Sheela (name changed) was 40, rather short, and stout. Since she delivered nearly two decades ago, she began putting on weight until the weighing scales groaned at 145 kg.
With a Body Mass Index of 49, she was ‘morbidly obese'. She also had the attendant problems – diabetes, high blood pressure, and thyroid abnormalities. However, she ignored her problem until doctors said it could cost her, her life. At a BMI of 49, exercise and dieting was not going to help her.
“Sheela is a classic case – her meals were fat and carbohydrate-rich, and she had literally no exercise. In fact, she would not move out of home. When she came to us, she was morbidly obese, but we still set her on a diet and exercise pattern,” says Deepak Subramanian, consultant laparoscopic and bariatric surgeon, Fortis Malar Hospital. Predictably, it did not help her at all.
“The problem was that she did not bother about gaining weight until her BP hit the roof. As she came to us, the only option we could provide her was bariatric surgery,” Dr. Subramanian explains. For anyone with a BMI of over 35, and with obesity-related medical conditions, the chances of getting back to normal weight are low.
By reducing the size of the stomach through bariatric surgery, the patient's ability to consume large volumes is curtailed, explains Prasanna Kumar Reddy, senior consultant laparoscopic surgeon, Apollo Hospitals. The weight loss is over a period of time. However, he makes it clear that the process is not automatic.
“After surgery, the patient has to follow lifestyle modifications that we recommend. They have to drop habits that tend to lead to weight gain. In order that they follow the protocols, especially diet, we ask them to report to the dietician once every three months,” he adds. Even after surgery, the stomach pouch can expand, leading to weight gain.
J.S.Rajkumar, bariatric surgeon, and chairman, Lifeline Hospitals, says, “The human being has a natural tendency to fall back on starchy and sweet food. Aerated drinks are a strict no-no. They can cause havoc in a patient who has had bariatric surgery.” While the procedure itself can turn out to be the only help for the morbidly obese, Dr. Rajkumar makes it clear that ‘we do not yet have a procedure that can circumvent the need to follow a diet and exercise pattern'.
Dr. Subramanian cautions again that bariatric surgery is not for every one. “We get a lot of enquiries from people, specially from north India and abroad, who want to get rid of abdominal fat. But we turn them down. If you can lose fat by other means, it must be done. “There is no lazy way to lose weight. Ideally, do not get obese,” he adds.
According to Dr. Reddy, one needs to start with the young. Children should be taught to eat healthy and exercise. Parents and schools should be involved in these activities for them to be effective.
