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Bariatric surgery for obesity is gaining ground in India, but has a long way to go

Though aggressive public awareness campaigns and programmes are being conducted by different institutions to promote bariatric surgery in the country, the social stigma associated with surgery for obesity, lack of awareness and non-coverage by health insurers are major hurdles.

March 04, 2023 / 04:45 PM IST
The report said that childhood obesity could more than double by 2035 (Representative image)

The report said that childhood obesity could more than double by 2035 (Representative image)

The National Family Health Survey 5, carried out between 2019 and 2021, has shown that one in every four men or women in India is obese. Overall, obesity has surged from 21 to 24 percent among women and from 19 to 23 percent among men in the last four years.

As expected, the COVID-19 pandemic has also exacerbated the issue of obesity as many people switched to work-from-home mode, leading to reduced physical activity. This has seen obesity widen in India, placing it third in the world, behind only the USA and China in the number of obese people.

Experts say that obesity is not a disease that afflicts only the affluent class. It plagues all sections of society, and research has established that Asian populations suffer more from visceral obesity and are more prone to develop diabetes and other obesity-related complications, even at a young age.

Nearly 20 years ago, the World Health Organization said that the relationship between body mass index (BMI) and body composition, and its effect on health, may differ between Asian and European populations.

This led to a change in the overweight and obesity classification for the Asian population, as also indications for a bariatric procedure, which involves surgical intervention in the digestive system for weight loss.

Since the first bariatric procedure was performed in India in 1999, there has been a steady increase in the number of procedures performed each year. Yet, according to specialists, the demand for and acceptance of this surgery may be far lower than what is needed.

What is the procedure and who needs it?

The surgery is done to help obese patients lose excess weight and reduce their risk of potentially life-threatening, weight-related health problems, including heart disease and stroke, non-alcoholic fatty liver disease, sleep apnea and type 2 diabetes.

The procedure is typically done after patients have tried to lose weight by improving their diet and exercise habits. It is an option for people with extreme obesity with other weight-related health problems, even though not all who are obese may qualify for it.

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Dr. Rajesh Kapoor, director, department of gastro-intestine and hepatopancreatobiliary surgery with Jaypee Hospital in Noida, says that bariatric surgery is a good option for patients who fail to achieve weight loss and good control of type 2 diabetes in spite of lifestyle modifications, dietary control and medical management.

However, metabolic or bariatric surgery should not be taken as a substitute for these measures, he cautions.

The International Federation for the Surgery of Obesity and Metabolic Disorders registry for 2019 showed that the number of bariatric procedures performed in India stood at 20,857 that year.

Effective, evolving tool

Dr. Roji Philip, consultant, general and laparoscopic surgery with Hiranandani Hospital in Mumbai, says that bariatric surgery has been around as an effective option to achieve weight loss in the morbidly obese for quite some time now.

Over the years, he says, surgery has gained recognition as a highly effective option in treating metabolic diseases such as diabetes and hypertension, leading to the development of what is now known as metabolic surgery.

According to Philip, surgeries such as sleeve gastrectomy, gastric bypass and mini gastric bypass have proven to be effective for glycemic control. Therefore, such procedures have been recommended by physicians and endocrinologists for obese patients who do not respond to medical therapy or lifestyle modifications.

Glycaemic control

Bariatric surgery induces significant physiological changes, such as a reduction in Insulin resistance, which yield sustainable long-term effects.

Dr. Mayank Madan, director, GI, minimal access & bariatric surgery, at the CK Birla Hospital in Gurugram, stressed that there are studies showing resolution or at least significantly better glycemic control, in 85-90 percent of patients after bariatric surgeries.

“Not only are sugars better managed or diabetes reversed, the complications associated with diabetes, such as retinopathy and nephropathy, are also prevented,” Madan said.

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According to Madan, awareness about bariatric surgery is rising by the day, and as it gets approved by more insurance companies, the number of patients opting for the procedure to manage obesity and blood sugar is bound to go up.

There is a flip side, too

Experts caution that while bariatric surgery can have significant benefits, there are also some potential drawbacks and risks to consider. Some of the cons of bariatric surgery include the need for long-term maintenance, nutritional deficiencies and changes in digestion.

“It's important to discuss the potential risks and benefits of bariatric surgery with a healthcare professional and to carefully consider all options before making a decision, Kapoor said.

According to Madan, one needs to take supplements like multivitamins- minerals, calcium and iron supplements, especially after a gastric bypass.

Also, follow-up is very important and one needs to check vitamin and calcium and iron levels every 6 months. Some patients can even experience hair loss and dry skin, he says.

Sumi Sukanya Dutta
Sumi Sukanya Dutta
first published: Mar 3, 2023 10:58 am