Hossain Intekhab, O'Brien Erin, Dogar Ibrahim, Dubinsky Isser, Pace David, Smith Chris
From the Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ont. (Hossain, Dubinsky); the Department of Surgery, University of Toronto, Toronto, Ont. (Hossain); the Department of Surgery, Memorial University of Newfoundland, St. John's, N.L. (O'Brien, Dogar, Pace, Smith)
From the Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ont. (Hossain, Dubinsky); the Department of Surgery, University of Toronto, Toronto, Ont. (Hossain); the Department of Surgery, Memorial University of Newfoundland, St. John's, N.L. (O'Brien, Dogar, Pace, Smith).
Can J Surg. 2025 May 21;68(3):E169-E174. doi: 10.1503/cjs.000125. Print 2025 May-Jun.
Indigenous Peoples in Canada have higher obesity rates (30%-51%) than non-Indigenous populations (12%-31%), and the Truth and Reconciliation Commission of Canada (TRC) has called for expanded health research to address disparities between Indigenous and non-Indigenous communities. We sought to compare bariatric surgery outcomes and patient experiences in Newfoundland and Labrador's bariatric surgery program among Indigenous versus non-Indigenous patients.
We conducted a mixed-methods retrospective cohort study, including patients who underwent bariatric surgery in the province's bariatric surgery program between 2011 and 2022. We assessed metabolic outcomes through chart review and captured patient experiences with phone survey questionnaires.
Among the 30 included patients (8 Indigenous, 22 non-Indigenous), there were no significant differences in excess weight loss (45% v. 48%, = 0.4), reduction in body mass index (9.5 v. 11.3, = 0.2), comorbidity improvement (63% v. 73%, = 0.6), or postoperative complications (25% v. 18%, = 0.6) at 1 year. However, on a 1-10 Likert scale, Indigenous patients reported lower satisfaction with weight loss (6.3 v. 8.2, = 0.03) and were less likely to recommend the program (5.6 v. 8.8, = 0.04). Both groups cited similar challenges with program referral, transportation, and postoperative supports, and recommended a longer follow-up period and increased mental health counselling services.
As a response to TRC's Calls to Action, our study shows bariatric surgery outcomes in Newfoundland and Labrador were similar for Indigenous and non-Indigenous patients. Given their lower satisfaction with postoperative decrease in weight, Indigenous patients may benefit from being offered metabolic procedures with greater expected weight loss, such as Roux-en-Y gastric bypass and duodenal switch.
加拿大原住民的肥胖率（30%-51%）高于非原住民人口（12%-31%），加拿大真相与和解委员会呼吁开展更多健康研究，以解决原住民和非原住民社区之间的差异。我们试图比较纽芬兰和拉布拉多省减肥手术项目中，原住民与非原住民患者的减肥手术结果及患者体验。
我们进行了一项混合方法的回顾性队列研究，纳入了2011年至2022年间在该省减肥手术项目中接受减肥手术的患者。我们通过病历审查评估代谢结果，并通过电话调查问卷了解患者体验。
在纳入的30名患者中（8名原住民，22名非原住民），1年后在超重减轻方面（45%对48%，P=0.4）、体重指数降低方面（9.5对11.3，P=0.2）、合并症改善方面（63%对73%，P=0.6）或术后并发症方面（25%对18%，P=0.6）均无显著差异。然而，在1至10的李克特量表上，原住民患者对体重减轻的满意度较低（6.3对8.2，P=0.03），且推荐该项目的可能性较小（5.6对8.8，P=0.04）。两组在项目转诊、交通和术后支持方面都提到了类似的挑战，并建议延长随访期和增加心理健康咨询服务。
作为对真相与和解委员会行动呼吁的回应，我们的研究表明，纽芬兰和拉布拉多省原住民和非原住民患者的减肥手术结果相似。鉴于原住民患者对术后体重减轻的满意度较低，为他们提供预期减重效果更好的代谢手术，如 Roux-en-Y 胃旁路术和十二指肠转位术，可能会使他们受益。
