Obesity is one of the main causes of poor health and premature death in New Zealand. Surgery is an effective treatment for those who are severely or morbidly obese and have been unable to lose weight and maintain the weight loss. Fewer Māori and Pacific people than expected undergo bariatric surgery, and this is something Auckland DHB is setting out to address.
Weight loss procedures either restrict the amount of food people are able to eat, absorb or both. Surgery is not for everyone and it involves a degree of risk and also a commitment to a permanent lifestyle change.
Patient experience drives service change
In 2015 Auckland DHB began a programme of work with Waitemata DHB to develop a standardised approach to bariatric surgery and improve access for Māori and Pacific people. An audit identified that attrition rates were significantly higher for Pacific people than other ethnicities, with more than 70% of Pacific patients referred not completing surgery.
They consulted with Māori and Pacific people who have been engaged with bariatric services, to better understand their experiences and identify areas for improvement.
The consultation feedback and audit results helped drive several service improvements. These include:
- The acceptance criteria were amended to no longer exclude smokers and the requirement to lose weight prior to surgery was abolished.
- The assessment process was streamlined with patients seen in a multidisciplinary one-stop-shop and provided with certainty about dates.
- Psychological support was strengthened, in response to patient feedback.
Results of changes
Early indications from the latest data show that the attrition rates for Pacific and for Māori patients have substantially reduced and are now similar to non-Māori non-Pacific rates. This means that more people are being supported to successful completion of surgery.
In 2017/18 68 people received bariatric surgery at Auckland DH, and of these 37 were Māori or Pacific.
Mike’s success story
After research and a referral from his GP to surgeon Mr Nicholas Evennett, 49 year-old Mike* underwent bariatric surgery at Auckland City Hospital in June 2018. After working hard to lose weight pre-surgery, and attending meetings with a specialist nurse, dietitian and psychologist, Mike qualified for the publicly funded surgery.
Mike says he chose the bariatric surgery path after trying several diet plans and exercise regimes and, in his words, failing miserably.
Life changing surgery
“Surgery changed my life. It probably also extended it by up to 20 years. I have significantly reduced my chances of contracting [sic] diabetes, high blood pressure, heart disease and, hopefully, will reduce my need for a CPAP machine when sleeping. I look and feel healthier and I find it much easier to find clothes that fit. I’m also playing sport for longer and with less pain so I’m enjoying it much more.”
Mike says he could not have gone through the whole process without the professional guidance and assistance of the Auckland DHB staff who facilitated his life-change.
“I know I came to the programme with my mind set on achieving results and I was as prepared as I could be, but I couldn’t have done what I’ve done without the care and assistance of the Auckland DHB team, particularly that of bariatric nurse Elaine Yi, who went out of her way to accommodate my work schedule when it came to arranging appointments.”
At his heaviest Mike weighed 136kg. His surgery weight was 116kg and he currently weighs 94kg. His goal weight is 85- 90kg. Mike has ongoing post-operative care including regular meetings with his dietitian, nurse and surgeon. He’s also part of a pilot programme with the ExerScience Clinic which is examining whether it’s feasible to implement a mandatory exercise component to the overall bariatric programme.
Mike’s advice to anyone in a similar situation is simple.
“Seek advice from your GP, ask them to submit a referral to ascertain your eligibility for publicly funded bariatric surgery. Just do it!”
*Name changed for privacy.
This article is an extract from the Auckland DHB Annual Report 2017-18