30% of the people in West Bengal are over-weight or obese, including children. According to a rough estimate 40000 people in Kolkata alone, require bariatric surgery. The major setback for these set of people is the high expense that refrains them from opting for the surgery. Unfortunately, almost all Insurance companies treat Morbid Obesity as a Life style problem and refuse the reimbursement in spite of several court order in contrary to their stand.
Suresh Gomez, a former 167 Kgs weighted young boy, enlightens us with a very significant insight that the consequences of being obese is not just physical but psychological also. His obesity has taken a huge toll on his social life which otherwise could have been as normal as rest of the youth. It has also landed him in immense health hazards, putting his regular life into a standstill. His broken hip joint could not be operated and fixed owing to his overweight. He was bedridden for 3-4 years withdrawing from academics and regular schooling for a prolonged period. The doctors had to wait for years to operate. Unfortunately his previous surgery also failed due to his obesity and he has been advised another surgery.
Like other similar people, X had been discriminated directly or indirectly on several incidences for his overweight, throwing him into a cocoon with depression, isolation and lack of confidence. He made several attempts to undertake certain technical trainings and secure a suitable job, however his obesity has always deceived him. People could not instill adequate confidence and faith in him to find him deeming fit for a job and hence did not even provide him with an opportunity to prove his mettle. Alongside, his relapsed hip joint pain started getting bad to worse, turning him physically impaired once again. The doctors had arrived at a decision to replace his hip to reach a permanent solution. His obesity stood in the way of operation, leaving him with no other choice but bariatric surgery.
It is during this time around that X and his family came across Dr. Vishnu Kumar Bhartia from department of obesity and diabetic surgery (bariatric), CK Birla Hospitals (CMRI). He underwent a two hour operation (Bariatric Surgery) in CK Birla Hospitals (CMRI). Dr. Bhartia’s expertise has led him to loss of 9 Kgs within a week. From initial 167 Kgs to becoming 158 Kgs post operation is an indication at sound improvement. His facial colour that was initially extremely dull has currently brightened. A glow on his face along with walking perfectly without limping can be observed. His sugar level which was initially high is now controlled without medication. In the course of next year he is likely to reduce his weight further by 60 to 65 Kgs converting him into a 90 Kgs smart, confident boy, fit for hip replacement surgery.
It is essential that one is well aware of the causes of obesity:
· Incorrect diet. Wherein instead of a regular person taking 1200 to 1500 calories a day, an obese person consumes 3500 to 4000 calories a day
· Lack of exercise, walking and physical activity
· Genetic pre-disposition, where the 2 fat genes from parents are also responsible for obesity apart from environmental problems.
· In West Bengal especially single child is vulnerable to pampering with excessive food, paving way for childhood obesity
· Constant snacking and not burning the calories, a deadly case where even 1200 calories can also be threatening
In India the mushrooming growth of obesity at an alarming rate and leading to depression has become epidemic. Hence, to ensure consultation with a doctor at the right time one must take care of the following:
· If somebody is 30-35 kgs overweight from normal weight, he should seek doctor’s guidance and plan for surgery.
· With comorbidities like diabetes, hypertension, sleep apnea , if somebody is 20-25 kgs overweight from normal weight, he should seek doctor’s guidance and plan for surgery.
Aftereffects of a bariatric surgery:
The outcome of a bariatric surgery is tremendously positive that can be witnessed in the following ways:
· Loss of 30 to 40 Kgs in a year which is a consistent pattern for everybody regardless age
· Restoration of confidence, colossal change in personality, development of an optimistic outlook and extrovert nature in life
Side-effects of a bariatric surgery:
· The side-effects of a bariatric surgery is minimalistic as compared to other surgeries like that of a gallbladder.
· 1% out of 100% i.e. 1 out of 100 develops serious complication in a gallbladder operation, however a minor proportion like 0.2% out of 100% i.e. 1 out of 500 gets serious complication in a bariatric surgery
The immense success rates can be attributed to the perfection and standardization of operation in the last 40-50 years.
Procedure and duration of a bariatric surgery:
· It is an absolute team-work and cannot operate on the basis of one man army. Psychologist, dietician, anaesthetist, surgeon, assistants, apart from support services like respiratory physicians, diabetologist and others work together as an unit
· A bariatric surgery has 2 parts to it:
1. Reduce stomach size. Our stomach is about a litre or 1.2 litres. 80 to 90% of this is either removed or disconnected from the body.
2. Little plumbing done inside abdomen, so that whatever food he is taking is also not absorbed completely.
Thus there are two parts, one is restrictive part which reduces the amount of food taken and another is mar absorptive part i.e. some amount of food taken will not be absorbed and will be passed on with his stool.
· The combination of which part is done more depends on the patient. In general the duration of the surgery is 2 hours
Challenges and requirements post bariatric surgery:
· Diet as prescribed is not nutritive enough. Hence, one requires vitamin and protein supplements. Constant follow up with doctors and close monitoring on taking these supplements while losing weight.
· Even after loss of weight, consumption of supplements is to be ensured for a lifetime so as to avoid nutritional complications like hair fall, loose skin, vomiting etc.
The result in a bariatric surgery is not immediate, one will lose about a kg every week. Hence one can lose around 45-50kgs in 52 weeks. In the first month the weight loss would be immense because of the diet, which is particularly liquid. The challenge lies with starting normal diet after that, when the weight reduction constricts to just a Kg per week. After 6 weeks there is no food restriction and diet chart. One can take whatever food one wishes to. Intake of adequate protein and vitamin supplement especially extra protein in terms of powders is a must. It is strongly advised not to snack or consume food too frequently or in between meals. Having normal meals 3-4 times a day adhering to stringent timelines is the most appropriate. One may take protein powder when hungry. It is a myth buster that falls prey to weakness with loss of weight. On the contrary there is development of a lot of energy with weight loss.
In conclusion, Dr. Vishnu Kumar Bhartia from department of obesity and diabetic surgery (bariatric), CK Birla Hospitals (CMRI), would like to say “diet and exercise are the key to lose weight, otherwise bariatric surgery is an absolute risk free operation.”