Surgery for Obesity

Obesity, when severe and resistant, is beginning to depend on surgery for relief in modern times. Bariatric or weight- loss surgery is emerging as reliable and safe option, and now available in several Indian centres, as more and more people are taking the plunge to get cut to size.

Taimina (name changed), told me proudly that she had lost 33 Kg from her earlier 110 Kg, in the last 6 months since she went under the knife. What she enjoyed most every day was to step on the weighing machine and see her weight drop by another 500 g! Her self esteem, smothered by the burden of her weight over the last few years, had begun to revive and her confidence had started to return.

She had undergone a gastric sleeve operation, in which the major portion of her stomach had been cut and removed, reducing it to a 30 ml pouch from its earlier 2 litres’ capacity, thus restricting her eating.

Bariatric surgery has evolved over the years, from the earlier malabsorptive procedures that diverted food from the intestines to prevent its absorption, to the currently popular restrictive procedures such as the gastric sleeve. Patients who are very grossly obese sometimes require a combination of these to achieve the desired effect.

Loss of weight in the first 3 months after surgery is usually very rapid, often around 20 Kg being shed in the first month. Patients often experience weakness, giddiness and low blood pressure at this stage. What helps offset these symptoms is the feeling of hurrah as they watch their excess weight melt away by a kilo every day. Attempts to eat more than a morsel at a time often results in vomiting, reminding that the stomach is no longer the accommodating sack it once was.

Bariatric surgery is not a cosmetic surgery meant for the mildly obese. To qualify you must be morbidly obese with Body Mass Index (BMI) in excess of 40 Kg/m², or have a BMI of 35 Kg/m² along with a disease such as diabetes, high blood pressure or sleep apnoea. Though small in trained hands, the procedure is not without risk, and share of side-effects such as nutritional deficiencies, wrinkling of skin, formation of stones in the gallbladder and kidneys, hernia and others.

There are compelling medical reasons however that have made bariatric surgery so popular even with doctors. Patients who have allowed their weights to climb to such high levels are often depressed and unable to stick to the strict diet and life-style changes required for achieving such weight loss.  Further, several diseases such as diabetes and sleep apnoea often disappear with the losing of weight that surgery brings about.

The growing need for bariatric surgery today is however also a reflection of our present day attitudes. We are becoming increasingly defenseless before the lure of surplus of appetizing food surrounding us. With our determination failing us, we are now resorting to expensive surgery to restrict our eating!

As published in HT City ( Hindustan Times) dated 1st July, 2012.