Obesity represents a significant public health challenge, and access to effective treatments remains unevenly distributed. Recent efforts in the state of Santa Catarina, Brazil, have dramatically increased access to bariatric surgery within the public healthcare system. From to , the number of bariatric procedures performed increased by 550%, with 3,815 surgeries completed since , ensuring coverage across all regions of the state.
The expansion is the result of a concerted effort by the state government to reduce wait times for essential procedures, including bariatric surgery. According to Diogo Demarchi, the State Secretary of Health, initiatives such as the “Catarinense Table of Procedures,” a program to support hospitals, and state-level accreditation have been instrumental in increasing capacity. “Since , following guidance from Governor Jorginho Mello, we have been working to alleviate the suffering of people, combating long waiting lists, including those for bariatric surgery,” Demarchi stated. The inclusion of previously private hospitals into the public network has further accelerated the pace of surgeries.
In alone, 2,228 bariatric surgeries were performed within the state hospital network – a six-fold increase compared to the 343 procedures carried out in . This growth builds on increases seen in prior years, with 410 surgeries in and 834 in . Concurrently, the number of participating hospitals grew from six in to nine in , broadening access for patients throughout the state.
The hospitals currently offering bariatric surgery include Hospital Geral Tereza Ramos (Lages), Hospital Regional Hans Dieter Schmidt (Joinville), Hospital Regional Homero de Miranda Gomes (São José), Hospital Universitário (Florianópolis), Hospital Santo Antônio (Blumenau), Hospital Azambuja (Brusque), Hospital Dom Joaquim (Sombrio), Hospital São Vicente de Paulo (Mafra), and Hospital São Miguel (Joaçaba). Hospitals Dom Joaquim, São Vicente de Paulo, and São Miguel were added to the network during the current administration.
Hospital Dom Joaquim has been a key driver of this expansion. After joining the network in , it performed 281 procedures through December of that year, and an impressive 1,337 surgeries in . Other leading hospitals include Hospital Regional Hans Dieter Schmidt (552 surgeries since ), Hospital São Miguel (546), and Hospital Santo Antônio (490).
The impact of these surgeries extends beyond weight loss, significantly improving patients’ quality of life. Naline Pires da Silva Borges, a records agent, experienced this firsthand. Diagnosed with diabetes and hypertension while weighing 122 kilograms, she has already lost 17 kilograms following bariatric surgery at Hospital Regional Hans Dieter Schmidt and aims to lose an additional 20 kilograms. “Today, the most important thing for me and my family is no longer needing to take medication for diabetes and hypertension,” Borges shared. She also emphasized the comprehensive support she received throughout the process, including guidance from nutritionists, psychologists, and the nursing team.
The public health system in Santa Catarina offers a comprehensive care pathway for individuals with overweight and obesity, encompassing interventions from primary care to specialized services. Individuals concerned about their weight are encouraged to consult with their local Basic Health Unit (UBS) for evaluation and, if appropriate, referral to a specialized hospital.
Rui Celso Vieira, a digestive surgeon at Hospital Regional Hans Dieter Schmidt, explained that bariatric surgery is typically considered after at least two years of conventional clinical weight loss treatment have been unsuccessful. Other criteria for candidacy include body mass index (BMI), the presence of co-existing health conditions, and evaluation by a multidisciplinary team of specialists. “In addition to the benefit of weight loss, surgery serves to reduce metabolic diseases, medication use, hypertension, and joint problems, meaning there is a reduction in all the comorbidities the patient may have,” Dr. Vieira noted.
Obesity is a chronic, non-communicable disease that affects people of all ages and can worsen over time without appropriate and ongoing treatment. It can reduce quality of life and contribute to the development of diabetes, cardiovascular disease, joint problems, depression, and certain types of cancer. Research has consistently demonstrated that increased access to bariatric surgery, particularly following policies like the Affordable Care Act’s Medicaid expansion in the United States, correlates with increased utilization of these procedures, especially among marginalized populations [1, 3]. This suggests that addressing systemic barriers to care is crucial for improving health equity.
The improvements in Santa Catarina align with broader trends highlighting the importance of expanding access to bariatric surgery as a vital tool in combating the obesity epidemic and its associated health consequences. While surgery is considered a last resort, the comprehensive, multidisciplinary approach employed in Santa Catarina emphasizes the importance of pre- and post-operative support to maximize patient outcomes.
