Lillian Coakley, a 42 year old resident of Nova Scotia, Canada, isn’t dead yet, but she has already written her own obituary. Coakely is obese and is currently on the waiting list for bariatric surgery, a procedure that reduces mortality rates and significantly improves the patient’s health. According to Capital Health, the clinic that provides weight loss surgery for the province of Nova Scotia, the waiting list is currently more than 10 years long. Coakley fears she won’t make it that long.
In a guest post on Weighty Matters, the blog of Ottawa obesity doctor Yoni Freedhoff, Coakely wrote that her province’s health care system has failed her and many others like her who struggle with their weight and with obesity. Her obituary began like this:
We are sad to inform you of the untimely passing of a young mother, sister daughter and friend. She died at a young age due to complication with obesity that she fought for years to overcome. She was the youngest child of 7 and she leaves behind her 2 sons, who both lived at home with her. Her entire life was lived for her boys who she loved immensely and were her pride and joy.
In her post, Coakley made a call to action, writing: “We as tax payers and humans need to be heard and helped. People need to stop putting a stigma and sweeping weight loss surgery under the carpet and realize people are going to die on this waiting list.”
Paying For Weight Loss Surgery is Worth It
Coakley’s blog post was picked up by media across Canada, including the Chronicle Herald, which interviewed Coakley and Dr. James Ellsmere, the surgical director at Capital Health. Ellsmere explained that his clinic has done 60 to 80 sleeve gastrectomies per year since the clinic opened in 2007 and that when patients get the surgery, “the outcomes are so impressive, life-changing for the individual.” Weight loss surgery also yields savings in other parts of the healthcare system, because patients no longer require treatment for diabetes, heart disease, asthma, sleep apnea, painful joints, and other conditions that are related to obesity.
The Blame Game
Coakley has struggled with her weight all of her life. According to the Chronicle Herald, “at six months, she was put on a skim milk-only diet” and later “her mother brought her to the IWK Health Centre in Halifax where the teenage Coakley was put on a diet and strictly monitored, only to gain more weight.” She has willpower, she says, citing the fact that she “quit smoking cold turkey, coffee and Pepsi all on the exact same day.” Ultimately, diets never worked for her and never yielded the expected results.
That doesn’t stop people from blaming her for her condition. After Freedhoff published her obituary, he received numerous comments claiming that she just needed to take personal responsibility and do something about her weight and that she obviously wasn’t trying hard enough. In a follow-up post, Freedhoff explained why the “good ole, pull herself up by her bootstraps and take things into her own hands” mantra just doesn’t compute. He wrote:
For readers who don’t know, I’m not a surgeon. I’m the medical director of a behavioural weight management program. And while I’ve seen with my own two eyes many a person lose enough weight to preclude surgery, I don’t delude myself into thinking that downloading the solution to extreme obesity onto personal responsibility is everyone’s answer.
If there were a non-surgical, reproducible and uniformly effective plan for the management of extreme obesity, I’d agree with you, but the fact is, there is no such plan.
Of course, even if you do want to embrace personal responsibility as the sole cause of obesity, medicine isn’t about blame. We patch up drunk drivers and folks who don’t wear seat belts. We offer smoking cessation programs. We treat asthmatics who don’t bother keeping up with their puffers, pneumonias exacerbated by the early discontinuation of antibiotics, and the psychotic breaks of folks who stop their antipsychotics.
Personal responsibility is just one part of the equation. We also need people to be educated about nutrition and fitness, we need healthy food to be affordable and accessible, and we need the regulation and cooperation of the convenience food industry to make food healthier. Even if we have all of that, there will still be people who struggle with their weight and the health care system needs to be there to help them, in the same way that it helps anyone who struggles with any aspect of their health.
The Wait is Too Long
Weight loss surgery is something that the government has rightly decided that it should be providing to Canadians as part of the public health care system. The business case is strong — it improves lives and reduces costs in other parts of the health care system. A 10 year wait for surgery is both inhumane and fiscally irresponsible. The Government of Nova Scotia needs to find a way to reduce the wait times and ensure that people can get the surgery that they so badly need.
Photo credit: Lillian Coakley (used with permission)
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