Nowhere is the failure of the health care system, as currently managed, more evident than in the surgical care of obesity. A marked contrast has emerged between surgery in the United States and Canada for these patients. It is not clear whether the reluctance to supply surgical services in Canada is due to a bias in favour of “more deserving” patients or whether the considerably higher rate of obesity surgery in the US is due to the excesses of private enterprise. Governments have acknowledged that an element of the former proposition is true by referring obese patients to centres in the US. This practice, which appears to be a measure to keep the peace with failing managements of the superhospitals, undermines the whole foundation of surgical practice in Canada. For the first time, surgeons have not acknowledged a responsibility for the care of a whole sector of society. Not only do considerable resources follow these patients over the border, but an opportunity to refine laparoscopic surgical skills is being wasted.
If there is a bias against gastrointestinal obesity surgery in Canada, there is almost a repugnance regarding the surgical care of patients after massive weight loss. Again, there is a considerable gap between care provided in Canada and the US. Evidence in this field of surgery is even harder to acquire than in gastrointestinal obesity surgery, but it seems negligent to have induced the appropriate weight loss without following through with the surgery that restores mobility, increases comfort and allows for the full participation of patients in society.
This textbook is the first to deal with surgery after massive weight loss. Its editor and contributors are the acknowledged leaders in this field in the US. The atlas format and the attached DVDs make the techniques eminently accessible to ordinary surgeons, so that it is an essential reference book for people considering this type of surgery. Canada has often found the middle ground in surgical debates, taking wisdom from all sides. With respect to care of people with obesity, regional programs of integrated paramedical, medical and surgical service are inevitable. Current knowledge dictates that surgery will be the major component of these programs and, as such, it should include body contouring as well as gastrointestinal obesity surgery. This textbook will allow planners to understand what is at stake and what can be gained by such surgery. The only advantage to the current practice of exporting patients with obesity is that the resources required for the regional programs are being defined and reserved.
Footnotes
The role of general surgeon in Canada continues to evolve. Where once the rise of specialist surgery eroded the requirement for services provided by general surgeons, the current lack of access to certain types of care has increased the burden on general surgeons, who are now ill-equipped to meet these demands. In this issue of the Canadian Journal of Surgery, 2 new textbooks of plastic surgery are reviewed. The second book, which deals with a topic likely to remain the preserve of the specialist, is reviewed because of its significant Canadian content. The subject of the first book, has so far found no surgical specialty champion.
Competing interests: None declared.