Annual Report 2023-24

By Marlene Leung

Photos by Eduardo Lima

Jose Gonzalez Quinonez has no regrets about his decision to have bariatric surgery at St. Joseph’s Health Centre to help him lose weight. At his heaviest last December, Gonzalez weighed around 430 lbs. At that weight, his mobility was severely limited – two prior foot surgeries compounded the problem – and he struggled with diabetes, hypertension and swelling throughout his lower body.

Desperate for relief, he fell into a dark place during the holiday season as he waited for surgery.

“I told my wife, if something didn’t change soon, I didn’t think I would make it through the next six months,” Gonzalez said.

Fast forward to March 5, the day St. Joseph’s Health Centre Surgeon Dr. David Lindsay performed bariatric surgery on Gonzalez. After the procedure, Gonzalez noticed an immediate improvement.

“I was walking the day after surgery. The swelling in my lower body started to disappear,” he said. “March 5 was like a rebirth for me. From that day on, I saw an immediate change. It’s life-changing.”

Filling a gap in access to care

Gonzalez is one of the hundreds of patients who are cared for at Unity Health Toronto’s Bariatric Centre of Excellence (BCOE) each year. Bariatric surgery, combined with a healthy diet and exercise, is an effective treatment for treating obesity and obesity-related diseases and chronic conditions, like diabetes and hypertension. Data show that up to 70 per cent of bariatric surgery patients resolve their Type 2 diabetes post-surgery. Bariatric surgery is also associated with several other health benefits, including increased mobility, improved fertility and pregnancy outcomes, and decreased risk of heart disease, stroke and some types of cancer.

Learn more about the Bariatric Centre of Excellence

Part of the Ontario Bariatric Network, the Unity Health BCOE is one of 12 designated bariatric centres in the province that offers pre-operative, peri-operative and post-operative care. It is coordinated across two of Unity’s hospitals, St. Joseph’s Health Centre and Providence Healthcare, and represents integration of care across the Unity Health Toronto network.

At the BCOE, referred patients start their journey at Providence, where an interdisciplinary team including physicians, nurses, pharmacists, social workers, psychiatrists and dietitians, helps patients mentally and physically prepare for surgery. Following surgery at St. Joseph’s, patients return to Providence for follow-up care for up to a year.

The province started the Ontario Bariatric Network in 2009, recognizing that obesity was a serious public health issue that needed to be aggressively treated, says Dr. Ori Rotstein, Unity Health Toronto vice-president of research and innovation, medical director of the Bariatric Program, and one of four BCOE surgeons at St. Joseph’s.

“As a top-tier academic teaching institution, Unity Health should be providing state of the art care,” Rotstein said. “We understood that obesity is increasing and in Toronto there was a bit of a gap in delivery of care. We wanted to provide care to the patients we serve in downtown Toronto, which includes marginalized and disadvantaged communities.”

Another important benefit of having a BCOE, is that it allows Unity Health Toronto to provide advanced surgical training and educational opportunities to learners, says Dr. Mary-Anne Aarts, surgeon-in-chief at St. Joseph’s Health Centre and another BCOE surgeon.

“Importantly, this program builds the skills of our surgeons here at St. Joseph’s by allowing them to perform hundreds of bariatric surgeries a year. Patients in our catchment also get access to this surgery and care closer to home, which is always a good thing,” she said.

Dr. Mary-Anne Aarts, surgeon-in-chief at St. Joseph’s Health Centre and Bariatric Centre of Excellence surgeon.

Both Aarts and Rotstein say that for many obese patients, bariatric surgery is the best treatment option, despite the growing popularity of GLP-1 inhibitor medications that help patients lose weight.

The majority of bariatric surgery patients can keep the weight off after surgery, but for patients on GLP-1 inhibitors, they gain the weight back soon after they stop taking the drugs, says Aarts. There’s also the cost of the medications, which can run thousands of dollars a year. In the long run, surgery is cheaper and has better outcomes, she said.

“It’s preventive medicine. These patients live longer and healthier lives, they can move more and exercise more,” Aarts said. “There’s a real joy in providing this type of care.”

Dr. Lindsay, the physician who performed the bariatric surgery on Gonzalez, agrees.

“As a surgeon, it is extremely rewarding to see our patients’ overall health improve following bariatric surgery. In many cases, patients have been struggling for years with medical problems that can be difficult to manage,” Lindsay said. “After surgery, many patients see rapid improvement in these problems and overall improvement in quality of life.”

Learn more about the Bariatric Centre of Excellence

Positive changes

Gonzalez continues to receive support at Providence, with a care team that monitors how he’s recovering and ensures that he’s continuing to lose weight in a safe and manageable way.

He credits the entire BCOE team with successfully helping him through the program.

“Everyone was fantastic,” he said. “You are set up for success when you have a great team behind you and working with you.”

L-R: Clinical Nurse Specialist Danielle Zvezdonkin, Jose Gonzalez Quinonez, Dietitian Cassandra Chan, and Registered Nurse Kyrene Fabroa.

Clinical Nurse Specialist Danielle Zvezdonkin coordinated care for Gonzalez as he prepared for surgery, and continues to work with him as he moves through his recovery.

“It is amazing to see Jose’s progress. Even before he had surgery he made so many positive changes in his life,” she said. “He recently told me he no longer needs to take some medication he previously required to manage his other health conditions.  These are the changes that I love hearing about, they are life-changing.”

Laurie Thomas, senior clinical program director of the St. Joseph’s Surgery Program, says it’s not surprising that Gonzalez has seen positive results.

“Our patients do exceptionally well, and it’s because we prepare them. Comprehensive pre-assessment planning supports our patients in achieving success and optimizes post-op outcomes,” she said.

L-R: Laurie Thomas, senior clinical program director of the St. Joseph’s Surgery Program, and Radha Pooran, patient care manager Ambulatory Care Centre Clinics, Bariatric Centre of Excellence.

Gonzalez continues to make healthy lifestyle adjustments, including adapting a protein and veggie-rich diet and increasing his physical activity. Since his surgery, his overall health and mobility continue to improve as the weight keeps coming off.

He has two goals for the rest of 2024: to get back to his old weight of 250 lbs and return to his job as a warehouse manager – a position he had to leave four years ago due to health issues.

In the meantime, he spends his days with family and friends, and going for hours-long daily walks with his 11-year-old dog, Mocha – a task he sorely missed when he was heavier.

“It’s the little things, like going out for a walk to enjoy a cold day, a windy day, a sunny day, a hot day,” he said. “You don’t realize how important those things are physically and mentally until they get taken away from you.”

Learn more about the Bariatric Centre of Excellence

*Note: Mocha, Jose’s beloved 11-year-old dog, sadly passed away between the time of Jose’s interview and the publication of this story. Mocha was a large part of Jose’s journey and is loved and missed. RIP.*

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