you. A medical professional is always present throughout the test. You start by walking slowly on a treadmill, then the speed of the treadmill is increased and the treadmill is tilted to produce the effect of walking up a small hill. 

Gastroscopy 

A gastroscopy is a test where a long flexible tube called a gastroscope is passed through your mouth, down your throat into the upper digestive tract. It allows the doctor to look at the lining of the esophagus, stomach and first part of the small intestine called the duodenum. A sample of tissue called a biopsy may be taken to check for H.Pylon. 

Colonoscopy 

A colonoscopy is a test that looks at the lower end of the intestine, colon and rectum. You need to prepare for this test the day before by emptying the bowel; This process will be explained to you beforehand.  
 
On the day of the test, after you have medication to make you relaxed and sleepy, a small flexible tube scope is inserted into your rectum. The end of the scope has a light and is attached to a screen similar to a television, allowing the doctor see the inside of your lower bowel.  

Blood Tests 

Blood tests are also done to look your health and well being. Some of the common tests are: complete blood count (CBC), blood glucose (sugar), different vitamin and mineral levels such as iron, calcium, B vitamins and vitamin D. 

Helicobacter Pylori (H. Pylori) Bacteria Test 

  1. Pylori is the name of a common bacteria that can cause problems such as stomach ulcers and stomach cancer. If you have H. Pylori you must be treated with antibiotic medication to make sure the bacteria is gone before you have bariatric surgery. It is important to note that ulcers can also be caused by other diseases or from smoking, drinking alcohol and caffeine use after surgery.
     
    Tests used to determine the presence of H. Pylori infection may include:  
  • Blood test : A blood sample may reveal signs of an H. pylori infection in your body 
  • Stomach Biopsy: A small sample of the stomach lining is removed by a scope passed from the mouth into the stomach. If bacteria are present, they can be seen when the sample is examined under a microscope.
  • C-14/13 breath test: During this test, you drink a solution that contains radioactive carbon molecules. If you have an H. pylori infection, the radioactive carbon is released when the solution is broken down in your stomach. Your body absorbs the radioactive carbon and releases it when you exhale. You exhale into a bag and your doctor uses a special device to detect the radioactive carbon. 

Pulmonary Function Tests 

These are a group of tests that measure how well your lungs take in air, release air and move oxygen from the air into your body’s blood. These tests help diagnose lung diseases such as asthma, bronchitis, emphysema or find the cause of shortness of breath. 
 
For some tests, you breathe normally and quietly. For other tests, you force air in or force air out during testing. 

It takes several months to meet with the bariatric team for various assessments and testing. During this time it is important for you to continue to focus on your health and weight loss to prepare for surgery.

To prepare for surgery and be in the best health possible to recover, you need to make some lifestyle changes before surgery. Your interdisciplinary bariatric team will advise you as to your plan before surgery. As general guidelines, you must stop:

  • Smoking
  • Using non-prescription non-medically supervised cannabis or illicit drugs
  • Drinking alcohol, beer and wine
  • Consuming caffeine
  • Drinking carbonated beverages

Smoking is unhealthy for many reasons. It can delay wound healing due to poor blood flow and lead to stomach ulcers after surgery. You need to stop smoking 6 months prior to surgery and cannot smoke at all after your surgery.

For help to quit smoking, contact Smokers’ Helpline: 1-877-513-5333
Website: www.smokershelpline.ca

Non-prescription non-medically supervised cannabis or illicit drugs may result in problems surrounding bariatric surgery. They may cause problems with medications you need to take before, during and after surgery. Some may increase appetite, making your ability to follow the required diet more challenging. Avoiding these substances 6 months before surgery and after surgery is highly recommended.

Alcohol can cause liver damage. When you lose weight quickly, your liver takes up waste products and toxins produced in your body. This puts stress on your liver and can cause many problems. If you drink alcohol, you will feel the effects very quickly. After surgery, alcohol may irritate the lining of your stomach pouch. It is also high in calories and sugar. After surgery, the alcohol is absorbed more rapidly and your blood alcohol level may rise more quickly and to a higher level. This means that you feel the effects more quickly and more intensely, and can become intoxicated after consuming a very small amount of alcohol. It may also cause Dumping Syndrome because of its sugar content. Your doctor or dietitian will discuss with you if/when you can have alcohol after bariatric surgery.

Caffeine irritates the lining of the stomach. It is a diuretic, and it can inhibit iron absorption. Caffeine also increases acid production.

Carbonated beverages can cause problems after bariatric surgery, as they produce gas in the small stomach pouch. Most people find this very painful. You need to stop drinking carbonated drinks 2 months before surgery to get used to not drinking carbonated beverages after your surgery.

On average, patients stay in the hospital for 2-3 days following bariatric surgery (longer if needed). It is important to talk to the members of the interdisciplinary bariatric team about this before surgery. The length of stay also depends on whether you develop any complications after surgery.

On average, patients usually return to work/school within 4-6 weeks following bariatric surgery; this may vary depending on the individual.

Yes, it is recommended that all patients take a multivitamin, calcium and vitamin D supplements daily after bariatric surgery. Other vitamins and/or supplements may also be needed depending on your nutritional status; your blood will be checked several times in the first year to determine if you require any other vitamins or supplements. Your bariatric team will work closely with you to ensure that you get the best nutrition possible in order to stay healthy.

Weight loss surgery has been shown to improve control of Type 2 diabetes, but not Type I.

In Type 2 diabetes, the degree of improvement depends on how long you would have had diabetes and the type of bariatric surgery. Talk to members of the bariatric team about this when you are thinking about surgery.

For some people, blood sugars normalize almost immediately within days of surgery. For others, blood sugar levels begin to fall soon after surgery, becoming completely normal within a year. Each person is different

Over the first 6 to 8 weeks after surgery, your diet will gradually increase from liquids to semi solid foods. This helps you heal. In the long term, you need to eat healthy in order to lose weight and maintain a healthy weight. You will follow guidelines provided to you by the bariatric team that include eating at mealtimes only, avoiding sugary foods, drinking enough fluids throughout the day, and avoiding overeating and overfilling your stomach. 

 

The amount of food you can eat depends on the type of bariatric surgery you had. Your stomach is smaller, which means you will feel full and satisfied with less food. Your interdisciplinary bariatric team will educate you about your diet before and after surgery; you will need to continue to follow this diet for the rest of your life.