Obese patients seeking treatment still face bias, stigma

Kevin Bruner had a life-long battle with his weight — eventually topping the scales at 370 pounds.

"I was in pain, uncomfortable," said Bruner. "Everything was an effort."

Bruner said his weight crept up year after year following high school and he couldn't get it under control.

"It was very tiring" to carry around 370 pounds, Bruner said. So after years of attempting to diet and exercise, Bruner turned to bariatric surgery — but it wasn't as easy as just asking for it.

First, he needed a referral from his family doctor for the bariatric Regional Assessment and Treatment Centre (RATC) at Hotel-Dieu Grace Healthcare. Once he was in the program, about a year went by before he actually got the surgery.

During that time, Bruner had to follow the program exactly. He couldn't miss any appointments, couldn't gain any weight and had to keep all other health concerns under control.

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When he went under the knife for a gastric sleeve procedure, about two-thirds of Bruner's stomach was removed.

Now, a year and a half later, Bruner has followed the program to the letter and continues to lose weight — down to 180 pounds.

"I haven't had a pop or a beer since my surgery," said Bruner. "In the first week I lost 20 pounds. For the most part I was average losing two to five pounds every week for a year."

Bruner isn't able to eat as much as he used to, confessing he can't even finish a whole hamburger.

Changes have been made in his lifestyle. While Bruner said he isn't necessarily "training for a marathon," he's no longer parking in the closest spot to work anymore.

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To remind him how far he's come, Bruner still wears the same belt he wore when he was 370 pounds.

"I'm never going back there," said Bruner. 

The lazy way out

Bruner says there's a stigma attached to bariatric surgery.  Some people have told him it was the lazy way out and that he should just eat less — but he just ignores the critics.

"I'm more than happy with what I did. I tell everybody I had surgery. I'm not embarrassed by it," he said.

Dr. Joseph Shaban, an endocrinologist and medical director of the RATC in Windsor, said the bias of obesity being a lifestyle problem creates barriers to getting proper treatment.

Patients are still being told to eat less and do more and that just doesn't work - Dr. Joseph Shaban

"We're now realizing there are factors that influence the ability to gain or lose weight that develop in utero," said Shaban. "In the majority of cases [the cause] is natural."

Family doctors are the gatekeepers to getting treatment, including bariatric surgery, but Shaban said some of those doctors still have systemic biases. 

"We now have great medications, surgical options … it's a matter of getting a referral to the centres," said Shaban. "Patients are still being told to eat less and do more and that just doesn't work."

Shaban added surgery is a tool — one of many used at the Windsor bariatric centre.

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"The tools that we have vary depending on the patient," said Shaban. "Surgery is an excellent tool and the risk is less than that of a gallbladder operation."

According to Shaban, the hormonal changes which occur after surgery are immediate, before any weight is even lost.

He said in the long-term, a sleeve gastrectomy surgery results in some patients regaining weight in the first year, but the majority keep the weight off after five years.

In the other type of surgery, a gastric bypass which he calls the "gold standard," the five-year success in keeping weight off is about 80 per cent.

High obesity rates in Windsor-Essex, Chatham-Kent

More than one third of all adults in the region are obese — and the Windsor bariatric centre sees close to 500 patients a year. It's just one of 12 centres across the province.

According to 2015-2016 data from Public Health Ontario, 26.5 per cent of all adults in Ontario are obese. In Windsor, that number is almost 35 per cent. In Chatham-Kent, 40 per cent of adults are obese — the second highest health unit region in the province. 

In the Lambton Public Health area, 31.7 per cent of adults are obese.

The Windsor-Essex County Health Unit considers obesity the most common local chronic health problem — with two out of three residents considered overweight or obese.

Hear more from Kevin Bruner and Dr. Joseph Shaban on the CBC's Windsor Morning.