Welcome to Nation Health Matters. This is the first of a new monthly health column that will explore different health topics that are being covered in the media or suggested by the readers of the Nation or health professionals working in Eeyou Istchee.

If you have a health topic that you would like to see discussed in the Nation, please contact me at amy.german@gmail.com so that I can look into the issue.

What can weight-loss surgery do for Type 2 Diabetes and if so, why does it not happen more often?

Every November, the Nation does a special on diabetes in the Cree Nation and looks at the most recent statistics, which are always staggering.

This past year we reported that more than one-in-five Crees over the age of 20 has diabetes and some young Crees in their 20s are experiencing serious complications from the disease as a result of obesity.

Adopting a proper diet and exercise routine is the recommended treatment for obesity. If a patient loses enough weight they can put their diabetes into remission so that they are no longer experiencing symptoms. However, for some patients losing weight is an impossible task, particularly in cases where patients are morbidly obese. In general, being morbidly obese is defined as being at least 100 pounds over their ideal body weight or having a Body Mass Index (BMI) of greater than 40 kg/m2.

To find out more about weight-loss surgery or bariatric surgery, the Nation turned to Nicolas Christou MD PhD, Professor of Surgery at McGill University and the Director of Bariatric Surgery at McGill University Health Centre.

According to Christou, for some patients who have gained so much weight that it is now causing them a variety of health complications, such as Type 2 Diabetes, weight loss through diet and exercise is very possible but for some the weight just keeps coming back.

In this case, bariatric surgery could be an option.

“It has been confirmed worldwide that bariatric surgery produces permanent weight loss. It improves most of the obesity associated conditions, especially Type 2 Diabetes, and it reduces the relative risk of death when you compare the patients who get operated on against those who remain morbidly obese,” explains Christou.

There are four types of bariatric surgery that can be offered in Quebec: Laparoscopic Roux-en-Y Gastric Bypass, Laparoscopic Vertical Sleeve Gastrectomy, Laparoscopic Adjustable Gastric Band and the Gastric Reduction Duodenal Switch procedure.

Unless you are willing to go privately and pay out of own pocket these kinds of procedures are very hard to come by in Quebec. Despite the fact that they may be effective, there is little funding in the public system to get these procedures done and an incredibly long waiting list.

According to Christou, the delay to get one of these procedures done through the provincial healthcare system is on average 5.3 years. But this can increase to 10 years depending on which hospital you try to get the procedure done at.

This is why Christou decided to opt out of the provincial medicare system and is now offering these types of surgeries – except the Duodenal Switch procedure – at his private clinic.

But, buyer beware, the three procedures that Christou offers at his clinic range from $17,000 to $19,500 and then there are other related costs.

At that, Christou says when it comes to patients from the north “laparoscopic banding might not be the best procedure for them because it requires a lot of maintenance or a very strong support program with the physicians”, and that may not be available everywhere.

And, like with any type of surgery there is a certain amount of risk involved in having these procedures – a matter that needs to be discussed at length by a patient and their doctor.

Taking the issue up with the Cree Board of Health and Social Services of James Bay, according to Dr. David Dannenbaum, this kind of surgery has not widely been prescribed to Crees.

At the same time, Dannenbaum questions whether these procedures should be seen as a “magic bullet” solution to solve the weight-loss problems of the obese. They can be risky and they do not address the entire issue when it comes to obesity.

“There are often many other issues behind a patient’s eating habits that just banding their stomach may not solve the problem,” says Dannenbaum.

But, for those who are interested in finding out more about these procedures, Dr. Christou’s website is http://weightlosssurgery.ca