Obesity, a disease in which excess body fat has accumulated to the extent that it is having a negative effect on your health, and which if untreated will lead to significant reduction in life expectancy, has reached epidemic proportions in India.

Morbid obesity is affecting 5% of the population, which is surprising in a country where over 250 million people live below the poverty line. In a study - titled 'Global, regional, and national prevalence of overweight and obesity in children and adults during 1980-2013:

A systematic analysis for the Global Burden of Disease Study 2013' published in the “The Lancet” in August 2014, India is very closely following USA and China in the prevalence of obesity - a trend in most developing countries. Rising income is increasing the average caloric intake per individual among the middle class. Unhealthy processed “junk” food, alcohol and sedentary lifestyles is making one in every five Indian overweight.

Obesity is most commonly caused by a combination of excessive food energy intake, lack of physical activity and genetic susceptibility, although a few cases are caused primarily by genes, endocrine disorders, medications, or psychiatric illness. Obesity is a leading preventable cause of death worldwide, with increasing rates in adults and children. WHO views it as one of the most serious public health problems of the 21st century.

In western countries a Body Mass Index (BMI - which is the ratio of the individual’s weight divided by the body surface area in M2) more than 25 kg/m2 is considered overweight. Due to genetic tendency of Indians towards abdominal obesity and its associated risk of related lifestyle diseases like diabetes, high blood pressure, obstructive sleep apnoea, infertility, arthritis of the hips and knees, depression and social ostracism.

As per the Ministry of Health & Family Welfare along with the Indian Council of Medical Research (ICMR) updated guidelines of 2012 Indians with a BMI over 23 kg/m2 is considered overweight; over 25 is considered obese and more than 32.5 an indication for Bariatric surgery. Based on data from the last (2007) National Family Health Survey conducted, the prevalence of obesity is highest in Punjab. Haryana is in the 6th position.


Bariatric (weight-loss) surgery

alters the digestive system to help people with severe weight-related health problems lose weight dramatically at an average rate of One Kg per week and significantly reduce all the obesity related health issues. It is very different from liposuction, as no fat is removed during the operation. The fat is lost by the patient by adhering to a diet and undertaking regular exercise. However, the alteration made in the digestive tract makes it easier for the individual to follow the dietary advice. Appetite is suppressed and even a small amount of food gives the patient a sensation of satiety and fullness.

Patients usually come for surgery having tried all kinds of weight loss regimens, packages & diets, and having experienced a number of rebound weight gain after some weight loss, also known as the “yo-yo” phenomenon. This is due to the extreme difficulty experienced in sticking to a rigid diet for too long. There are many types bariatric surgery. All of them are performed through a method of minimal access (by laparoscopy) under general anesthesia. The three commonly performed procedures are: Gastric Banding is a procedure in which surgeons place an adjustable silicone band around the upper portion of the patient's stomach to reduce stomach to a small pouch of a capacity of 30 ml. The band requires frequent adjustments, has the complication of slippage or displacement and a high chance of infection or erosion into the stomach. Although, it has the advantage of being reversible but in practice is hardly ever reversed. The procedure has now been largely given up.           

Gastric Bypass

Procedure reduces stomach size and diverts the passage of food through the small intestine to limit digestion, leaving patients feeling full after eating less. However, it is a complex procedure which alters the anatomy of the digestive tract significantly and has a definite risk of developing a leak from the sight of anastomosis.         

Sleeve Gastrectomy

procedure is a surgical weight loss option in which 75 percent of the patient's stomach is removed, thus converting the stomach from a bag or pouch like organ into a tube. The part of the stomach which produces the hormone called Grehlin, which stimulates the feeling of hunger (appetite) is removed and the patient feels satiated after a small meal. The way food passes through the alimentary tract is not altered. Although there have been complications of leak and bleeding reported, these are much less that in the Gastric Bypass procedure. The longitudinal gastric sleeve resection is the currently preferred operation by most Bariatric surgeons.

The patient goes through a protocol based preoperative preparation, which includes a detailed evaluation by an endocrinologist, psychological counselor, getting clearances from the Cardiologist & Respiratory physician as a preanaesthetic assessment. He / she is also counseled by the dietitian as to the diet to be used for two weeks prior to the operation and what to expect after the procedure. Three to five days admission to the hospital is all that is required before you can embark upon an exciting journey of progressive and sustained weight loss at the rate of one Kg per week for the next two years, to regain your health and self-confidence after reaching your ideal weight. Some dietary supplements like proteins, calcium, iron and vitamins are required to be taken life long, a small price to pay when you consider the benefits of being off insulin and blood pressure medicines and being able to slip into your favorite old pair of jeans!

Some myths

You’ll live on a liquid diet and protein shakes for the rest of your life & it will be difficult to eat with family and friends.
All patients put on a liquid diet for 10 – 14 days before and after surgery, to help with the operation and healing process. A couple of weeks post-surgery, they are weaned off liquid diet and soon all patients eat small quantities of home cooked food. Dietitians work with patients to show them the kinds of meals they can make that will fit in their new healthy lifestyle, which can actually be shared with family members and friends.

Bariatric surgery is the easy way out.
Bariatric surgery is only a tool to help patients follow a diet plan & achieve weight-loss faster and for a prolonged duration, and to prevent a rebound weight gain by reducing their appetite and inducing early satiety. If patients don’t follow a healthy diet, exercise, and take their vitamins, it won’t work.

You will be left with a big scar after weight loss surgery.
All weight loss surgeries are now carried out laparoscopically, meaning you will be left with a very small mark. The laparoscopic technique is a way that a surgeon can perform complex procedures that used to require the conventional large incisions through minimal access.

You cannot get pregnant after weight loss surgery.
It is possible to have children after weight loss surgery, your fertility will improve. However, most doctors will advise you to wait 1-2 years before trying to get pregnant. This is because you need to wait until you have lost most of what you wanted to lose and your weight loss has stabilized.