The Regional Bariatric Care Centre (RBCC) is a Bariatric Centre of Excellence that provides specialized treatment options for adults living with obesity and weight-related complications. The RBCC team works with patients living in Northern Ontario to support improvements in health and quality of life.
Read the story of how two brothers changed their lives with support from TBRHSC’s Regional Bariatric Care Centre.
What is Obesity?
Obesity is a chronic, progressive and relapsing disease, characterized by the presence of abnormal or excess adiposity (fat tissue) that reduces health and social well-being.
Watch Obesity: A Chronic Disease of the of the Brain
Obesity can affect anyone of any age, culture or income bracket. One in four struggle with obesity in Northwestern Ontario, which has the second highest obesity rate of any region in the province.
Referrals
Patients must be referred by their family doctor or nurse practitioner through the Ontario Bariatric Network’s referral portal. This centralized system improves the care of patients with obesity and streamlines the process.
Referral Portal
Surgical Program
The Surgical Program at Thunder Bay Regional Health Sciences Centre (TBRHSC) offers surgical (bariatric surgery) treatment of obesity and weight-related complications through safe weight loss and management and support with maintaining healthy lifestyle habits.
For some, bariatric surgery is an option for obesity management. Bariatric surgeries either cause some reduction in the amount of food you are able to eat comfortably or a reduction in the absorption of calories from the food you eat, or both. While these surgeries can have major impacts on a person’s weight and other health-related factors, continued success and improvements in overall health still depend on maintaining healthy behaviours.
TBRHSC offers two types of bariatric surgery procedures:
Sleeve Gastrectomy – Here, surgeons will remove most of the stomach, leaving only a banana-sized vertical “sleeve” of it in place.
Gastric Bypass – A small stomach pouch is created using surgical staples, which allows food to bypass some of the small intestine.
Benefits of Bariatric Surgery
With appropriate patient selection, education and follow up, bariatric surgery can offer sustainable weight loss (20-30% reduction) with large reductions in weight-related complications and significant improvements in mental health and quality of life.
*Specific outcomes include:
- Independence and enhanced mobility
- Up to 94% resolution of high cholesterol
- Reduction or elimination of some chronic pain
- Greater than 80% resolution of type 2 diabetes
- Reduced need for medication
- Greater than 90% resolution of liver disease
- Improved cardiovascular health
- Greater than 75% resolution of sleep apnea
- Reduced risk of acquiring serious diseases
- 41% resolution of arthritis
- Improved changes of fertility
- 80% resolution of high blood pressure
*Individual results vary
Eligibility for Bariatric Surgery
Eligibility criteria for bariatric surgery include:
- 18 years of age and older
- Body Mass Index (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 co-morbidities (as determined by your primary care provider:
- Coronary heart disease
- Type II diabetes mellitus
- Hypertension (high blood pressure)
- Diagnosed sleep apnea
- Gastroesophageal Reflux Disease (GERD)
Ineligibility for Bariatric Surgery
Ineligibility criteria for bariatric surgery include (but are 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
- Smoking or vaping nicotine or cannabis (including cigarettes, cigars, e-cigarettes) within 6 months of referral
Bariatric Surgery Frequently Asked Questions
Bariatric Surgery – What to Expect
Before surgery
Once you are referred to the program, our program clerks will start coordinating your journey. You will be contacted to attend an orientation session to learn if bariatric surgery is a suitable option for you. If you choose surgery, you will be assessed by our team. You will be expected to attend multiple appointments (some appointments can be done virtually) so the team can assess and prepare you for surgery. The assessment process starts with a medical intake appointment with our Internal Medicine Physician. You will be required to have bloodwork and an electrocardiogram (ECG), and you may have to do other test(s) to make sure you are safe to have surgery. After you see the doctor, you will be assessed by our support team, including a nutritional assessment by the dietitian and psychosocial assessment with the social worker and/or Psychologist. There will be many opportunities to ask questions during these appointments. You are welcome to bring a support person to any of these appointments. Missing multiple assessment appointments before surgery will result in discharge for 1 year.
The surgical care team also includes nurses and a kinesiologist (exercise specialist). We have 2 surgeons who perform the bariatric procedures: Dr. Scott Cassie and Dr. Andrew Smith, who we welcomed to our team in 2014.
Bariatric surgery is a life-altering procedure, and is usually not reversible. For that reason, the RBCC team provides a thorough assessment to make sure that all patients know the risks, potential outcomes and benefits, as well as assesses the patient’s physical and emotional readiness to determine eligibility. You want to carefully consider if this is the right time to make this type of lifelong commitment.
At the medical intake appointment
You will be greeted first by one of our nurses, who will take some measurements from you before you see the doctor. The nurse will measure your height and weight to confirm or update what was received on your referral. They will measure some vital signs such as your blood pressure. The nurse will also measure around your waist. This is called “waist circumference” and research shows that it can identify patients at increased risk for certain diseases. The size of your waist often decreases after losing weight and can show how your risk for these diseases is decreasing over time. You can discuss this with your team at any time. Some patients say they feel embarrassed to have their waist measurement. Our nurses will do their best to make you feel comfortable and let you know when it is time to take this measurement. They can explain why this is important and answer any questions you have.
The doctor will review your health history and ask you about any past surgeries you have had. They will examine you in the same way that your family doctor or nurse practitioner does. The doctor may order other tests such as tests to check on your heart, or breathing or other things to make sure you are safe to have surgery.
After surgery
You are expected to have regular follow up with our clinic in the first year after surgery to help you adjust to your new lifestyle. You may be transitioned to your primary care provider or nurse practitioner after the first year, when appropriate (as determined by the team). The bariatric team will remain available if you need support. Lifelong support is important to help with your healthy lifestyle decisions but also to screen and monitor you for any medical, nutritional and/or emotional side effects and complications. You are expected to take vitamins (up to 3 times/day) every day for life, as well as have bariatric bloodwork done every year for the rest of your life.
Support Group
Groups are offered regularly, and run by clinic staff. This is an opportunity to connect for conversation about healthy lifestyle and promote peer support while gaining knowledge and sharing experiences. The support group is available to patients before and after surgery. Call our clinic for more information, or to register (807) 684-6058. (email address and computer/tablet/smart phone are required to attend)
Medical Program
The Medical Program is a medically supervised program, which includes a combination of meal replacements and weekly education and support to incorporate healthy lifestyle changes. The goal of the program is to help patients achieve a healthier state of wellness by providing knowledge and skills to explore eating and coping behaviours, and to promote healthy eating, physical activity and healthy living.
Eligibility for the Medical Program
Eligibility criteria for the Medical Program include:
- 18 years of age and older (allow referrals at age >= 17.5 years)
- Body Mass Index (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 co-morbidities (as determined by your primary care provider):
- Complicated Type II diabetes mellitus
- Idiopathic intracranial hypertension (high blood pressure)
- Poorly controlled hypertension (high blood pressure)
Ineligibility for the Medical Program
Ineligibility criteria for the Medical Program include (but are 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
Medical Program Frequently Asked Questions
Medical Program – What to Expect
Once you are referred to the Medical Program, our program clerks will start coordinating your journey. You will be contacted to attend an orientation to learn if the Medical Program is a suitable option for you. If you choose the Medical Program you will attend an medical intake with our nurse practitioner who medically monitors all patients registered in the Medical Program. You will be required to have bloodwork and an electrocardiogram (ECG), and you may have to do other test(s) to make sure you are safe to proceed with medically supervised weight loss. There will be many opportunities to ask questions at the orientation or with the nurse practitioner. You are welcome to bring a support person to any of the appointments.
The program involves a commitment to attending group sessions weekly for six months and then monthly for an additional six months, for a total of a one year commitment. In addition to the group sessions you are expected to attend regular appointments with the nurse practitioner who will medically monitor your outcomes and progress. Weekly classes are done virtually, and some of the other appointments can be done virtually. You want to make sure that when you are offered to start the program, that it is the right time to make this type of commitment (you can defer your start date once), as you can only participate in this program once. Missing multiple appointments (medical appointments or group sessions) may result in discharge from the program.
During the weekly group sessions you will be encouraged to ask questions and participate in discussions. Individual 1:1 support is provided as needed.
The weekly classes are provided by a dietitian, social worker and kinesiologist (exercise specialist). The team also includes a medical director and Psychologist, who can be consulted as needed.
Helpful Links
Medical Program Resource Portal
