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Weight-loss operation can send diabetics into remission

ANDRÉ PICARD

From Wednesday's Globe and Mail

Latest comment posted at 1:02 PM EDT 11/02/08

Almost three in every four obese people suffering from diabetes can be cured of the disease with bariatric surgery ...Read the full article

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  1. Patrick Yau from toronto, Canada writes: This is an important article that highlights the understanding that obesity is truly a disease and the surgery to cure this illness leads to multiple health benefits. As a surgeon that has performed over 2000 of these operations, I think that it is important the also note that the follow-up program for these patients are intense and that the outcomes of the surgery are nothing without a multidisciplinary follow-up team of medical staff dedicated to patient success. Lets be honest, a diet is a short term concept and will never lead to long term changes that are necessary for long term success. This surgery is certainly without risk but many fail to notice that not treating this disease properly also has a substantial health risk
  2. Stephen Harper from Canada writes: Obesity is not a disease. Its eating too much, and exercising too little.

    And thats a fact, jack.

    Oh, and as someone who profits from these surgeries, you should lose your medical license for dangerously misrepresenting this surgery.
  3. Perry Brodkin from Toronto, Canada writes: Dr. Lau is mistaken when he stated that Ontario refuses to cover the cost of the procedure. Ontario covers the cost of the procedure where the procedure is performed in a public hospital. That is because the Health Services Appeal and Review Board has required the Ontario Health Insurance Plan to cover the cost of the procedure where the procedure is performed in a public hospital. In that regard, I would refer Dr. Lau to the Decision and Order of the Board in E.C. v. The General Manager, Ontario Health Insurance Plan. The Decision and Order are on the Board's website. The Decision is dated October 2, 2007 and the Order is dated December 17, 2007. In that case, the procedure was performed by Dr. Laz Klein at Humber River Regional Hospital. The effect of the Decision and Order is that the procedure has been an OHIP insured service since July 1, 2003. A surgeon must submit his or her account for the procedure directly to OHIP and will receive payment from OHIP in the amount of $750. A surgeon must not submit any account to the patient.
  4. Tracy Gomes from Toronto, Canada writes: Dr. Lau is not mistaken. OHIP covers the VBG - Vertical Banded Gastroplasty (or Stomach Stapling) procedure. I had the OHIP sponsored surgery 6 years ago and I gained most of the weight back. It doesn't cover the lap band which is proven to be more effective over time.
  5. Jay Wortman MD from West Vancouver, Canada writes: With all due respect to my surgical colleagues - this is crazy.

    There is a growing body of science showing that a low-carb diet can reverse type 2 diabetes. But, we aren't allowed to promote this because there might be long term adverse effects. While we wait for long term studies, even though it is obvious from existing literature and clinical experience that it is extremely unlikely that anything negative will be discovered that cannot be rectified with a supplement, a low-carb diet approach is not supported by anything like what Dr. Yau describes when he states, " the follow-up program for these patients are intense and that the outcomes of the surgery are nothing without a multidisciplinary follow-up team of medical staff dedicated to patient success". While everyone is hand-wringing over the mere possibility of some long-term problem associated with this simple diet change, we gladly promote a major surgical intervention that has well documented risks and a significant potential for long-term harm.

    Here is what one of my learned colleagues had to say on the topic:

    What is ignored in this group of patients is that 3-5 years out, many of them become overtly depleted of major and trace minerals such as calcium, magnesium, zinc, copper, manganese, and selenium.
    Iron inadequacy is usually not a problem because their MD's shoot them up with iron dextran and EPO. Of course, this tends to overload them, which increases ROS [free radicals] and inflammation, which compounds their inability to maintain SOD activity [the mechanism that protects from free radicals]
    So, because oxylipid production and inflammatory biomarkers precede type-2 diabetes, what do we guess will happen to diabetics a few years later who got better shortly after having gastric banding or bypass?

    If we put half these resources into helping these patients adhere to a low-carb diet we would get the same benefits without the risks.
  6. Perry Brodkin from Toronto, Canada writes: Tracy Gomes from Toronto, OHIP covers adjustable gastric banding ("AGB") surgery when it is performed in a public hospital since the Decision and Order of the Health Services Appeal and Review Board in E.C. v. The General Manager, Ontario Health Insurance Plan. The Decision is dated October 2, 2007 and the Order is dated December 17, 2007. The Decision and Order are retroactive to July 1, 2003. In all likelihood, Dr. Lau is unaware of the Decision and Order since he was not the surgeon who performed the surgery. I was OHIP's lawyer, I am now in private practice, and I am aware of the Decision and Order. You can read the Decision and Order for yourself on the Board's website. The Decision and Order speak for themselves.
  7. Emma Hawthorne from Canada writes: 05-HIA-0084

    HEALTH SERVICES APPEAL AND REVIEW BOARD



    IN THE MATTER OF AN APPEAL UNDER SUBSECTION 20(1) of the Health Insurance Act, Revised Statutes of Ontario, 1990, Chapter H.6, as amended





    B E T W E E N:



    E.C.

    Appellant



    and



    THE GENERAL MANAGER,

    ONTARIO HEALTH INSURANCE PLAN

    Respondent/Requestor



    ORDER





    Overview

    In a decision dated October 2, 2007 the Health Services Appeal and Review Board (the “Appeal Board&8221;) found that Adjustable Gastric Banding surgery (&8220;AGB&8221;) is an insured service of the Ontario Health Insurance Plan (&8220;OHIP&8221;) under the Health Insurance Act (the &8220;Act&8221;). OHIP has requested a review of that decision. For reasons that follow, I find that it is not desirable to review the original decision of the Appeal Board.

  8. Emma Hawthorne from Canada writes: It is worth noting that a study, albeit an outdated study, on OHIP's web site stated that gastric banding results in no changes to body chemistry. Given that the band is a mechnanical device that cinches the stomach only, I don't see how there could be any change. Gastric bypass, on the other hand, is a major interference with body systems with major lifelong consequences and biochemical changes. The death rate from banding is only one out of 1,000 to 2,000 patients while the death rate from gastric bypass is about 40 times higher, with most deaths occurring in surgeries where physicians were performing their first 19 bypass surgeries, according to the old study posted on OHIP's web site. OHIP link is: http://www.health.gov.on.ca/english/providers/program/ohtac/tech/reviews/sumbaria010105.html
    A more moderrn paper presented in "Las Vegas" (suggesting a commercial component) is found at:
    http://clos.net/contents.htm
  9. Tracy Gomes from Toronto, Canada writes: Thank you. I was not aware, I went back to my surgeon in July 2007 and was told it was not covered. But it raises the question. How does this decision affect patients who have had VBG and experienced problems after?
    Having tried most methods (including low carb) to deal with weight loss, I found the surgery was more effective. Shortly after the surgery my health improved and I had significantly fewer visits to my doctor. Sadly it was only temporary fix with VBG. I may be dealing with a different set of issues now but I know that bariatric surgery is effective in treating the disease and other symptoms of obesity.
  10. Perry Brodkin from Toronto, Canada writes: Tracy Gomes from Toronto, you may wish to consider contacting your surgeon and advising him or her that the surgery is now an OHIP insured service. In all likelihood, your surgeon is unaware of the Decision and Order of the Health Services Appeal and Review Board. Your surgeon may wish to contact a medical consultant at OHIP to confirm that the surgery is now an OHIP insured service and that your surgeon must submit his or her accounts for the surgery directly to OHIP and must not submit any accounts for the surgery to his or her patients.
  11. LowCarb Barb from Canada writes: 'If we put half these resources into helping these patients adhere to a low-carb diet we would get the same benefits without the risks."

    I agree with Jay, only I'd call it a low-carb LIVE-IT. It's a lifestyle change, not a short-term diet, and it works. My husband and I are living it, 50 lbs and 25 lbs lighter respectively (for over a year now), and feeling better than we've ever felt in our lives.

    We tried the low-fat, high-carb advice and we got fat and unhealthy.
    Reading Gary Taubes' "Good Calories, Bad Calories" only confirmed my already strong conviction that current dietary guidelines promoted by government and other agencies are hogwash.

    I'm not spending the rest of my life waiting for them to get it right.
  12. Emma Hawthorne from Canada writes: Hi LowCarb. Overeating for many is an addictive behavior that has nothing to do with food and everything to do with trying to mediate anxiety and depression. All the nutritional and excercise advice in the world is pointless for a person driven to eat by overwhelming feelings. Shouldn't society deal with the root cause? Western medicine is only allopathy - symptom removal. Under that system, doctors strive to take off the weight and hope patients maintain it. A more valid approach, I think, is to find a way to turn off the need that drives the behaviour. Overeating is hard work, expensive and uncomfortable. Don't you think these people are struggling to escape? Of course they are. They deserve real help, which I think psychologists and social workers could provide as they are expert psychotherapists, head and shoulders above others. Compulsive eating groups might also work but our healthcare system is so focused on medicine, which is excellent for injuries and heart attacks, but disatrous for for most all chronic problems and obesity, that more valid approaches are overlooked. In the meantime, until the real psycholocial treatment is rolled out, gastric banding is a valid approach, with relatively low cost and little risk, that can stave off diabetes.
  13. Emma Hawthorne from Canada writes: "The Hunger Within: A twelve-Week Self-Guided Journey from Compulsive Eating to Recovery" by Marilyn Migliore is excellent, a watershed book on overcoming compulsive eating. Most compulsive eating is wrapped up in child abuse, cruel families of origin in crisis, or worse. The real fix will remove the compulsive eating while quickly (ie not 12 years of sterile over-intellectualized psychoanalysis - but real, fast, immediate, progressive help) helping sufferers take hold of the childhood memories and angst that is driving their compulsive eating, put it in proper perspective and free themselves from both obesity and the abuse or whatever preceded the overeating. This is why we need those clinical psychologists and social workers who want to be in OHIP, to be in the plan. There is so much fast, productive, efficacious work for them to do!!! No one else can do it. Psychiatry is just not efficacious, efficient, competent of suitable for this kind of task.
  14. Jay Wortman MD from West Vancouver, Canada writes: Emma, you need to read "Good calories, Bad calories".
  15. Emma Hawthorne from Canada writes: Hi Jay Wortman MD. I guess it all really depends on what percentage of obese persons are compulsive eaters and what percentage are making poor food choices. I'm guessing 40/60.
  16. Jay Wortman MD from West Vancouver, Canada writes: Emma, the issue that Gary Taubes explains so well in his book is that our current failed hypothesis about the cause of obesity has it as a behavioural problem while the overwhelming bulk of scientific evidence is pointing to a metabolic defect as the root cause.
    My guess is that your ratio is probably more like .01/99.99.
  17. Andrew Porter from New York City, United States writes: I weighed 265 pounds when I was diagnosed, and subsequently went down to 215 pounds by stepping up the amount of physical activity I engaged in, and completely changing my diet. However, I still have Diabetes. Recently I had other health problems unrelated to Diabetes and went down to 180 pounds. The Diabetes remains, though. And having had a Whipple Procedure, I'm never going to have another major operation on my stomach. I Hope...

    So I guess I'm just screwed...
  18. Emma Hawthorne from Canada writes: Hi Wortman. What's your's? Your writing seems to definitely indicate an imbalance. But seriously, your comment is quite offensive. Personal assignments of any kind in a public forum are very passive-aggressive and offensive.
  19. Emma Hawthorne from Canada writes: I am not EC. I merely looked up the decision after Perry Brodkin mentioned it and then pasted the first paragraph above.
  20. Perry Brodkin from Toronto, Canada writes: On January 24, 2008, the Cabinet changed the law by means of a regulation made and filed under the Health Insurance Act as Ontario Regulation 8/08 such that adjustable gastric banding by laparoscopic or open surgical method is not an insured service and has not been an insured service after September 1, 1999.
  21. Tracy Gomes from Toronto, Canada writes: Is it possible to make an appeal on the decision?
  22. SusieQ 321 from NoWhereVille, Canada writes: The AGB is not and has never been covered as a weight loss surgery in Ontario other provinces have covered it on an experimental basis. I have read that the AGB is used in other surgeries on a very limited basis nothing to do with weight loss. Get your facts straight. I can refer you to hundreds of patients who will reinforce this. I even know of a couple who appealed to OHIP and went to a hearing OHIP refuses to cover lapbanding as a viable alternative Weight loss surgery. OHIP will cover RNY and VBG they are different animals
    One more thing it is Dr Yau not Lau please read.
    Dr Yau is right, it isn't just about the surgery as someone who has had the lapband surgery over 6 years ago it is all about the aftercare. I was obese for many reasons the one that everyone jumps on is you eat to much and don't move enough. Well I swam laps, walked treadmills and yes I ate crappy foods, but I did move my body too and yes it was my own fault I was obese. Over the last six years I have learned that WLS helps give you a tool to lose the weight you have to do the head work on why you eat what you eat. And the head work is much harder than losing weight ever was.
    And the band is an amazing tool to help you maintain the weight loss because it is adjustable. Over 90% of the people who diet will regain their weight, over time. I had dieted and regained over time many times. The band helps me not regain, I eat reasonably, I think about what I eat and I move my body too.
    Unless you have been there you don't know where there is or anything about it. It is easy to say WLS is the easy way out, it only helps you, it doesn't do the work for you. It does help you, it allows you to progress and reach goals with a lot of work.
    And I have to say Dr Yau in his private practice gives to his patients, his clinic has set up extensive post operative methods to help his patients conquer their demons and those demons are not easy to identify or conquer no matter what you believe.
  23. Perry Brodkin from Toronto, Canada writes: Tracy Gomes from Toronto, there is no "appeal" from decisions that are made by the Cabinet and this was a decision that was made by the Cabinet. You may wish to consider contacting the Premier, the Minister of Health and Long-Term Care, your MPP, the opposition health critics, the media, etc. with regard to the decision that was made by the Cabinet. That would be your only recourse. The Health Services Appeal and Review Board must comply with the law and the law is now clear. It wasn't clear before.
  24. SusieQ 321 from Canada writes: Sorry, I stand corrected I posted before reading all the comments... this will make for an interesting situation. OHIP has refused up to and including at the hearing level to cover patients for adjustable gastric banding.
    The decision was not made by OHIP.
    Now I was banded at a public hospital I am wondering can I go back and get my money back.
    The second part of the equation is how many surgeons are willing to perform this in a hospital and wait for waiting rooms and will the hospital programs have the same type of aftercare which is vital to the weight loss.
  25. Perry Brodkin from Toronto, Canada writes: SusieQ 321 from Canada, the only people who can "go back and get their money back" are people who served a notice of appeal to the Health Services Appeal and Review Board on the General Manager of the Ontario Health Insurance Plan before November 19, 2007. If you did not serve a notice of appeal before November 19, 2007, you cannot "go back and get your money back".
  26. Emma Hawthorne from Canada writes: OHIP has so little credibility. It denies useful treatments as GSB and even chiropractic services are only partially covered, while it funds expensive orthopaedic surgeries, plus complex and risky gastric bypass surgeries (40 times the risk of death), even sending patients to the states where fees are through the roof. Perhaps the cost of healthcare could best be brought down by revamping OHIP fee schedules to use simple and less complex interventions wherever possible.
  27. Jay Wortman MD from West Vancouver, Canada writes: Emma, I was referring to your suggestion that the ratio of obese people who are compulsive eaters vs those who make poor food choices was 40/60. I suggested that it is more like .01/99.99. I'm not sure why that provoked a personal attack. Perhaps this clarification will help.
  28. smail-djamel lounis from kingston, Canada writes: The decision to de-insure the procedure which was legally insured under OHIP for many decades is absolutely irresponsible and in defiance of the principles of the Canada Health Act.
    It is very sad to see the Ontario Government, especially the current one, to let down people with the described condition. What really is insane is to have The Health Service Appeal Board decision bypassed by bureaucrats with the unwilling complicity of an elected and well regarded politician such as the current Minister of Health and other elected politicians who are members of The government's Regulations Committee.
    This action was not well reflected and will lead to more de-insuring of medically necessary services. Obviously the procedure referred to under OHIP code S120 is not a cosmectic procedure. To take such a drastic action there must have been outside pressure. What will be next de-insured medical services? Ontarians need to know and have input. They are the consumers who pay heavy taxes to sustain the current health care system
  29. Emma Hawthorne from Canada writes: Thanks Wortman, M.D. The clarification is appreciated. However, aong the severely obese, I think the rate of compulsive eaters must be more like 60 or 70%. Why isn't medicine sortingout these people, especially given the high failure rate of diets?
  30. Emma Hawthorne from Canada writes: OHIP officials who obviously relied upon the outdated bariatric surgery paper referred to above, which pushed gastric bypass surgeries, have egg on their faces now. They had exquisitely bad timing to delist GSB just as it is found to be an especially helpful treatment!!

    Next time they torpedo valid relatively inexpensive treatments, let's hope they do a little current research before setting back health care in Ontario by 30 years or more. Is it any wonder that Canada spends the most on health care but ranks well back from the leaders? Is OHIP the reason?
  31. Emma Hawthorne from Canada writes: Will Ontario's health minister require OHIP to reverse its obvious error and cover the inexpensive treatment, in the best interests of both patients and taxpayers, or ignore Ontarians altogether to play politics with OHIP?
  32. Perry Brodkin from Toronto, Canada writes: Emma Hawthorne from Canada, it was Ontario's Health Minister, the Premier, and the rest of the Cabinet who made the decision to overturn the Decision and Order of the Health Services Appeal and Review Board by means of a Regulation filed under the Health Insurance Act on January 24, 2008. The effect of the Regulation is that AGB surgery is not an insured service of the Ontario Health Insurance Plan and has never been an insured service. Apparently, the Minister, the Premier, and the rest of the Cabinet were unhappy with the Decision of the Board which found that AGB surgery was an insured service.
  33. Emma Hawthorne from Canada writes: Hi Perry Brodkin. I agree, but I stronly suspect cabinet relied perfunctorily on the reccommendations of OHIP. But OHIP had negligently relied upon the outdated gastrict bypass study it has had posted on its web site for about three years. In Ontario especially, government is enamoured with expert reccommendations while simultaneously blind to the fact that tjhese same experts operate right in front of their eyes with their own private agendas. The premier and cabinet had the misfortune to negligently rely on outmoded OHIP opnion just as a watershed study reccommending gastric banding was published. Cabinet should reverse itself now or risk an even further loss of credibility. A close study of OHIP policies and how they defeat medicare is also warranted. I suspect government needs to load alternative heath care specialists into OHIP maanagement positions to enable the schedule of fees to be optimally designed to serve health care and the public.
  34. Emma Hawthorne from Canada writes: As in this case, better healthcare policies will often mean savings for OHIP. Gastric banding is a 40-minute out-patient surgery, with a miniscule death rate, whereas gastric bypass is major surgery with a relatively high risk of death and major-life-long ocmplications requiring medical monitoring. I am guessing the gastric banding costs 1/4 to 1/5 of gastric bypass. Time and money savings would permit OHIP to perform up to five times more surgeries without expending any more money. It is safer, faster and significantly cheaper and would rescue many more sufferers.
  35. Perry Brodkin from Toronto, Canada writes: Emma Hawthorne from Canada, I would suggest that you contact the Premier, the Minister of Health and Long-Term Care, your MPP, and the opposition health critics. While OHIP civil servants recommended to the Cabinet that the Decision and Order of the Health Services Appeal and Review Board be overturned, it was the Cabinet that made the ultimate decision to overturn the Decision and Reasons of the Board. And I very much doubt that the opposition health critics are aware of the Cabinet decision.
  36. Emma Hawthorne from Canada writes: Why me?
  37. Emma Hawthorne from Canada writes: In Ontario, the 40-minute adjustable gastric banding surgery would cost approximately $750 for the surgeon, about the same for the anaesthetist and drugs, and the cost of 45 minutes of operating room time. I'm guessing $3,000 to $4,000, or about the same as 12 years of medical appointments to monitor the diabetes, not counting the cost of any medications during this period. As long as the procedure is not covered by OHIP, Torontonians are being asked to pay $17,000 by private clinics.
  38. Perry Brodkin from Toronto, Canada writes: E.C. paid Dr. Laz Klein $15,000 for the surgery. And the surgery was performed at Humber River Regional Hospital which is a public hospital.
  39. Emma Hawthorne from Canada writes: The key question is whether OHIP rationally makes adviseable and economically feasible treatments accessible to the public by covering surgeons' fees. All physicians, except a few staff and resident physicians, are small private business owners who bill OHIP, a publicly funded insurance plan, for covered services, and bill patients directly for non-insured services. Some non-insured services are performed in private clinics. Many are not. The concern is the growing list of inexpensive treatments that logically should be covered becauce they obviate the need for more expensive surgeries that are covered. As long as $10,000 hip surgeries are covered but $60 chiropractors are not, many seniors who cannot afford to spend $60 to see a chiropractor will go directly to surgery when they might have avoided surgery by seeing a chiropractor. Gastric band surgery also falls in this category as the province will spend $20,000 to $80,000 to send a patient for risky gastric bypass surgery here or in the US even with its lifelong side effects (hair loss, gastric upset, etc.) while delisting $4,000 safer local treatment such as gastric banding. Clearly OHIP needs a major overhaul by multifaceted modern professionals who are capable of stepping beyond personal surgical/medical contacts, and who are willing and able to review modern research. Ontario politicians need to wake up from the dream of the holy grail of surgery and medicine. They need to hire private consultants, medical and non-medical and rake OHIP over the coals. Modern health insurance has to be health care insurance, not limited medical insurance. Typically Ontario sets up committees, appoints a majority of doctors and they seize and write the agenda, minutes and final report. I found this out myself when asked to sit on a downsizing committee many years ago. Unbeknownst to the medical bullies, I filed my own reports to a grateful "home office" that was desperate for non-medical input. All below the media radar.
  40. Emma Hawthorne from Canada writes: Ontarians who want treatments covered need to write to their politicians and alto to opposition MPPs who are health critics for their parties as they will take government to task. Cost-benefit analysis can justify additions.
  41. Emma Hawthorne from Canada writes: Its worth noting that social workers, psychologists and other health carel professionals are routinely bullied into silence on hospital advisory committees on fear of losing their jobs and careers, and patient spokespersons are ignored, even though the healthcare system was built for them and not for the medical profession. The medical fear of more effective psychologists was best exemplified by psychiatrists' routing of psychologists from hopsitals, patient care and preferences be damned. The province should load more non-medical professionals and alternative healthcare professionals onto committees along with more vocal patient spokespersons. I would satrongly suggest independent lawyers who do not represent the medical industry in any way. Various sectors could file their own reports if medical bullies attempt to take over, or ask them to leave.
  42. smail-djamel lounis from KINGSTON, Canada writes: The amended Regulation to exclude adjustable gastric banding by laparoscopic or open surgical method from OHIP payment under fee schedule code S120 set a risky precedent. There will be nothing to prevent OHIP to use the same approach to "decompose" any other medical fee schedule codes to allow physicians to, willingly or unwillingly, bill patients over and above OHIP rates for elements they willpick and choose as not a part of an insured service.
    Codes in the OHIP Schedules of Benefits are identified for specific type of assessments and procedures but never for components they do not include.
    OHIP's action sets a dangerous precedent which opens the door to eventual abuse by OHIP covered providers who will come up with thousands of reasons for excluding various elements of their services so they can "extra-bill' patients. I do not think that this is what the government wants.
  43. Emma Hawthorne from Canada writes: Of course the ideal solution to obesity is effective counselling and instruction to overcome the tendency to overeat or eat compulsively and to instead become active, which would cost as little as $200 to $800 for social workers, kinesiologists, etc. This would be a lot cheaper than even adjustable gastric banding if highly successful programs could be developed by by skilled experts, and they would lead to better quality of life. Given OHIP's emphasis on extremely expensive gastric bypass surgeries over even cheaper surgeries, let alone solutions that attack the behaviour at the root of the problem, one can't help but wonder how much medicare costs would fall if OHIP was rationalized with proper cost-benefit analysis using modern healthcare researchers with no vested medical interests. It could be substantial. Could surgeries be cut in half, for example?
  44. Jay Wortman MD from West Vancouver, Canada writes: Emma, you seem like an intelligent person with an analytical mind. I urge you to read "Good calories, Bad calories" by Gary Taubes. It does a good job of explaining why obesity is not a behavioral problem but is rather a metabolic problem. The behavioral hypothesis has been the accepted approach for the past 30 years during which time the epidemic has accelerated dramatically. Prior to that obesity was regarded as a disturbance of fat metabolism. It is time to return to the earlier hypothesis if we are going to make any headway. Clinging to the failed behavioral hypothesis is both bad science and bad public policy and is getting us nowhere fast.
  45. Emma Hawthorne from Canada writes: I hope someone writes a book that ends obesity but I am not holding my breath. Of course high protein and Atkins-style low-carb diets take weight off. Nearly all overweight persons know this. For some reason, apparently unknown to medicine, this information has not stemmed the tide of obesity in the population, which appears to be getting heavier, suggesting to me that there are other emotional/behavioural components.
  46. smail-djamel lounis from kingston, Canada writes: Having already expressed an opinion regarding the ramification of the new regulation excluding adjustable gastric banding by laparoscopic or open surgical method from OHIP coverage under physicians services fee schedule code S120, I would simply remind and urge the current Ontario Minister of Health to agree that the new regulation is also barrier for Ontario obese people for accessing medically/required health services as prescribe under the Canada Health Act.
    As recently published in this newspaper the minister "blasted" and rightly so, Health Canada for regulations making it difficult for homosexuals to become organ donors. Would he agree that this new regulation is also " ghettoizing" obese persons.
    For the readers information, I am not obese, not a lawyer but simply a retired Ontario public servant involved in related activities to this issue.
  47. Sue Lieggi from Lindsay, Ontario, writes: Having had the surgery, lost weight, off all my diabetic medication I can tell you most emphatically that it worked....at least it did for me. I continue to believe that it is preposterous that the government does not fully cover this surgery, I have had contact with the Minister of Health, several MP's and MPP's. The government is very narrow sighted. They complain about how obesity taxes the health care system but does little to support effective change. I had Dr Klein from Humber River Regional Hospital do my surgery, I am pleased, his follow up has been good. It is interesting to me that if I resided in another province I would likely receive coverage for this surgery. But as usual our government is narrow sighted and narrow minded.

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