Grazilia Khatri [GK]: Obesity is always more than what meets the eye. Weight loss through the conventional methods is time-tested and endorsed by all experts. It takes time, effort and dedication, but involves no hidden pitfalls or drawbacks. There will always be easier and more convenient alternatives, but the first option should be going the natural way. Losing weight by surgery only tackles the superficial signs while the cause of morbid weight gain continues to exist.

Abhay Agrawal [AA]: These surgeries are not suggested to everyone who is overweight. It’s only when obesity begins affecting quality of life that one should consider surgery as an option and after other natural means of weight loss have been tried. Surgical weight loss is better than living with the weight, poor body image and a host of other diseases.

Results of a gastric bypass surgery are not remarkable or worth the effort. Conventional methods give same results. Is it true?

GK: Many people who have lost weight continue to keep it off with healthy eating habits, regular exercise and a commitment to staying healthy. All this is without the exorbitant expenses that these surgeries require and without the risk of complications. Early morbidity associated with weight loss surgeries is 15 per cent – 50 per cent.

AA: What has worked for one, may not work for another. Besides, weight loss surgeries are not a magic wand; they are a means to weight loss. Studies have proved that conventional or non-surgical methods of weight loss in morbidly obese have a 95 per cent – 98 per cent failure rate in maintaining sustained, long-term weight loss.

The trend in surgical weight loss may risk breeding poor eating habits in people.

GK: With the surge of various weight loss techniques such as tummy tuck or arm tuck that make losing weight so easy and convenient, there is a risk that people may develop an unhealthy attitude—eat all you want and lose it later with surgery. As more people are opting for these surgeries, their acceptance among society is increasing. Also, since it’s all made to look so hassle-free, patients are more curious about this option than the usual exercise-diet route.

AA: Surgical weight loss should not be considered as an easy way out. The need for a healthy diet and lifestyle modification is emphasised by all bariatric surgeons. Bariatric patients are counselled and followed up for life. They need to be reminded to be careful of the quality/quantity of food they take and the benefits of regular exercise.

Weight loss surgeries don’t work for all. One can undergo a surgery and still not lose weight.

GK: There have been cases where patients undergoing weight loss surgeries have not lost as much weight as anticipated. Also, there is always the risk of a band slipping or the procedure failing. Often patients are seen to get back to their original weight a few years after surgery.

AA: A failed bariatric surgery is not common. It could fail if there is total non-compliance from the patient’s side. Published results show that 80 per cent of patients have maintained 50 per cent – 70 per cent of their weight loss even after 16 years of surgery.

Emotional factors can affect the rate of weight loss.

GK: As already stated, obesity is a condition of the mind and the body. If the person is emotionally not stable or prepared to go under the knife, then it can adversely affect the rate of weight loss. Also, if the patient is being forced by the family for surgery, she might not adhere to pre- and post-operative advice. If weight loss does not happen as anticipated, it may cause further loss of morale and depression in the patient.

AA: All bariatric patients are counselled extensively before and after surgery. The results of the surgery are better in patients who have volunteered for surgery and are motivated. Weight loss in every patient depends on a lot of other factors and also on the type of surgery. The surgeon orients the patient about the outcome to avoid unrealistic expectations and ensure successful results.

Weight loss surgeries can sometimes worsen problems.

GK: Gastric bypass involves reducing the size of the stomach and bypassing a part of the small intestine. This affects absorption of nutrients and patients may develop long-term anaemia and nutritional deficiencies.

There is a risk of hernia, bowel obstruction and infection that may develop as a complication of the surgery. Weight loss surgeries help but thorough research needs to be done to ascertain if you are a fit candidate for it and to know what to expect from your choice of surgery.

AA: Bariatric surgeries are of different types—restrictive and combined [restrictive and malabsorptive]. Gastric bypass is a combined variety and does cause a bit of malabsorption of calcium, iron and vitamins along with calories and these patients do need supplements for life. However, the benefits of a gastric bypass are far superior to the agony of popping a few tablets everyday.

In 98 per cent cases, diabetes gets resolved and this includes even uncontrolled diabetes, requiring heavy doses of insulin. The post surgery benefits also include lowering of cholesterol levels and blood pressure. Patients are also relieved from sleep apnoea and knee and back pain. Overall, the health benefits give them a better quality of life while also prolonging their life expectancy.

If regular weight loss measures have failed, post-surgery weight maintenance can fail too.

GK: If the person couldn’t adhere to a diet and workout routine to lose weight before surgery, there is always a risk that the person may not stick to post-surgery diet. After surgery, it takes careful monitoring of diet to maintain weight loss. But that’s also what a conventional successful weight loss plan entails.

It’s probably the investment in terms of time, effort and money spent on the surgery that makes post-surgery efforts more determined.

AA: All bariatric surgery patients have tried diet and exercise before surgery, in vain. They cannot sustain the weight they lose with non-surgical options. Post-surgery, the results are so good that it encourages and enables the patient to adhere to the prescribed small, frequent meal pattern. The quality and quantity of food has to be monitored at all times after surgery. Patients are advised to follow a high protein and low carbohydrate, fat and sugar diet.

Will one surgery suffice?

GK: Often, after the first surgery, other surgeries may be required to remove excess skin that hangs after surgical weight loss. Repeat surgeries are also required in case of complications or if the first surgery fails.

AA: Excess skin removal is purely a cosmetic option and why not? If patients have lost all that weight with so much effort and dedication, they deserve to look good and wear clothes of their choice. It’s every girl’s dream to be slim enough to wear tight jeans.

Revisional surgeries are needed only in a handful of patients who show unsatisfactory weight loss. The majority of them benefit by leaps and bounds.

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Severely obese people have difficulty in performing day-to-day activities. For example, some of them find it difficult to tie their shoe laces, descend stairs or fit in one seat on a plane, bus or theatre.

There are more than 150 million obese people in India. Here, we are not referring to the pleasantly plump ones, but to the kind of people who just seem to keep getting larger— no matter what they do, how little they eat or how much ever they exercise.

People work long hours, eat junk food high in calories, lead a stressful life with no time to exercise. It’s a viscous cyclle … the person gains weight, so becomes less active and because s/he is less active, s/he gains more weight.

Obesity is the #2 preventable killer disease today. Overweight and obese patients suffer from many diseases and often end up treating the individual conditions, rather than treating the root cause. Let us take a look at some other serious problems that are caused by being overweight.

1. Gall stones: The incidence of gall stones is high in women who are overweight and according to studies about 23 per cent of obese individuals suffer from gall stones.
2. Skin diseases: Obese or overweight individuals are prone to skin conditions like varicose veins, and bacterial or fungal skin infections due to friction in skin folds in the lower belly and groin region. Low hygiene in these sites often results in an unpleasant body odour, which may contribute to social isolation and depression.
3. Hernia: Weight is a risk factor for umbilical and other abdominal hernias, both as a feature of their occurrence and as factor in recurrence after surgical repair. People planning to undergo ventral hernia repair are strictly advised weight loss. This improves the technical circumstance of the operation and helps reduce potential recurrence.
4. Intimacy and sexual satisfaction: It has been shown that eating as well as feeling physical satisfaction can gratify and balance stress, reduce anxiety, anger, loneliness and depression. Studies have shown a decrease in sexual activities and satisfaction being reported during periods of weight gain and increase during weight loss. People have also reported increased sexual activity after undergoing weight loss surgery.
5. Gynaecological issues: The adverse effect of obesity includes gynaecological and obstetric derangements. The incidence of menstrual dysfunction increases proportionally to the degree of increasing weight. Common gynaecological problems associated with excess weight are irregular menstrual cycles, menorrhagia [abnormally heavy and prolonged menstrual period] and anovulation [a menstrual cycle in which ovulation fails to occur]—all due to the imbalance of different sex hormones.
6. Obstructive Sleep Apnoea [OSA]: It is a medical condition that affects quality of life and is defined as complete or severe reduction in respiratory air-flow during sleep. This results in frequent arousals from sleep and daytime drowsiness. Significant improvement is seen in OSA in individuals who lose 50 per cent of their excess weight.
7. Renal disease: Recent research indicates that obesity causes renal disease like renal failure and proteinuria and if combined with hypertension or diabetes, can have a synergetic effect on renal dysfunction and damage. This renders the patients permanently dependent on dialysis or kidney transplant. Furthermore, there is evidence that weight loss improves renal function.
8. Breast cancer: Research shows that weight gain can increase the risk of breast cancer by up to one and a half times. According to the data presented by the American Association for Cancer Research, the risk of death from breast cancer is 2.4 times higher in obese women than women of normal weight.
9. Joint and back pain: Overweight individuals are more prone to joint and back pain than indivduals with normal weight. The knee joints often found take the brunt of the weight and get damaged. Orthopaedic surgeons advise patients to reduce weight in order to make them eligible for knee joint replacements. The knee joint replacement surgery may not be helpful in the long run if the patient is grossly overweight.
10. Psychological factors: Obese individuals confide to their homes and hence may not have friends or family to share feelings. This leads to depression, lower self-esteem and negative emotions.

Apart from these, obese people tire quickly and are always short of breath when climbing stairs because of the decreased lung capacity. This leads to low levels of stamina and inability to exercise. Hence, it is extremely important to maintain weight at all times to live a healthy and happy life.

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