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Metabolic and bariatric surgery for obesity

Weight loss surgery is also known as metabolic and bariatric surgery. At Richmond Metabolic and Bariatric Surgery (RMBS), we give patients the tools to conquer obesity and realize their potential. We are one of the only two comprehensive multidisciplinary bariatric surgery programs in British Columbia. Find out when this surgery is recommended, who is eligible and other general information below. Watch the introduction to bariatric surgery video.



When to choose bariatric surgery

Many patients with obesity have tried to treat this on their own, with diet and exercise. Many have had some success, only to have weight regain. More often, patients have little to no success with diet and exercise alone. This is not a result of a lack of willpower or the wrong diet. When a patient has a body mass index (BMI) greater than 35, their chances of reaching a normal body weight for a lasting period of time is less than 1%. That's why surgery is an option for patients with severe obesity. 

If non-surgical methods for treating obesity have not succeeded, bariatric surgery could be considered. Before considering surgery, non-surgical means must have been tried and found to be ineffective in the long term. This includes drugs, physical activity, dieting, and behavioural modification techniques. Surgery is an addition to treatment strategies, not a replacement.

Morbid obesity is a serious health problem with a high risk of disease and death. Obesity is the second leading health-related cause of mortality worldwide after smoking. This disease has become an epidemic in Canada over the last 20 years. The Public Health Agency of Canada estimates that 25% are now obese. These numbers are rising.

Weight loss surgery does not just treat the disease of obesity, but it can reduce and eliminate obesity-associated diseases and prolong life expectancy. A body mass index > 40 is associated with a shortened life expectancy of 20 years in men and 5 years in women. These operations have the ability to prevent future health problems and allow patients to enjoy a better quality of life and a longer lifespan.

Impact of obesity

Severe obesity is a major contributor to many serious health problems, such as:

  • Diabetes

  • High blood pressure

  • Heart disease

  • Elevated blood cholesterol and triglycerides

  • Breathing problems

  • Depression

  • Decreased mobility

  • Cancer

  • Sleep apnea


Although bariatric surgery can provide benefits, as with any surgery there are risks. Risks may vary from one patient to another. It is important to discuss all your concerns with your bariatric surgeon and ensure they have all your health information in order to assist in making the best decision. Your bariatric surgeon will explain all potential risks in your consultation.



Eligibility

Watch video: Who qualifies for bariatric surgery

  • 18 years of age

  • < 65 years of age at the time of referral (Note: waitlist may be 24-36 months)

  • BMI > 40, or a BMI > 35 with at least one of the following comorbidities:

    • Heart Disease

    • High Blood Pressure

    • Sleep Apnea

    • Diabetes

    • Degenerative Joint Disease/Osteoarthritis

    • GERD

    • Dyslipidemia

  • Medical problems that increase the risk for elective surgery

  • Inability to follow directions or comply with recommendations

  • Active substance abuse

  • Smoking (must be smoke-free for 6 months)

  • Unstable mental health

    • Recent suicide attempt – within 18 months

    • Active suicidal ideation

    • Severe personality disorder

    • Major neurocognitive disorder

 

How it works

It is important to take time to follow this process and work on lifestyle changes in order to determine if surgery is the correct step for you. At any point, you may opt-out of the program if you decide surgery is not suitable for you.

  1. Referral to RMB – Once your physician has referred you, you will be placed on our waitlist for approximately 2.5 years. During this time, you can prepare yourself by working on lifestyle, diet, exercise, research and building robust supports. Visit the Preparing for surgery page to learn more.

  2. Attend orientation – This session will inform you about the RMBS program, surgeries offered through RMBS, multidisciplinary team and their roles, medical, nutritional, physical activity, stress management, the impact of bariatric surgery on lifestyle, and program expectations.

  3. Complete candidacy package – After orientation, you will have 2 weeks to confirm if you are interested in proceeding with the program. If so, you will need to consent to our contract.

  4. Pre-operative assessment – The assessment process consists of several appointments with our multidisciplinary team (dietitians, nurses, internists, endocrinologists, respirologists, social workers and psychiatrists). You are encouraged to ask questions and find out as much about surgery as possible. Over 6 to 12 months, we will support you in eating and exercising in a way that will ensure your long-term weight loss goals. Patients who are successful in completing the pre-operative assessment and demonstrate significant lifestyle modification will be considered for surgery. When your lifestyle is as optimized as it could be and your mental health stability has been confirmed, you will have your first surgeon consult. You will fill out questionnaires and discuss the results together.

  5. Schedule surgery – Once cleared by all team members, you will be placed on the surgery waitlist for approximately 2.5 years. You will continue to meet with your surgeon regularly until the date of your surgery. Your progress will be reviewed and surgery discussed at these follow-up appointments. The surgeon's medical office assistant (MOA) will call you once a surgery date is available, then associated appointments such as pre-admission clinic, bloodwork, endoscopy, and anesthesia are arranged.  

  6. Post-surgery support – To help ensure your long-term success, you will continue to meet with our multidisciplinary team for scheduled appointments for 2 years after surgery. Watch nutrition videos on our post-surgery information page.

If you are a resident of British Columbia, the BC Medical Services Plan (MSP) covers the consultation and bariatric operations offered by our program.

If you had bariatric surgery elsewhere, please inquire about coverage through your family physician.

 

Referral

You will need a referral from your family physician to Dr. Nam Nguyen, Dr. Sharadh Sampath or Dr. Yorke. Medical professionals can download our referral package on Pathways and fax it to 604-231-0583.

Waitlist

Before you inquire about the waitlist, find out when your family physician submitted your referral.

  • If it's been under 2.5 years, do NOT call our clinic about your referral as this is the current waitlist length of time

  • If it's been over 2.5 years, you may call us at 604-273-4447, extension 8 to inquire about your referral

Our staff are quite busy so calling the clinic will disrupt their work. The best way to get the answer is to contact the physician who sent the referral and then wait for our phone call. Please note that the bariatric surgeons' office stamps the referral and sends it back to where it came from as confirmation that it was received.

No show & cancellation policy

We require a minimum of 24 hours' notice if you are unable to attend a scheduled appointment unless an EMERGENCY (death in the family, sudden illness, hospitalization, etc.) occurs. You will be discharged from the program if you have two no-shows or cancelled appointments (less than 24 hours' notice), which were non-emergency.

Richmond Metabolic and Bariatric Surgery Clinic

Unit 120 – 6091 Gilbert Road, Richmond, BC  V7C 5L9 [View map]
Phone: 604-675-3505
Fax: 604-279-1784

Richmond Hospital

7000 Westminster Highway, Richmond, BC  V6X 1A2 [View map]

Richmond Hospital has state-of-the-art Minimally Invasive Surgery operating rooms with high-definition 3D digital video laparoscopes and bariatric operating tools to deliver surgical precision and improve patient safety. The hospital is also equipped with bariatric-size patient transfer devices, ceiling lifts, scales, beds, chairs, wheelchairs, showers, wide-bore MRI, and CT scan table threshold of 400 lbs. 

Unlike daycare surgical centers that lack inpatient beds, sophisticated diagnostic imaging and interventional radiology, our patients have access to all of Richmond General Hospital’s state-of-the-art technology as well as exceptional 24-hour nursing care. Our patients are monitored closely and carefully in the hospital until they are ready for discharge.  We feel our patients are worth it!

Our team

Visit our RMBS team page to learn more. 


Frequently asked questions (FAQs)

For a full list of FAQs, download the Frequently asked questions PDF. 

The rate of weight loss depends on a number of factors, including your baseline weight, weight loss thus far, activity, hydration and diet. Each person’s weight loss pattern is different. If you lose weight too quickly, you are at risk for muscle loss, hair loss, and nutritional deficiencies. 

On average, weight loss will continue for 12 to 18 months after surgery. The expected excess weight loss goal for each surgical procedure ranges from 55 to 80%, more specifically:

  • 55% for sleeve gastrectomy

  • 70% for gastric bypass

  • 70-80% for single anastomosis dudeno-ileal bypass with sleeve gastrectomy (SADI-S)

  • 80% for biliopancreatic diversion – duodenal switch with sleeve gastrectomy (BPD-DS) 

Once you have reached your lowest weight after surgery, it is normal to regain some weight. For most people, their weight will stabilize at about 10% higher than their lowest post-surgery weight. 

It is normal to experience weight plateaus where your weight may not change for a few weeks. During this time, your body is adjusting to the amount of food and exercise. Continue to follow your nutritional guidelines and exercise routine to facilitate weight loss.

 

For 70-80% of patients, the majority of their weight loss is maintained for many years. However, up to 30% of patients will regain the weight. As with other methods of managing weight, weight loss will not be permanent without lifestyle changes. You will likely regain weight if you do not maintain healthy eating habits, exercise regularly, monitor your intake and manage stress.

  • Advocate for people waiting for bariatric surgery. Sign the petition to ask BC to increase funding for more bariatric procedures.

  • Help buy equipment for bariatric surgery by donating to Richmond Hospital Foundation. Under "Tribute gift", select the checkbox and type "Richmond Metabolic and Bariatric Surgery" for the "Message on Card". Thank you for your support!

SOURCE: Metabolic and bariatric surgery for obesity ( )
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