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Governmental or Social Support of Bariatric Surgery in the Asia-Pacific Region
임지선,조영혜,Hiroshi Yamamoto,Alvin Eng,Tania Markovic,김경곤 대한비만학회 2017 The Korean journal of obesity Vol.26 No.1
Herein we review the management status of governmental financial support of bariatric surgeries in several Asia-Pacific areas of Japan, Singapore, and Australia, which were discussed in the 2016 International Congress on Obesity and Metabolic Syndrome (ICOMES). Patient’s body mass index criteria of bariatric surgery for public support are different one another in the three countries. Whereas laparoscopic sleeve gastrectomy (LSG), Roux-en Y gastric bypass (RYGB), and laparoscopic adjustable gastric banding (LAGB) are applicable in both Singapore and Australia, the coverage of insurance is limited to LSG in Japan. In addition, the surgical fees and equipment costs are not fully covered by public health insurance for performing sleeve gastrectomy in Japan, but patients with morbid obesity can still use public health insurance. In Singapore, the waiting time for surgery in public hospitals is longer on average than for private hospitals. However, patients can obtain subsidies of up to 80% of the costs of surgery in public hospitals, while particularly needy patients may even be able to obtain completely free bariatric surgery through Medifund. In Australia, bariatric surgeries in public sectors are publicly funded, but most bariatric surgeries occur in the private sector and Medicare only reimburses surgical costs in the private sector. Although certain characteristics need to be improved, the access to bariatric surgery has shown steady progress through public support in each of these countries.
Hong Chang Tan,Matthew Zhen-Wei Tan,Kwang Wei Tham,Shanker Pasupathy,Alvin Kim Hock Eng,Sonali Ganguly,Oi Fah Lai,Alvin Choong Meng Ng 대한골다공증학회 2015 Osteoporosis and Sarcopenia Vol.1 No.2
Objectives: Bone loss after bariatric surgery is well recognized but the best method for quantifying bone mineral density (BMD) remains controversial. BMD measured with dual energy X-ray absorptiometry (DXA) is prone to measurement errors in this population while quantitative computed tomography (QCT) is less affected. We report the skeletal changes after bariatric surgery at 1-year in a multi-ethnic Asian cohort using both central DXA and QCT. Methods: Areal BMD (aBMD) and volumetric BMD (vBMD) of twenty-two participants (mean age 40.6; female 59%) undergoing sleeve gastrectomy (n ¼ 12) or gastric bypass (n ¼ 10) were measured with central DXA and QCT respectively before and 12-months after surgery. Results: Weight and BMI decreased significantly but discordant QCT and DXA results were noted. aBMD was significantly reduced at the total hip (TH) and femoral neck (FN) by 6.9 and 8.5% respectively but was not significantly different at the lumbar spine (LS). By contrast, there were no significant changes in vBMD at TH and FN. Instead, a significant 11.2% decrease in vBMD was noted at the LS. These findings were largely similar between the two surgical subgroups. Interestingly, cortical vBMD increased at both TH and FN while trabecular vBMD decreased at the TH. These changes were observed despite no significant post-operative changes in serum calcium, iPTH or 25-OH vitamin D levels. Conclusion: Technical or physiological factors may be involved in the discordance between QCT and DXA results during short-term follow-up and the most suitable method of bone density measurement for post-bariatric surgery patients remains uncertain. © 2015 The Korean Society of Osteoporosis. Production and hosting by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).