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Purpose: Like most Western armies, obesity affects Canadian Armed Forces (CAF) personnel. Bariatric surgery is an effective treatment for obesity. However, this is not yet accepted for active-duty soldiers in most countries. The CAF have approved bariatric surgery since 2005. Our aim is to assess weight loss, resolution of obesity-related comorbidities, and impacts of bariatric surgery on military careers., Materials and Methods: We retrospectively reviewed the perioperative data, long-term bariatric results, and military outcomes of 108 CAF active-duty military personnel who underwent bariatric surgery in Canada over a 61-month period., Results: The cohort was predominantly male (66.7%) with a mean preoperative body mass index (BMI) of 43.6 ± 5.8 kg/m 2 . Roux-Y gastric bypass was performed in 59 patients, sleeve gastrectomy in 29, and gastric banding in 20. All the surgeries were performed laparoscopically. The total body weight loss at the last follow-up visit was 22.5 ± 11.0%. Remission or improvement of hypertension was observed in 91.2%, diabetes in 85.7%, gastroesophageal reflux disorder (GERD) in 43.6%, sleep apnea in 43.1%, and dyslipidemia in 42.9%. One patient (0.9%) was medically released due to postoperative complications. Fifteen patients (13.9%) were deployed postoperatively. The combined deployable and possibly deployable statuses increased from 35.4% preoperatively to 47.9% postoperatively., Conclusion: This is the largest series of bariatric surgeries performed in active-duty military personnel. Bariatric surgery is effective and safe and improves deployability without impairing military careers. These results are relevant to the military of many industrialized countries. Bariatric surgery should be considered for all active-duty military personnel who meet surgical criteria for the treatment of obesity., (© 2023. The Author(s).)

Purpose: Evidence for comparative and cost-effectiveness of weight-loss interventions is lacking as there are no obesity-specific measures fit for this purpose. This study aimed to estimate the extent to which a prototype of a brief, multi-dimensional obesity-specific Preference-Based Index of Weight-Related Quality of Life (PBI-WRQL) could fill this gap., Methods: Longitudinal data from a Canadian bariatric cohort was used. Forty-eight items from the IWQoL-Lite, EQ-5D-3L, and SF-12V2 were mapped onto the WHO ICF domains, and one item was chosen for the dimension based on fit to the Rasch model. Individuals' health ratings (0-100) were regressed on each dimension, and the regression coefficients for the response options were used as weights to generate a total score. Generalized estimation equations were used to compare measure parameters across groups and levels of converging constructs., Results: Pre-surgery data were available on 201 people (Women: 82%; BMI: 48.8 ± 6.7 kg/m 2 ; age: 43 ± 9.0 years) and on 125 (62%) at 6 months post-bariatric surgery. Seven dimensions with three response options formed the PB-WRQL prototype: Mobility/Physical Function, Pain, Depression, Participation, Energy, Peripheral Edema, and Dyspnea. The prototype showed substantial change (mean + 40) with bariatric surgery, higher than the EQ-5D (mean + 11.5). The prototype showed the strongest relationship with BMI at baseline (t = - 3.68) and was the most sensitive to change in BMI (t = - 3.42)., Conclusion: This study demonstrates that a brief, 7-dimension index weighted by health impact performed as well as the 31-item IWQoL-Lite and better than the EQ-5D-3L. These findings demonstrate the potential value of the brief PB-WRQL prototype index and support its further development using preference weights to reflect the current generation's needs and concerns., (© 2022. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Introduction: A comprehensive proficiency-based curriculum for an advanced, minimally invasive procedure was previously developed and shown to be more educationally effective than conventional surgery training., Objective: To implement and evaluate this proficiency-based curriculum in 2 academic general surgery residency programs in Canada., Setting: Two academic, general surgery residency programs at university hospitals in Ontario, Canada., Methods: An 8-week, proficiency-based curriculum consisted of a didactic component (lectures, small group sessions, assigned readings) and a simulation-based component (proficiency-based training in laparoscopic enteroenterostomy and a simulated operating room crisis scenario). It was offered to postgraduate years 2-5 general surgery residents in 2 academic programs in Canada. Pre- and postcurriculum procedure-specific knowledge and psychomotor skills were assessed using a 25-item knowledge test and a procedure-specific assessment scale. Postcurriculum nontechnical skills were assessed using the Nontechnical Skills for Surgeons scale. Participants' perceptions about the curriculum were assessed using a questionnaire. Direct costs for curriculum implementation were recorded., Results: Twenty-five residents participated in the curriculum across 2 programs. Completion of the curriculum resulted in significant improvement in technical skills (45 [37.5-65] versus 88 [85-93]; P < .01) and demonstration of "acceptable" situational awareness (3 [3-4]), decision-making (3 [3-4]), teamwork and communication (3 [2-4]), and leadership (3 [3-4]) skills. There was no improvement in procedure-specific knowledge (48 [40-64] versus 58 [48-60]; P = .39). Participants perceived all components of the curriculum as educationally valuable, and 96% agreed and/or strongly agreed that this curriculum should continue to be a part of academic curriculum. The average cost of curriculum implementation was $613.05 Canadian dollars per participant. Lack of faculty supervision was the main barrier to implementation with only 65% of participants agreeing and/or strongly agreeing that quantity of faculty supervision was optimal., Conclusions: A comprehensive proficiency-based curriculum for an advanced, minimally invasive procedure was successfully implemented and evaluated at 2 academic general surgery residency programs in Canada. Adequate faculty preceptor resources are essential for widespread implementation., (Copyright © 2019 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.)

Background: Bariatric surgery has been shown to induce type 2 diabetes mellitus (T2DM) remission in severely obese patients. After laparoscopic Roux-en-Y gastric bypass (LRYGB), diabetes remission occurs early and independently of weight loss. Previous research has identified preoperative factors for remission, such as duration of diabetes and HbA1c. Understanding factors that predict diabetes remission can help to select patients who will benefit most from bariatric surgery., Methods: We retrospectively reviewed all T2DM patients who underwent laparoscopic sleeve gastrectomy (LSG) or LRYGB between January 2008 and July 2014. The primary outcome was diabetes remission, defined as the absence of hypoglycemic medications, fasting blood glucose < 7.0 mmol/L and HbA1c < 6.5%. Data were analyzed using multivariable logistic regression analysis to identify predictive factors of diabetes remission., Results: We included 207 patients in this analysis; 84 (40.6%) had LSG and 123 (59.4%) had LRYGB. Half of the patients (49.8%) achieved diabetes remission at 1 year. Multivariable logistic analysis showed that LRYGB had higher odds of diabetes remission than LSG (odds ratio [OR] 6.58, 95% confidence interval [CI] 2.79–15.50, p < 0.001). Shorter duration of diabetes (OR 0.91, 95% CI 0.83–0.99, p = 0.032) and the absence of long-acting insulin (OR 0.0011, 95% CI < 0.000–0.236, p = 0.013) predicted remission., Conclusion: Type of bariatric procedure (LRYGB v. LSG), shorter duration of diabetes and the absence of long-acting insulin were independent predictors of diabetes remission after bariatric surgery., Competing Interests: S. Karmali is a consultant for Gore Medical and Ethicon. D. Birch is a consultant and has received educational grants from Ethicon and Covidien, educational grants from Stryker, and teaching honoraria from Cook Surgery and Bard Davol. No other competing interests declared., (© 2019 Joule Inc. or its licensors)

Background: Long-term complications and lack of weight loss have caused a surge in laparoscopic adjustable gastric band (LAGB) removal. This study reviews the trend of LAGB removal and examines outcomes of patients undergoing subsequent revision bariatric surgery at a single tertiary care centre in Canada., Methods: All LAGB removals performed between January 2008 and December 2016 were reviewed. A subset of patients who underwent revision surgery was then analyzed for patient demographics, weight, body mass index and postoperative complications., Results: During the study period, 211 patients underwent LAGB removal (87.7% female). Most bands were inserted out of province. Reasons for band removal included dysphagia, band slip and weight recidivism. Fifty-nine patients (28%) underwent revision surgery at a mean of 12.8 ± 9.3 (range 0–55) months after LAGB removal. Mean age was 47 ± 9.7 (range 26–63) years, and mean pre-LAGB weight was 131.0 ± 30.0 kg. Following LAGB, the mean weight decreased to 120.5 ± 26.4 kg, but most regained weight after removal to a mean prerevision weight of 125.1 ± 27.0 kg. The lowest mean weight was achieved 12 months after revision surgery (98.7 ± 30.2 kg). The mean percent total weight loss was not significantly different after revision laparoscopic Roux-en-Y gastric bypass compared with revision laparoscopic sleeve gastrectomy (22.8 ± 9.6% v.17.5 ± 6.5%, p = 0.179). The overall revision surgery 30-day complication rate was 18.6% and increased to 23.7% long-term. No deaths occurred., Conclusion: The number of LAGB removals is increasing. Revision bariatric surgery leads to improved weight loss; however, revision surgery is associated with complications., Competing Interests: None declared., (© 2019 Joule Inc. or its licensors)

Background: Bariatric surgery is an effective treatment for severe obesity. However, there has been an evolving role for bariatric surgery as a primary treatment in the management of class I obesity., Objectives: We aimed to assess the safety of surgery by directly comparing surgical outcomes of laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB) in class I obesity (body mass index [BMI] 30-35 kg/m 2 ) with those with class II obesity (BMI 35-40 kg/m 2 ) and higher (BMI >40 kg/m 2 ) using an analysis of a large-scale matched-patient cohort analysis., Setting: Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database, United States and Canada., Methods: We performed a retrospective analysis using the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database, which collects patient information from >790 bariatric surgery centers in North America. Patients included in our analysis underwent surgery in the years 2015 and 2016 and had either LRYGB or LSG for weight loss., Results: Initial analysis included 274,091 patients. Propensity-matching resulted in 9104 patients for analysis in each of the class I and class II and higher groups. The overall major complication rate between the 2 matched groups was 3.9% for class I and 3.5% for class II and higher (P = .11). We did not find that class I obesity was associated with an increased risk of 30-day complication or death., Conclusions: In our analysis of propensity-matched patients undergoing LSG and LRYGB for weight loss, class I obesity did not have statistically higher risk of postoperative complication rates compared with class II and higher., (Copyright © 2019 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.)

Background: The extent of weight loss among patients undergoing bariatric surgery is highly variable. Herein, we tested the contribution of genetic background to such interindividual variability after biliopancreatic diversion with duodenal switch., Methods: Percentage of excess body weight loss (%EBWL) was monitored in 865 patients over a period of 48 months after bariatric surgery, and two polygenic risk scores were constructed with 186 and 11 (PRS186 and PRS11) single nucleotide polymorphisms previously associated with body mass index (BMI)., Results: The accuracy of the %EBWL logistic prediction model - including initial BMI, age, sex, and surgery modality, and assessed as the area under the receiver operating characteristics (ROC) curve adjusted for optimism (AUCadj = 0.867) - significantly increased after the inclusion of PRS186 (ΔAUCadj = 0.021; 95% CI of the difference [95% CIdiff] = 0.005-0.038) but not PRS11 (ΔAUCadj= 0.008; 95% CIdiff= -0.003-0.019). The overall fit of the longitudinal linear mixed model for %EBWL showed a significant increase after addition of PRS186 (-2 log-likelihood = 12.3; P = 0.002) and PRS11 (-2 log-likelihood = 9.9; P = 0.007). A significant interaction with postsurgery time was found for PRS186 (β = -0.003; P = 0.008) and PRS11 (β = -0.008; P = 0.03). The inclusion of PRS186 and PRS11 in the model improved the cost-effectiveness of bariatric surgery by reducing the percentage of false negatives from 20.4% to 10.9% and 10.2%, respectively., Conclusion: These results revealed that genetic background has a significant impact on weight loss after biliopancreatic diversion with duodenal switch. Likewise, the improvement in weight loss prediction after addition of polygenic risk scores is cost-effective, suggesting that genetic testing could potentially be used in the presurgical assessment of patients with severe obesity., Funding: Heart and Stroke Foundation of Canada (G-17-0016627) and Canada Research Chair in Genomics Applied to Nutrition and Metabolic Health (no. 950-231-580).

The purpose of this study was to evaluate the relationship between patient, clinical and laboratory characteristics, and bleeding after bariatric surgery. A retrospective chart review was performed for all patients, who underwent a laparoscopic Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy at our institution between March 2012 and May 2014. In total, 788 patients were included in this study. Seventeen patients had postoperative bleeding. The demographics, comorbidities, and preoperative medications were similar between the groups. Mean postoperative hemoglobin in the bleeding group was significantly lower (94 vs. 126; P<0.001) with a larger decrease from the baseline value (-43 vs. -12; P<0.001). The mean heart rate (91 vs. 81; P<0.001) and its increase from baseline (12 vs. -0.01; P<0.001) were significantly different in the bleeding patients. Postoperative hemoglobin and heart rate were associated with bleeding but not systolic blood pressure or patient characteristics. Further research is needed to develop a robust predictive model.

The delay in turning research into practice for the benefit of patient care has been compared to a "leaky pipeline." In the early 2000s, this delay raised concerns among governmental agencies and other sponsors of health services in many countries. Facilitating the translation of basic and clinical research into clinical practice through evidence-based decision-making and improving population health is now a major goal of health research investment agencies. Translational research or knowledge translation has emerged to bridge the gaps between basic and clinical research, and between clinical research and clinical practice. Various frameworks and definitions of translational research are presented. We present an example of an Integrated Knowledge Translation Team in Bariatric Care, and explain how an integrated knowledge translation (iKT) approach was created at the program's inception. This led to evidence-based decision-making and subsequent practice change in one area of the health care system. Real-world successes and challenges in moving research to practice are discussed.

Canada faces a similar epidemic of obesity in their adolescent population as other Western countries. However, the development of programs to treat obesity and manage its sequelae has evolved in a unique way. This is in part due to differences in health care funding, population distribution, public demand, and availability of expertise and resources. In this article, we will describe the evolution of adolescent bariatric care in Canada and describe the current programs and future directions. The focus will be on the province of Ontario, the site of the first adolescent bariatric program in the country., (© 2013 Published by Elsevier Inc.)

Background: Body contouring, which encompasses a range of surgical procedures on different areas of the body, is one of the most rapidly growing areas of plastic surgery. Little is known about outcomes from the perspective of post-weight loss body contouring patients. The aim of our qualitative study was to identify the health and aesthetic concerns of such patients through in-depth patient interviews., Methods: Forty-three bariatric surgery post-weight loss body contouring patients were recruited between September 2009 and January 2011 from the offices of five plastic surgeons located in the USA and Canada. Interviews were used to explore the impact that obesity, weight loss, and body contouring surgery had on all aspects of the patient's life. Interviews were transcribed and data analysis involved coding and the use of the constant comparison method to develop categories and themes. Interviewing continued until no new themes emerged., Results: Patients described a range of important health and aesthetic concerns related to body contouring surgery following massive weight loss, including the following: appearance-related concerns, physical health concerns, sexual health concerns, psychological health concerns, and social health concerns. Body contouring surgery played an instrumental role in the completion of the entire weight loss process for patients., Conclusions: The removal of excess skin leads to improvements in a patient's appearance and enhanced physical, psychological, and social health and well-being. In order to appropriately measure the impact of body contouring procedures from the patient's perspective, a well-developed psychometrically sound patient-reported outcome instrument is needed.

Background: Surgical treatment of obesity is cost-effective and improves life expectancy. Roux-en-Y gastric bypass (RYGB) and adjustable gastric banding (AGB) are dominant surgical techniques, but RYGB is the only publicly insured procedure in all Canadian provinces. Private clinics currently offer AGB with minimal wait times. We sought to compare RYGB in public facilities with AGB in private clinics in terms of cost, wait times and certain aspects of patient care., Methods: We conducted telephone interviews of all bariatric surgery providers across Canada (100% response rate). We asked about various aspects of care, such as wait time, cost, pre- and postoperative care and surgeon experience., Results: The median out-of-pocket cost for AGB at private facilities is $16,000 (range $13,160-$18,375). Private clinics have much shorter wait times for AGB than public facilities do for RYGB (1 v. 21 mo, p < 0.001). Private clinics provide significantly fewer preoperative visits with multidisciplinary health professionals (2.7 v. 4.3, p = 0.045), and 5 of 12 (42%) private clinics conduct AGB surgeries without on-site critical care for high-risk (based on the respondents' definitions) patients., Conclusion: Private clinics performing AGB offer short wait times, but the cost is high. We found a great deal of variation between pre- and postoperative care among bariatric surgery facilities, and in some cases patient care appears to be less comprehensive. Our findings suggest that further research on obesity treatment is needed to inform policy so that all Canadians can have equitable and timely access to proven, evidence-based care.

Background: The number of Canadians who self-refer for bariatric surgery outside of Canada or to private clinics within Canada remains undefined. The outcomes from this questionable practice have not been evaluated systematically to date., Methods: We completed a chart review of known cases referred to our center for complications related to medical tourism and bariatric surgery., Results: We present a series of patients who have experienced complications because of medical tourism for bariatric surgery and required urgent surgical management at a tertiary care center within Canada. Complications have resulted from 3 commonly used procedures: adjustable gastric banding, gastric sleeve resection, and Roux-en-Y gastric bypass., Conclusions: Because of this review, we propose that a medical tourism approach to the surgical management of obesity-a chronic disease-is inappropriate and raises clear ethical and moral issues., (Copyright 2010 Elsevier Inc. All rights reserved.)

Bariatric surgery is a treatment option for obese patients when weight-reduction strategies such as lifestyle modifications and pharmacotherapy fail. To date, bariatric surgery has resulted in sustained weight loss; the resolution of diabetes for some patients has also been observed. The objective of this study was to explore changes in-patient bariatric surgery delivery in Canada between 2004-2005 and 2008-2009.

Periodically, the state of bariatric surgery worldwide should be assessed; the most recent prior evaluation was in 2003. An email survey was sent to the leadership of the 36 International Federation for the Surgery of Obesity and Metabolic Disorders nations or national groupings, as well as Denmark, Norway, and Sweden. Responses were tabulated; calculation of relative prevalence of specific procedures was done by weighted averages. Out of a potential 39, 36 nations or national groupings responded. In 2008, 344,221 bariatric surgery operations were performed by 4,680 bariatric surgeons; 220,000 of these operations were performed in USA/Canada by 1,625 surgeons. The most commonly performed procedures were laparoscopic adjustable gastric banding (AGB; 42.3%), laparoscopic standard Roux-Y gastric bypass (RYGB; 39.7%), and total sleeve gastrectomies 4.5%. Over 90% of procedures were performed laparoscopically. Comparing the 5-year trend from 2003 to 2008, all categories of procedures, with the exception of biliopancreatic diversion/duodenal switch, increased in absolute numbers performed. However, the relative percent of all RYGBs decreased from 65.1% to 49.0%; whereas, AGB increased from 24.4% to 42.3%. Markedly, different trends were found for Europe and USA/Canada: in Europe, AGB decreased from 63.7% to 43.2% and RYGB increased from 11.1% to 39.0%; whereas, in USA/Canada, AGB increased from 9.0% to 44.0% and RYGB decreased from 85.0% to 51.0%. The absolute growth rate of bariatric surgery decreased over the past 5 years (135% increase), in comparison to the preceding 5 years (266% increase). Bariatric surgery continues to grow worldwide, but less so than in the past. The types of procedures are in flux; trends in Europe vs USA/Canada are diametrically opposed.