In a province with one of the highest obesity rates in the country, a group of New Brunswick researchers are looking to find out the impact it has on patients that have gone through cardiac surgery.
On the surface, it’s a question that has an easy answer, but they’re finding out that the issue isn’t as black and white as it seems.
“There have been numerous studies that have been published in the past that have looked at obesity on outcomes following heart surgery. The results from these studies have been mixed,” says Dr. Ansar Hassan, a cardiac surgeon at the Saint John Regional Hospital and one of the eight researchers leading the project.
“Some of the studies have shown that obesity across the board affects people in a negative way such that they have worse outcomes after surgery. While other studies have actually shown that obesity may not necessarily be much of a negative predictor and that in some people, it may actually be protective, meaning that they have better outcomes. They refer to that as an ‘obesity paradox.’ ”
With such a mixed bag of results, the team decided to take the research a step further.
“We wanted to do a more in-depth analysis on obese patients and try to figure out which obese patients did well and which ones didn’t,” says Hassan. “I think all the studies by and large in literature have focused so much on Body Mass Index (BMI) as a singular measure of obesity … but there are other ways to look at obesity and we wanted to try to figure that out by looking at other measures like hip-to-weight ratio, or weight-to-height ratio, and body adiposity index.”
Dr. Assan’s team also wanted to understand how each patient physically functions. Just like there are thin people who are not in shape, there are people who are overweight who are.
“I think we all know that there are some obese people, much like there are many older people, who are extremely fit and actually get around,” says Hassan. “So despite their age or despite their obesity, they’re still very functional and active and they don’t behave like someone who’s obesity actually negatively impacts them. We wanted to look at other measures of functionality.”
This research project has been going on since 2014 and patients are still being enrolled to take part. But the team does have some preliminary findings that can be shared.
“What we found is it’s still quite challenging to differentiate fit from non-fit obese patients even with all the data we collected. Interestingly, the more obese you are, the worse all your markers all, whether it be at the biological level or at the clinical level,” says Hassan. “I think we are still trying to adopt a strategy where we can better differentiate these two, but we haven’t really gotten there yet. We’re going to continue to collect data until we get there.”
Hassan says it’s important to study the impact obesity has post-cardiac surgery because there is no standard practice for doctors to go by. For example, some doctors choose to operate on patients right away so they can get better, which will allow them to address their obesity. Meanwhile, some physicians advise obese patients to lose weight before surgery to avoid the possibility of complications due to the condition.
“There’s no shortage of people in New Brunswick who are obese, so I thought we need to look at this more objectively as opposed to adopting a feel-based approach to obesity where some people are more proactive with treating these people and other are less proactive,” he says. “I want to come out with something that allowed me to say, ‘hey, not all obese patients do poorly. Some actually do just fine, let’s try to identify these so we can offer them a surgery instead of withholding it from them.’ “
Ultimately, they hope their research will help create a more objective set of rules that will look at obese patients on a case-by-case basis and give patients a realistic look at what their risks are, as well as give them appropriate treatment/rehab options.
“From a surgical perspective, I want to be able to identify who is at a higher risk and who is not,” says Hassan.
Hassan and his team, which includes, Dr. Christie Aguiar, Jeff McLeod, Dr.Keith Brunt, Dr.Jean-francois Legaré, Dr. Petra Kienesberger, Dr.Thomas Pulinilkunnil, Sarah Melville and Alexandra Yip are being recognized by the New Brunswick Health Research Foundation (NBHRF) as its Rising Stars for the month of June. Hassan says the foundation, which also helped fund the project, is important because it’s a one-stop resource for all health-related research in the province.
“The beauty of the New Brunswick Health Research Foundation is that it is an umbrella organization overlooking all health research in the province,” he says. “It doesn’t dictate what kind of research you do … it facilitates your research so that if you were to go to them and say, ‘I’m interested in doing this project,’ they will help you.
They may not necessarily be able to fund you through their own budget, but they will help you look for opportunities that will allow you to be funded.”
It’s organizations like the NBHRF that make New Brunswick an excellent place to do research.
“I think at the end of the day, New Brunswick really affords a lot of great opportunities for researchers. I think a lot of people have it in their minds that if you’re going to be a big researcher you should be in Montreal, Toronto, or Vancouver,” says Hassan. “But I would argue for the size of the province that we live in, we’ve been incredibly productive and we will continue to be productive.”
This story is sponsored by the New Brunswick Health Research Foundation (NBHRF).