With the rise of obesity in India —a 2016 survey found 18.9 per cent of all males and 20.7 per cent of all females in the country overweight or obese — the number of people opting for bariatric surgeries has increased by thousands. However, the surgery doesn’t guarantee a blanket remedy and sometimes has its own share of complications. In a two-part series, Pune Newsline looks at the increasing popularity of bariatric surgeries, and the kind of restrictions it imposes on patients.
Part 1 of the series:
Vice-President M Venkaiah Naidu has gone through it. So have Union ministers Arun Jaitley and Nitin Gadkari. Maharashtra Chief Minister Devendra Fadnavis has also opted for it. Bariatric surgery, an operative procedure to lose weight, is not the sole preserve of prominent ruling party politicians, or of the rich and famous.
In the last few years, the demand for weight loss surgeries has grown manifold. According to the Obesity Surgery Society of India, nearly 15,000 such surgeries are being performed every year in India. The first one, incidentally, was performed less than 20 years ago, on a 28-year-old in Pune. By 2003, the number of surgeries had already touched the 1,000 per year mark.
The increase in the number of bariatric surgeries is in line with the steady growth in the number of overweight people in India in the last 20 years. The latest round of National Family Health Survey, published in 2016, found 18.9 per cent of all males, and 20.7 per cent of all females in India, overweight or obese (with a body mass index of 25 kg or more). Just a decade ago, its previous survey had found these numbers to be 9.3 per cent and 12.6 per cent respectively.
A study published in the medical journal Lancet four years ago said India had already become the country with the third largest number of obese people in the world. With as many as 46 million obese people, India was ranked only after the United States and China. Last year, a study in The New England Journal of Medicine said the number of obese children in India was 14.4 million.
Many of these people suffer from what is known as morbid obesity, with a BMI of 32.5 or more. In such cases, surgical intervention is often the easiest and fastest way to lose weight. “From my own experience of 20 years of clinical practice, I would say that the number of obese males would have doubled while the number of females would have increased by about three times in the last 10-15 years,” said Dr Shashank Shah, who runs the Laparo Obeso Centre in Pune.
Shah said while sedentary lifestyle and poor nutrition had fuelled the obesity epidemic in the country, there was a growing evidence that endocrine-disrupting chemicals were also affecting metabolism in human beings. “Indians are genetically predisposed to less muscle and more fat. Several environmental factors have led to disrupting of metabolism. And this has happened at a much faster rate in the last two to three decades,” Shah said.
Last year, Shah’s clinic performed more than 600 bariatric surgeries. About 10 years ago, it used to have barely 100 surgeries in a year. Shah says clinics across the country have been reporting similar increase in their numbers. The states worst hit by obesity happen to be Punjab, Kerala and Delhi, he said.
Dr Jayashree Todkar, a laparoscopic and bariatric surgeon who helped Fadnavis lose 26 kg, said a national registry on bariatric surgeries was being maintained and its data was showing that the number of such procedures was rising very fast. “The four weapons that can fight obesity are healthy and regulated diet, physical activity, surgery, and proper medical treatment at the right time,” she said.
Traditionally, obesity was not looked upon as a disease requiring medical attention, but that has changed in the last few years. Dr Arun Prasad, president of OSSI, said the explosion in the number of diabetes cases had some role to play in the change in peoples’ attitude towards obesity. Today, there are an estimated 350 surgeons and about 50 hospitals or centres in the country that perform this surgery. Nearly half of them are concentrated in Delhi, Mumbai, Chennai, Pune and Hyderabad, and a couple of cities in Gujarat.
Dr Srihari Dhorepatil, who performed the first bariatric surgery in India in Pune in 1999, said the surgery has become much more acceptable now. “It is not that people did not require surgery in the past. In many cases even at that time, surgery could have been the only solution. I remember, about a decade back, I would see about 40-60 patients every month, who would have required a weight loss surgery. But only about 6-8 of them used to opt for one. The situation is very different now.”
Increasing awareness about the problems associated with obesity, a sharp decline in the costs of the surgery, and technological improvements over the years has made the surgery more acceptable to people. Weight loss surgeries barely take half-an-hour, if the pre- and post-operative care is discounted. The CGHS (Central Government Health Scheme) approved cost of bariatric surgery is Rs 2.5 lakh, which can go up to Rs 5 lakh in some cases. In many other countries, this cost can be three to four times higher.
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