In 1991, the National Institutes of Health, Washington D.C. concluded in its consensus conference on Surgery for, 'morbid obesity', that diet, exercise programs, appetite suppressants and behaviour modifications are not effective therapies for inducing weight loss in obese persons.

From then onwards, Bariatric Surgery" or "Weight Loss Surgery" gained a logical momentum as the long term treatment and in many persons, a permanent therapeutic measure for the treatment of obesity in Western countries.

According to Dr M Ramesh, Director, Division of Bariatric Surgery, AV-Hospital, Bangalore, who has conducted over a hundred Bariatric surgeries in the last three years, "In India, five percent of the urban population or fifty million people are suffering due to the consequences of varied degrees of obesity.” 

“In fact, researchers have found a startling revelation that obesity has surpassed starvation!  If 33 per cent of American citizens are reportedly affected by obesity, in India, over all about 2.2 crore people are affected by obesity and its related disorders!"

Since obesity brings along several medical diseases such as diabetes, hypertension, cardiac diseases, arthritis, depression and infertility etc., the burden of expenditure on the affected person and his or her family for the treatment of these co-morbid conditions is quite enormous, especially in India, wherein the awareness about the significance of health insurance is quite minimal.

Obesity is usually measured by the term called 'Body mass index' (BMI). A person is categorized as
Overweight if the BMI is 25 - 29.9

obesity class I  if the BMI is 30-34.9
obesity class II if the BMI is 35-39.9
obesity class III if the BMI is more than 40.

According to Dr M Ramesh, "Substantial weight loss cannot be achieved by low calorie dieting alone, since after an initial phase of weight loss, a plateau is reached, during which time further weight loss is very negligible or 'no loss' at all.

Such persons experience a 'Yo - Yo' phenomenon in whom frustration sets in followed by discontinuation of the diet and gain in body weight more than before!"  Many obese people hence are resorting to 'Laparoscopic bariatric surgery' after experiencing the ‘'Yo - Yo phenomenon' or dissatisfactory results after having tried varied other methods such as diet, exercise and medicines for losing weight.

Contrary to the popular belief, ‘Bariatric surgery' is not a cosmetic surgery [whereas liposuction is a cosmetic surgery wherein a few kgs of fat is removed by suction].  Cosmetic surgery like 'liposuction' will only help in body contouring, unlike Bariatric surgery which induces long term weight loss, along with treating the medical problems (which are a consequence of obesity) or co-morbid conditions such as diabetes, blood pressure, arthritis etc.

Bariatric surgeries can be done through both open and laparoscopic approaches.  Laparoscopic Bariatric surgery has the advantage of being associated with less pain, rapid recovery and fewer wound complications, because the surgery is done through small incisions. 

Based on fitness

Says Dr Ramesh "Candidates for 'Laparoscopic Bariatric Surgery have to be selected based on their 'fitness' to undergo the same.  They will be subjected to clinical examinations by endocrinologists (to rule out hormonal causes for obesity) and other specialists.

Screening tests will also be done to assess whether the person intending to undergo the surgery has already got any protein deficiencies or any psychiatric disorders.  Most importantly we counsel the person before the surgery since a very high level of self-motivation is needed on his or her part, to follow our instructions regarding the diet post-operatively, for example, patients who undergo the surgery would be asked to avoid aerated drinks, since aerated drinks tend to stretch the stomach wall."

"Laparoscopic Bariatric Surgery" will either restrict or reduce the amount, which a person eats, or it can reduce the amount of food absorbed or combination of these two effects.

Next week: advantages and procedural details of Bariatric surgery