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Complete Guide to Bariatric Care in Ontario

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Bariatric care in Ontario is an important healthcare service to address obesity and its related health complications. This comprehensive guide provides detailed information on the Ontario Bariatric Network (OBN), a collaborative initiative established by the Ontario government to centralize and standardize bariatric care across the province.

Table of Contents:

What is the Ontario Bariatric Network?

The Ontario Bariatric Network (OBN) is a collaborative network of designated bariatric centers across the province of Ontario, established in 2009 to address the increasing demand for bariatric surgery services.

The Ontario Bariatric Network was created by the Ontario government to provide a comprehensive, standardized program for bariatric medical and surgical care within the province. It centralized referrals to designated Bariatric Centres of Excellence, which initially included St. Joseph’s Healthcare Hamilton, the University of Toronto Collaborative Bariatric Surgery Program (involving multiple hospitals), The Ottawa Hospital, and Guelph General Hospital.

The network established clear eligibility criteria for bariatric surgery in Ontario. Patients must be at least 18 years old with a body mass index (BMI) greater than 40, or a BMI greater than 35 with at least one obesity-related comorbidity that could improve with weight loss, such as type 2 diabetes or hypertension.

In addition to standardizing patient eligibility, the Ontario Bariatric Network also implemented surgical protocols, perioperative care standards, and mandatory pre-operative requirements across its centers. These include orientation sessions, medical testing, psychological evaluations by an interdisciplinary team, and formal anesthetic assessments to ensure patients are properly prepared for bariatric procedures.

A key component of the Ontario Bariatric Network is the structured post-operative follow-up protocol. Patients are required to follow up with bariatric nurse practitioners at regular intervals up to 5 years after surgery, with physician assessments conducted only if deemed necessary by the nurse practitioner. Follow-ups occur at 1 month, 3 months, 6 months, 1 year, and annually thereafter.

By centralizing and standardizing bariatric services through its designated centers, the Ontario Bariatric Network aims to provide consistent, high-quality care for patients undergoing weight-loss procedures in Ontario. It replaced the previous practice of outsourcing publicly-funded bariatric surgeries to facilities outside of Canada due to long wait times within the province.

What are programs in the Ontario Bariatric Network?

The Ontario Bariatric Network (OBN) provides two main programs to address obesity and related health conditions: the Medical Program and the Surgical Program. These programs offer comprehensive treatment approaches tailored to the individual needs of patients.

  • The Medical Program is a non-surgical option designed for patients seeking medically acceptable weight loss to improve their co-morbidities and overall quality of life. This one-year program combines active treatment with meal replacements for the first six months, followed by an intense six-month maintenance phase. Throughout the program, patients receive education and develop essential life skills to adopt healthy eating habits, increase physical activity, and cultivate a sustainable healthy lifestyle. Interdisciplinary team assessments and group education classes are integral components of the Medical Program, which requires mandatory attendance and follow-ups for any missed sessions.
  • The Surgical Program provides a comprehensive range of services for patients undergoing bariatric surgery. This program encompasses pre-operative assessments, surgical procedures, and post-operative care, all delivered by an interdisciplinary team of healthcare professionals. Eligibility criteria for the Surgical Program include a body mass index (BMI) of 40 or higher, or a BMI of 35 or higher with certain co-morbidities such as diabetes, hypertension, or sleep apnea. Various bariatric surgeries, including gastric bypass and sleeve gastrectomy, are offered through this program, with a focus on safe weight management and facilitating long-term lifestyle changes.

Both the Medical and Surgical Programs offered by the Ontario Bariatric Network aim to provide comprehensive and personalized treatment options for individuals struggling with obesity and related health conditions. These programs are designed to address the multifaceted aspects of weight management, promoting sustainable weight loss, improved health outcomes, and an overall enhancement in quality of life.

When choose the Ontario Bariatric Network?

A key advantage of the Ontario Bariatric Network is the standardized, comprehensive multidisciplinary care pathway it provides. Patients undergo thorough pre-operative assessments, receive extensive education and preparation, and benefit from structured post-operative follow-up care from an interdisciplinary team of specialists across the designated Centers of Excellence. This coordinated, patient-centered approach helps ensure individuals are properly prepared, supported, and set up for long-term success following their bariatric surgery.

Another consideration of pursuing bariatric surgery via the Ontario Bariatric Network is the proven effectiveness of these procedures in achieving substantial and sustainable weight loss. Gastric bypass and sleeve gastrectomy can lead to a substantial reduction in total body weight. Long-term data shows many patients maintaining a significant loss of excess weight after undergoing gastric bypass surgery. Achieving this level of significant weight reduction can often extremely difficult through diet and exercise alone for individuals with severe obesity.

In addition to facilitating substantial weight loss, bariatric surgeries have also been demonstrated to improve or resolve various obesity-related comorbidities and chronic health conditions. By effectively treating the root cause of obesity, these procedures can have a profound positive impact on managing associated diseases that often plague individuals struggling with severe obesity.

Furthermore, for Ontario residents who meet the eligibility criteria of having a BMI greater than or equal to 35 with obesity-related comorbidities, or a BMI of 40 or higher, bariatric surgeries performed at Ontario Bariatric Network centers may be covered under the provincial OHIP health plan. This publicly-funded option makes the proven benefits of bariatric surgery more accessible compared to having to pay out-of-pocket for private surgical weight loss programs.

What is the eligibility for bariatric surgery?

The Ontario Bariatric Network has clearly defined eligibility criteria for patients seeking bariatric surgery in the province. To be eligible, patients must be at least 18 years of age and meet one of the following body mass index (BMI) requirements:

  • Have a BMI greater than or equal to 40, regardless of any obesity-related health conditions. This means patients with a BMI of 40 or higher automatically qualify for bariatric surgery consideration.
  • Have a BMI greater than or equal to 35 but less than 40, along with at least one obesity-related comorbidity or health condition that could improve with weight loss. Such comorbidities include type 2 diabetes, hypertension, sleep apnea, osteoarthritis, high cholesterol, heart disease, non-alcoholic fatty liver disease, and gastroesophageal reflux disease.

It’s important to note that even if patients meet the BMI and comorbidity requirements, they still undergo a comprehensive assessment by an interdisciplinary team at one of the designated Bariatric Centres of Excellence. This team evaluates factors like motivation, willingness to make lifestyle changes, psychological readiness, and overall appropriateness for bariatric surgery before proceeding.

The eligibility criteria aim to identify patients for whom the benefits of bariatric surgery in treating obesity and related conditions would likely outweigh the risks and lead to improved health outcomes. By standardizing these criteria across Ontario, the Bariatric Network ensures consistent patient selection and access to bariatric surgical care.

What is the cost of bariatric surgery in Ontario?

The Ontario Health Insurance Plan (OHIP) does provide coverage for certain bariatric surgeries, but with specific eligibility criteria and limitations. OHIP primarily covers gastric bypass surgery, which is considered the preferred bariatric procedure under the provincial health plan.

In contrast, OHIP rarely covers gastric sleeve surgery, which is another common bariatric procedure. Gastric sleeve is typically only covered by OHIP if the patient has a BMI over 60, making gastric bypass too risky to perform safely. Alternatively, OHIP may cover gastric sleeve in cases where the patient has severe scar tissue from a previous surgery that prevents them from undergoing gastric bypass, or if they have certain pre-existing medical conditions that would make gastric bypass excessively risky.

It’s important to note that even when OHIP covers the cost of the bariatric surgery itself, patients may still be responsible for paying out-of-pocket for certain pre-operative supplies, assessments, and preparation requirements mandated by the program.

What are wait times for bariatric surgery in Ontario?

Wait times for the Surgical Program in Ontario can widely vary. Good Caring Canada tracks bariatric surgery wait times in Ontario.

Wait times for the Medical Program are not available.

What is the bariatric registry in Ontario?

The Ontario Bariatric Network (OBN) maintains a comprehensive Bariatric Registry, which serves as a vital component of the provincial Bariatric Services Strategy.

The Bariatric Registry is a multi-center database designed to collect and analyze patient outcomes and current practices related to bariatric treatment across Ontario. As obesity and obesity-related illnesses continue to rise, the Ministry of Health and Long-Term Care (MOHLTC) recognized the need for a centralized data repository to inform evidence-based decision-making and improve patient care.

The establishment of the Bariatric Registry was an integral part of the MOHLTC’s Bariatric Services Strategy. By capturing data from the OBN, the Registry enables the examination of patient outcomes, treatment efficacy, and the identification of best practices. This comprehensive database plays a crucial role in monitoring and enhancing the quality of bariatric services provided across the province.

Through the Bariatric Registry, healthcare professionals and researchers can access valuable insights into the effectiveness of various treatment approaches, patient demographics, and the long-term impact of bariatric interventions. This data-driven approach facilitates continuous improvement in the delivery of care, ensuring that patients receive the most appropriate and effective treatments tailored to their individual needs.

Where are locations with the Ontario Bariatric Network?

The Ontario Bariatric Network (OBN) consists of Bariatric Centres of Excellence across Ontario that provide comprehensive medical and surgical bariatric services:

Bariatric Centres of Excellence are full acute care hospitals that meet specific criteria like having an ICU, 24/7 emergency department, oximetry beds, at least two bariatric surgeons performing a minimum number of cases annually, and a multidisciplinary clinic for pre/post-operative care.

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