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Wednesday, March 26, 2008

How Far Will You Travel for Obesity Treatment?

One consequence of the rapid increase in obesity is that the vast majority of Canadians cannot rely on local facilities or expertise for obesity treatments. As a result, patients often have to travel long distances or even across borders to seek obesity treatments.

For example, our program has over 300 patients from other provinces awaiting assessment and hoping for treatment.

This throws up a number of logistical but also practical issues: how do you provide cross-border management for a chronic disease?

It is one thing to fly across the country to consult an expert for a diagnosis of a rare condition or a one-time specialized procedure. But what do you do for a common condition that requires on-going lifelong management? How do you provide education, counseling, monitoring and support across 1000s of kilometers?

Sure there are telephones, internet and telehealth but this does not entirely replace the need to actually see and examine a patient face-to-face.

Remember, obesity is a complex and heterogeneous condition - patients may require 10s of visits with a whole array of health professionals to determine the best treatment plan. Successful obesity management requires continued intervention and monitoring to keep the patient in remission. Early signs of relapse need to be recognized and dealt with to prevent weight regain. Surgical patients need band readjustments, dietary counseling and psychological support.

Much of this is theoretically possible across distances with modern communication technologies but in reality often impractical and inefficient.

On the other hand, how do you refuse to see patients who are clearly in dire straits for whom no local help is available or forthcoming any time soon?

Frankly, I see no alternative to rapidly ramping up obesity care across Canada - this will take both time and resources but most of all a change in attitude: ignoring obesity is no longer an option - limiting efforts to prevention is not helping the millions already struggling with this condition.

AMS

1 comment:

Suzan I Nashashibi Bsc RNUtr said...

Im a health professional working in my own Obesity management clinic in Amman the capital of Jordan -We offer diet and behavioural therapy on long term basis
I totally agree w what was mentioned in article -u can follow up people on email-tel, fax, but only after u have seen them for a while in clinic- u cant treat on line eye contact is essential and so is interaction for several sessions otherwise treatment will not succeed-
I work in the capital and some people are more than willing to travel from the southern city of Aqaba which is 4-5 hrs drive by car twice a week just for treatment
but of course only if they can afford to and if they have time -
Obesity management is a lifelong proceedure that one should get relaxed with and relapses are a major headline and reality that should be addressed through therapy- follow up is another vital part as some people need to be pushed back into therapy again and again
I have been working w obese patients long enough to know how patient and willing the therapist should be to be able to help a broadspectrum diversity of suffering people
Treaments should be individually based - Behavioural and pysiological conditions to be equally considered- if so we will raise success rate drastically
Last point we are of course a small contry compared to Canada so travel distance i mentioned might be insignificant