Why bariatric surgery is an answer to uncontrolled diabetes

At 29, Pune’s Heena Shaikh was the first woman in the country to undergo a bariatric procedure in 1999. “I had just delivered my baby via Caesarean section. Somehow, I started gaining weight and was almost 125 kg. My high blood pressure compounded matters,” recalled Heena. While her mother and brother were initially against the procedure, Heena remembers post-surgery her blood pressure levels became absolutely normal. It is only now, in recent years, that I have started taking tablets against hypertension,” said the 52-year-old, who weighs 89 kg.

Sixty-year-old Aneeta Sanas, also from Pune, who conducts meditation classes and other programs at her centre, grimaced when she recalled her diabetic condition some 14 years ago as she had to take five insulin injections. “My diabetologist, Dr CS Yajnik, told me about the bariatric procedure, which sounded radical in its time. I weighed 100 kg then and decided to go ahead with the surgery. Today, my weight is stable, between 68 and 69 kg. Also, my diabetes has been managed and blood sugar levels are under control,” Sanas said.

Obesity has become a serious health problem in the country, necessitating a surgical intervention to avert life-risks. However bariatric surgeries to treat this condition have not risen proportionately. Ever since the country’s first bariatric procedure in 1999, the number of surgeries now approximates to 15,000 per year, when the requirement is for almost four lakh, according to surgeons with the Obesity Surgery Society of India.

“If you look at the percentage of obesity, vis-a-vis the number of bariatric surgeries, India is one of the lowest in the world. The numbers are extremely small compared to what is a health imperative. Obesity is not a cosmetic issue and uncontrolled diabetes does not have many medicines to treat the condition. So, we cannot keep telling the patient to just walk, exercise and eat less. The metabolism levels of such patients are so low that it is not possible to lose weight by conventional means. Bariatric surgery is a life-saver in such cases and the numbers need to go way higher than what they are. We should be doing three to four lakh surgeries every year but as of now we are only doing a fraction of that,” Coimbatore-based bariatric surgeon Dr Praveen Raj, who is president of the Obesity Surgery Society of India (OSSI), told The Indian Express.

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Liposuction is cosmetic, bariatric is a life-saver

Dr Shashank Shah, former OSSI president and a Pune-based bariatric surgeon, couldn’t agree more. He says though the number of deserving people for bariatric surgery is high, the numbers are treated even less than one per cent. Besides, failed cases of liposuction, obviously resorted to as a quick measure, only highlight the need to treat severe obesity via bariatric surgery.

Recently, a 21-year-old Kannada actress, Chetana, died of cardiac arrest while undergoing liposuction. She is the perfect example of how liposuction gets confused with bariatric surgery. Liposuction aims at removing excess fat, contouring the shape of the body and does not tackle the root cause of obesity. “Liposuction is not taken up by bariatric surgeons,” Dr Raj added.

Bariatric and metabolic surgeries are procedures that are effective in treating obesity and associated co-morbid conditions. In 2019, bariatric and metabolic surgery was included in health insurance by the Insurance and Regulatory Development Authority of India for treating obesity.

A rising health concern

According to the National Family Health Survey-5 report, the proportion of overweight or obese women in India has increased from 21 per cent in 2015-16 to 24 per cent in 2019-20 while among men the proportion has risen from 19 to 23 percent . A report, “Bariatric and Metabolic Surgery in India: Where Do We Stand,” published this January in the Indian Journal of Surgery has said that with over 135 million individuals suffering from obesity, India ranks third in the world behind the USA and China. Worldwide, more than 1.9 billion adults are overweight and around 650 million are obese. Obesity has been one of the leading causes of death with over 2.8 million deaths globally, as per the report.

The diabetes overload

Obesity was declared an epidemic by WHO in 1997. According to the Indian Journal of Surgery report, it is known that the Asian population suffers more from visceral obesity and is more prone to diabetes and other obesity-related complications even at a younger age. The International Diabetes Federation says the prevalence of diabetes in the Indian adult population is approximately 9 per cent with some states recording an incidence of as high as 21.9 per cent. Dr Srihari Dhorepatil, who performed the first bariatric procedure in Pune, said that this surgery has become an important mode of treating diabetes and metabolic syndrome in other countries.

“Most European, North American countries, Brazil and even a small country like Taiwan have taken up bariatric surgery in a big way as they look at obesity as another diabetes threat and treat it accordingly,” Dr Raj said. Dr Shah feels with medical insurance now covering bariatric surgery as a treatment for obesity in several countries, including India, the cost burden has been significantly taken care of. “We began with about 5,000 surgeries annually and in the last couple of years there have been approximately 15,000. We have also started training over 400 surgeons so that we can handle the demand,” Dr Shah said.

While the OSSI has set up a registry to look at different procedures and outcomes of bariatric interventions, surgeons admit that there are no official statistics yet. However, Dr Raj quoted a Swedish Obese Subjects trial that followed patients for 25 years and found that those who had bariatric surgery had a reduced risk of dying from a cardiac ailment. “There are studies related to the safety of bariatric surgery vis-a-vis gallbladder surgery and mortality in both is 0.2 per cent,” Dr Raj said. Pune-based Prasad Kelkar, who underwent bariatric surgery 12 years ago, vouched for its efficacy. “I weighed 145 kg at the age of 26 and had a 48 inch waist. I used to feel embarrassed going to restaurants. I developed terrible acidity and was so uncomfortable. After the surgery, my weight is around 80 kg and yes instead of six paani puris, I can easily have three. That is enough to feel satiated,” he said.

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