As Saudi man Khalid bin Mohsen Shaari’s transformation, from weighing 610 kg to now 63.5 kg, made headlines, it highlighted why bariatric surgery with comprehensive treatment is still the best bet to manage morbid obesity, known to shorten life spans. Pune’s bariatric surgeon Dr Shashank Shah, who performed surgeries on both the heaviest woman and oldest man in the country, says in extreme obesity, surgery guarantees the best outcome.
“Evidence-based medicine suggests that even in the era of medications, bariatric and metabolic surgery still provide the best proven long-term outcome. The one who is metabolically, psychologically and physically affected due to obesity should seek options for bariatric surgery,” says Dr Shah, who will be presenting his case studies at the world congress of obesity surgeries in the first week of September.
What is bariatric surgery? Who needs it?
This surgical procedure reduces the size of the stomach and also bypasses a portion of the intestine to reduce food intake, changing the way the body demands or absorbs food for energy. It is needed for Class III obesity, also known as morbid obesity, in which a patient has a body mass index (BMI) of 35 to 40 or higher and a waist circumference that’s between 115-125 cm or higher. This group is at risk of heart disease, stroke, high blood pressure, and uncontrolled diabetes. “Asians, and Indians in particular, need a more aggressive approach in treating obesity and its co-morbidities as it is associated with higher morbidity and mortality at a relatively lower BMI,” says Dr Shah.
Patients can get back to normal weight
Amita Rajani, 42, from Vasai (Mumbai) weighed 300 kg and had been bedridden for eight years. Post-surgery, she weighed 86 kg and led a normal life for nine years. “A few years ago, I operated upon 81-year-old Saifullah from Hyderabad at 130 kg, rare because we seldom operate on people over 65. But he had multiple problems like breathlessness, inability to walk, joint pain, very high blood pressure,” Dr Shah says.
What are reasons for morbid obesity?
This is the result of unknown hormonal abnormalities which can slow down metabolism significantly and trigger massive deposition of fat in the body.
Why weight loss drugs still not equivalent to surgeries
Dr Randeep Wadhwan, president, Obesity Surgery Society of India, says drugs aren’t equivalent to a life-saving surgery, where the total weight loss is approximately 35 per cent over a year and brings down the risk of co-morbidities greatly. “Medicines currently available may help you lose weight by up to 10 per cent and the weight can come back once you stop the drug. The weight rebound is still lower in bariatric. For the morbidly obese, these drugs won’t help,” he adds.
Do patients need repeat surgeries?
More than 80 per cent of patients opting for surgery have a significant remission in comorbid conditions, a significant reduction in weight and maintain that for ten years and beyond with strict lifestyle management and food discipline. “About 10-15 per cent who will regain weight because there is no regular follow-up or a switching back to original habits. We start treatments and lifestyle counselling and if that does not work, then conduct a revision procedure. In India out of 17,000, the number of revisional were 850 or less than five per cent,” says Dr Wadhwan.
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