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Whyte M, Fowler-Woods M, Fowler-Woods A, Shingoose G, Hatala A, Daeninck F, Vergis A, Clouston K, He W, Hardy K. Sacred Sharing Circles: Urban Indigenous Experience with Bariatric Surgery in Manitoba. Obes Surg 2024:10.1007/s11695-024-07405-z. [PMID: 39096443 DOI: 10.1007/s11695-024-07405-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 06/26/2024] [Accepted: 07/15/2024] [Indexed: 08/05/2024]
Abstract
INTRODUCTION Obesity and type 2 diabetes (T2DM) are growing global health concerns. A disproportionate number of Indigenous Peoples live with obesity and its complications. Bariatric surgery offers superior weight loss and comorbidity resolution when compared to medical management. There is a paucity of literature regarding the experiences of Indigenous Peoples undergoing bariatric surgery. The aim of this study was to employ two-eyed seeing and a decolonizing approach to explore the experiences of urban Indigenous bariatric surgery patients. METHODS An Indigenous Advisory Committee guided the conception and design of the study. Four urban Indigenous bariatric surgery patients with T2DM participated in two sequential sharing circles and individual interviews facilitated by an Elder. Audio transcripts were analyzed for emerging themes using inductive thematic analysis. RESULTS Themes generated from shared participant experiences and knowledge included the following: (1) Experiencing hardship or challenges; (2) Reflecting on the importance of supports; (3) Understanding relationships with food; and (4) Healing and recovery. Overall, the participants described a generally positive experience with the bariatric pathway. Participants also described varied connectedness to their Indigenous identity but uniformly expressed interest in more culturally diverse supports such as sharing circles, access to an elder, and Indigenous peer mentorship. CONCLUSIONS Indigenous Peoples have strong motivators for pursuing bariatric surgery and desire access to culturally relevant supports. Suggestions for program improvement included offering sharing circles, providing access to an elder, and Indigenous peer mentorship. This study is the first to qualitatively explore the bariatric surgery experiences of Indigenous Peoples in Canada.
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Affiliation(s)
- Marta Whyte
- Section of General Surgery, Department of Surgery, Max Rady College of Medicine, University of Manitoba, 409, Taché Avenue, Winnipeg, MB, R2H 2A6, Canada
| | - Melinda Fowler-Woods
- Section of General Surgery, Department of Surgery, Max Rady College of Medicine, University of Manitoba, 409, Taché Avenue, Winnipeg, MB, R2H 2A6, Canada
| | - Amanda Fowler-Woods
- Section of General Surgery, Department of Surgery, Max Rady College of Medicine, University of Manitoba, 409, Taché Avenue, Winnipeg, MB, R2H 2A6, Canada
| | - Geraldine Shingoose
- Faculty of Community Health Sciences, University of Manitoba, 750 Bannatyne Avenue, Winnipeg, MB, R3E 0W3, Canada
| | - Andrew Hatala
- Section of General Surgery, Department of Surgery, Max Rady College of Medicine, University of Manitoba, 409, Taché Avenue, Winnipeg, MB, R2H 2A6, Canada
| | - Felicia Daeninck
- Section of General Surgery, Department of Surgery, Max Rady College of Medicine, University of Manitoba, 409, Taché Avenue, Winnipeg, MB, R2H 2A6, Canada
| | - Ashley Vergis
- Section of General Surgery, Department of Surgery, Max Rady College of Medicine, University of Manitoba, 409, Taché Avenue, Winnipeg, MB, R2H 2A6, Canada
| | - Kathleen Clouston
- Section of General Surgery, Department of Surgery, Max Rady College of Medicine, University of Manitoba, 409, Taché Avenue, Winnipeg, MB, R2H 2A6, Canada
| | - Wenjing He
- Section of General Surgery, Department of Surgery, Max Rady College of Medicine, University of Manitoba, 409, Taché Avenue, Winnipeg, MB, R2H 2A6, Canada
| | - Krista Hardy
- Section of General Surgery, Department of Surgery, Max Rady College of Medicine, University of Manitoba, 409, Taché Avenue, Winnipeg, MB, R2H 2A6, Canada.
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Murphy R, Plank LD, Clarke MG, Evennett NJ, Tan J, Kim DDW, Cutfield R, Booth MWC. Effect of Banded Roux-en-Y Gastric Bypass Versus Sleeve Gastrectomy on Diabetes Remission at 5 Years Among Patients With Obesity and Type 2 Diabetes: A Blinded Randomized Clinical Trial. Diabetes Care 2022; 45:1503-1511. [PMID: 35554515 PMCID: PMC9274222 DOI: 10.2337/dc21-2498] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 03/25/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To determine whether silastic ring laparoscopic Roux-en-Y gastric bypass (SR-LRYGB) or laparoscopic sleeve gastrectomy (LSG) produces superior diabetes remission at 5 years. RESEARCH DESIGN AND METHODS In a single-center, double-blind trial, 114 adults with type 2 diabetes and BMI 35-65 kg/m2 were randomly assigned to SR-LRYGB or LSG (1:1; stratified by age-group, BMI group, ethnicity, diabetes duration, and insulin therapy) using a web-based service. Diabetes and other metabolic medications were adjusted according to a prespecified protocol. The primary outcome was diabetes remission assessed at 5 years, defined by HbA1c <6% (42 mmol/mol) without glucose-lowering medications. Secondary outcomes included changes in weight, cardiometabolic risk factors, quality of life, and adverse events. RESULTS Diabetes remission after SR-LRYGB versus LSG occurred in 25 (47%) of 53 vs. 18 (33%) of 55 patients (adjusted odds ratios 4.5 [95% CI 1.6, 15.5; P = 0.009] and 4.2 [1.3, 13.4; P = 0.015] in the intention-to-treat analysis). Percent body weight loss was greater after SR-LRYGB than after LSG (absolute difference 10.7%; 95% CI 7.3, 14.0; P < 0.001). Improvements in cardiometabolic risk factors were similar, but HDL cholesterol increased more after SR-LRYGB. Early and late complications were similar in both groups. General health and physical functioning improved after both types of surgery, with greater improvement in physical functioning after SR-LRYGB. People of Māori or Pacific ethnicity (26%) had lower incidence of diabetes remission than those of New Zealand European or other ethnicities (2 of 25 vs. 41 of 83; P < 0.001). CONCLUSIONS SR-LRYGB provided superior diabetes remission and weight loss compared with LSG at 5 years, with similar low risks of complications.
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Affiliation(s)
- Rinki Murphy
- Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Lindsay D Plank
- Department of Surgery, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Michael G Clarke
- Department of Surgery, North Shore Hospital, Waitemata District Health Board, Auckland, New Zealand
| | - Nicholas J Evennett
- Department of Surgery, North Shore Hospital, Waitemata District Health Board, Auckland, New Zealand
| | - James Tan
- Department of Surgery, North Shore Hospital, Waitemata District Health Board, Auckland, New Zealand
| | - David D W Kim
- Department of Endocrinology, North Shore Hospital, Waitemata District Health Board, Auckland, New Zealand
| | - Richard Cutfield
- Department of Endocrinology, North Shore Hospital, Waitemata District Health Board, Auckland, New Zealand
| | - Michael W C Booth
- Department of Surgery, North Shore Hospital, Waitemata District Health Board, Auckland, New Zealand
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Variation in publicly funded bariatric surgery in New Zealand by ethnicity: cohort study of 328,739 patients. Surg Obes Relat Dis 2021; 17:1286-1293. [PMID: 33941480 DOI: 10.1016/j.soard.2021.03.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 02/27/2021] [Accepted: 03/27/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND New Zealand health services are responsible for equitable health service delivery, particularly for Māori, the Indigenous peoples of New Zealand. Recent research has indicated the presence of inequities in publicly funded bariatric surgery in New Zealand by ethnicity, but it is unclear whether these inequities persist after adjustment for co-morbidities. OBJECTIVES To determine whether receipt of publicly funded bariatric surgery varies by ethnicity, after adjustment for co-morbidities. SETTING New Zealand primary care. METHODS A cohort study of New Zealanders aged 30-79 years who had cardiovascular risk assessment in primary care between January 1, 2010 and June 30, 2018. Data were collated and analyzed using an encrypted unique identifier with regional and national datasets. Cox proportional hazard modeling was performed to determine the likelihood of receipt of a primary publicly funded bariatric procedure up to December 31, 2018, after adjustment for sex, age, ethnicity, locality, socioeconomic deprivation, body mass index, diabetes status, smoking status, and co-morbidities. RESULTS A total of 328,739 participants (44% female, median age 54 yr [interquartile range, IQR, 46-62], 54% European, 13% Māori, 13% Pacific, 20% Asian) were included in the study and followed up for a median of 5.6 years (IQR 4.1-6.9). The likelihood of receipt of bariatric surgery was lower for Māori and Pacific compared with Europeans (adjusted hazard ratio .82 [95% CI .69-.96] and .24 [.20-.29], respectively). The likelihood of receiving bariatric surgery was also inversely related with increasing socioeconomic deprivation and rurality. CONCLUSIONS Consistent with data worldwide, there is evidence of unequal access to publicly funded bariatric surgery by ethnicity, locality as well as socioeconomic deprivation among New Zealanders who were cardiovascular risk assessed in primary care.
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Rahiri JL, Tuhoe J, MacCormick AD, Hill AG, Harwood M. Exploring motivation for bariatric surgery among Indigenous Māori women. Obes Res Clin Pract 2019; 13:486-491. [PMID: 31591083 DOI: 10.1016/j.orcp.2019.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 09/21/2019] [Accepted: 09/23/2019] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Bariatric surgery is the most effective intervention for alleviating obesity and its complications. Indigenous people worldwide experience higher rates of obesity and obesity disease burden. However, few studies exploring bariatric surgery among Indigenous peoples are published. In this study we aimed to explore the motivation of Māori women in coming forward for bariatric surgery. METHODS Māori women who had bariatric surgery prior to December 31, 2014, were invited to participate in semi-structured interpersonal interviews. Kaupapa Māori research, an Indigenous Māori research methodology, informed this study. Interviews were recorded, transcribed and subject to inductive thematic analysis. RESULTS Twenty-nine Māori women participated in semi-structured interpersonal interviews. The majority of women reported that the presence of obesity-related disease alongside the desire for a better quality of life served as the greatest sources of motivation for having bariatric surgery. Whānau (family) were key for participants achieving the preoperative milestones needed to be accepted for bariatric surgery. Interpersonal experiences of fat-shaming and yo-yo dieting also impacted their choice to have surgery. CONCLUSION This study is one of the first to describe the motivations of Indigenous Māori women to have bariatric surgery. Our study conveys the importance of health, a desire to have a better quality of life and whānau in motivating Māori women to come forward for bariatric surgery.
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Affiliation(s)
- Jamie-Lee Rahiri
- Department of Surgery, South Auckland Clinical Campus, University of Auckland, Middlemore Hospital, 100 Hospital Road, Otahuhu, Auckland 2025, New Zealand.
| | - Jason Tuhoe
- Department of General Practice and Primary Care, University of Auckland, Tāmaki Campus, Morrin Road, Glen Innes, Auckland, New Zealand
| | - Andrew D MacCormick
- Department of Surgery, South Auckland Clinical Campus, University of Auckland, Middlemore Hospital, 100 Hospital Road, Otahuhu, Auckland 2025, New Zealand
| | - Andrew G Hill
- Department of Surgery, South Auckland Clinical Campus, University of Auckland, Middlemore Hospital, 100 Hospital Road, Otahuhu, Auckland 2025, New Zealand
| | - Matire Harwood
- Department of General Practice and Primary Care, University of Auckland, Tāmaki Campus, Morrin Road, Glen Innes, Auckland, New Zealand
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