Obesity is a rising epidemic in the world, and India is no exception. In India, over 30 million people are obese, and it is expected that this number will double in a few years. Unfortunately, it is heavily under-recognised and is not a public health priority.

The primary reason for obesity are two-fold – unhealthy diet and lack of exercise.

Obese individuals are at a higher risk of developing heart disease, high blood pressure, diabetes, joint problems and multiple other health issues that require constant attention and treatment. Weight reduction has been associated with a significant decrease in the development of these risk factor.

The truth behind weight loss

Weight loss needs a great deal of determination, focus and sacrifice, especially if one is looking to lose a lot of weight.

These days, gyms around India have trainers who can help you achieve that goal. People have resorted to group classes such as Zumba and aerobics, and the increasing number of 5km and 10km run events have given people a goal towards which they can work.

In the United States, obesity is as big an issue as it is in India, and probably more. Not everyone gets the time to exercise, so many individuals resort to strict dieting or following online weight loss programs such as the 3 week program and the Venus factor. But not everyone who tries these weight loss strategies is successful.

Considering weight loss surgery

If you have been trying to lose weight for a while now, and have not been successful, then you may want to consider weight loss surgery as an option. Studies have shown that the risk of death from conditions such as high blood pressure, cancer, diabetes and heart disease reduces remarkably after weight loss surgery.

We spoke with Dr M G Bhat, a leading senior laparoscopic surgeon at Nova Specialty Hospitals and Manipal Hospitals, Bangalore regarding bariatric surgery (weight loss surgery) and asked him about how it can help change people’s lives.

HeartSense: Thank you for taking the time to do this interview Dr Bhat. We greatly appreciate it.

Dr Bhat: My pleasure!

HeartSense: Obesity is a big problem in India, and our hectic lives mean we do not have much time to exercise. People have now become more aware about the harmful effects of being overweight, but many times despite their best efforts fail to drop their weight. At what point would you recommend weight loss surgery to these patients?

Dr Bhat: The first thing that we need to see before recommending surgery to patients is that they have tried hard to lose weight through diet and exercise. Objective evidence is essential and the patients must have tried for at least a few months. If the body mass index (BMI) of the patient is more than 30, and there are associated co-morbidities (such as high blood pressure, diabetes etc.) then weight loss surgery may be considered.

HeartSense: Are there any prerequisites to be met before a patient can be considered for weight loss surgery?

Dr Bhat: Most certainly. I always make sure that my patient has tried everything in their power to lose weight first. This includes going on a low calorie diet and performing regular exercise. I look at this as these practices must be continued after surgery is performed as well. The level of commitment must be unparalleled and I must see evidence of this during my consultation with them.

HeartSense comments: All patients who wish to undergo weight loss surgery require a detailed examination and psychological assessment prior to taking up surgery. Weight loss achieved through surgery can increase the chances of the woman getting pregnant. Infertility seems to be reversed to an extent with reduction in weight.

HeartSense: Is there an age limit at which surgery can and cannot be performed?

Dr Bhat: Most surgeries are performed in patients below the age of 65 years. We are cautious to suggest surgery after the age of 65 years.

HeartSense comments: Surgery remains controversial in patients below the age of 18 years. This is because juvenile obesity requires a greater degree of counseling, which not always work due to the mental make-up of younger patients.

HeartSense: What are the types of weight loss surgeries you perform in your practice?

Dr Bhat: There are 3 main types of surgeries that we perform, and all of these are done through laparoscopic route (minimally invasive). The 3 types include sleeve gastrectomy, gastric bypass and mini gastric bypass (MGM).

HeartSense comments: In a sleeve gastrectomy, a part of the stomach is removed which in turn makes the size of the stomach smaller to about 25% it’s normal size. In a gastric bypass, an alternate pathway is created that bypasses the stomach and allow food to directly enter the bowel through a small pouch.

HeartSense: What are the benefits of undergoing weight loss surgery?

Dr Bhat: The benefits are huge! Firstly, patients will notice a significant degree of weight loss which they failed to achieve through diet and exercise alone. Their confidence level increases and they feel a lot happier. However, they must remain committed to their diet and exercise routine.

HeartSense: A recent report suggests that bariatric surgery can completely reverse diabetes. Is this true?

Dr M G Bhat, Senior laparoscopic surgeon, Nova Specialty Hospitals and Manipal Hospitals.

Dr Bhat: Yes it does. I see patients with type 2 diabetes come off their medicines completely in a few weeks after surgery!

HeartSense: What is your experience on the long term outcomes with patients who undergo this surgery?

Dr Bhat: With a strong commitment to diet and exercise, weight loss surgery as a compliment can be totally successful. Losing weight is the first phase of the results. The second stage is maintenance of the lost weight. Both these require a great deal of commitment. However, I have also seen some patients falter, and these people go on to regain their lost weight in 2 to 3 years.

HeartSense comments: It is important to remember that weight loss surgery is not a cure for obesity, but is a complimentary therapy. Having the surgery does not guarantee that you will lose all your weight and keep it low over the long term. It is important for you as a patient to continue with your regular diet and exercise routine for the rest of your life. Giving up on this and not taking care of your diet is a sure-fire recipe for weight gain!

HeartSense: How much can one expect to lose?

Dr Bhat: In the first year following surgery, you can expect to lose around 30 to 40 kilograms, which is usually around 40% of the body weight. However, it is possible to regain this lost weight if the patient does not exercise regularly or follow the right diet.

HeartSense: How long does it take people to recover from surgery?

Dr Bhat: The recovery times are very quick, and I discharge my patients 48 – 72 hours after surgery. They will initially have to stay on a liquid diet and over time will gradually get back to a normal diet within a month. They can resume normal activities within a week. They can start performing regular exercise within 3 weeks.

HeartSense: Are there any risks associated with the surgery?

Dr Bhat: If a patient is deemed fit for surgery, then they must be aware of certain risks. In the short term, there are risks associated with the use of anaesthesia, but these are almost next to nil these days. During the surgery, there may be a little bleeding, which can be controlled at surgery. Delayed bleeding may occur which sometimes needs dealing with. The risk of this is around 1 – 3%. A small amount of blood may leak from the site where the staples are placed during the surgery. This can be controlled immediately during the operation. The risk of this developing is also around 1 – 3%.

In the long term, a small number of patients may experience a phenomenon called malabsorption, which requires constant assessment. Follow is lifelong, and patients must be motivated enough to keep the weight down after the operation.

HeartSense comments: Another complication that is sometimes seen is depression. Patients may not be ready for the degree of weight loss they experience, or may have trouble keeping up with the lifestyle and dietary changes. It is believed that the depression may be related to low carbohydrate intake, which indirectly can alter the level of serotonin in the brain. Often patients who are due to undergo weight loss surgery require a psychological assessment.

HeartSense: Is weight loss surgery reversible?

Dr Bhat: Yes, if required, a gastric bypass can be reversed. However, a sleeve resection cannot be reversed as a part of the stomach is removed. However, the stomach gets a bigger in these patients over a period of time.

HeartSense: What is the average cost of weight loss surgery?

Dr Bhat: The cost of surgery varies between surgeons and hospitals. At Nova Hospitals, we do a package starting from Rs 3 lakhs to Rs 5 lakhs depending on the requirements of the patient and the procedure performed.

HeartSense: Are there any support groups that can guide people who wish to undergo weight loss surgery?

Dr Bhat: Yes, we do have a very active weight loss support group. I personally lead support groups for patients of mine at our hospital. The patients seem to enjoy the interaction they have with other similar patients.

HeartSense: Thank you very much for taking the time out of your busy schedule to answer questions about weight loss surgery Dr Bhat. We appreciate it tremendously!

Dr Bhat: My pleasure!

Dr M G Bhat is a senior consultant laparascopic surgeon at Nova Specialty Hospitals and Manipal Hospital, Bangalore. He is a renowned bariatric surgeon and has performed numerous surgeries over his long career spanning 35+ years. You can read about him at www.drmgbhat.com. For more information, visit www.bariatricsurgerybangalore.com.