Shahid Akhter, editor, ETHealthworld spoke to Dr Abhay Agarwal
, Laparoscopic, Robotic and Bariatric Surgeon, Mumbai. He discusses the emerging trends in Diabesity and how bariatric surgery
is becoming more of a norm in the management of obesity.Diabetes and Obesity- the interlink
Obesity and Diabetes are very closely related to each other so much so, that we have coined a terminology called Diabesity. Obese individuals are very prone to develop diabetes especially in this part of the world where India is a diabetic capital of the world and we have the highest number of diabetics. Because obesity causes a layer of fat around your body and this layer of fat acts like a resistance to the same amount of Insulin, if an obese and thin individual secrets the same amount of Insulin, the obese is likely to develop the diabetes whereas the thin individual is not likely to develop diabetes. Managing obesity through weight loss
So typically the obese individual visits gym or a weight loss centre and they are subjected to diet and exercise. Studies have now shown that once you cross the BMI of 32, you cross a point of no return, after this, there is 95% failure with regular means of weight loss; conventional, non- surgical means. You will tend to regain most of the weight back within 5-7 years, whatever weight you have lost with diet and exercise is difficult to sustain because body develops a set point and the amount of weight you lose, the body tends to get back to that set point the moment you stop dieting and exercise.Current Scenario in Bariatric Surgery
Bariatric surgery is the fastest evolving field in general surgery today. When I started 17 years back we were hardly 20 of us, today there are about 100 bariatric surgeons. 5 years back we clocked about 10,000 cases, today we have clocked about 20,000 cases. So it’s one of the fastest evolving and most acceptable and most effective surgeries to cure morbid obesity and diabetes. If we tweak the bariatric part a little, we do it for uncontrolled diabetes; we call it metabolic surgery, this surgery completely takes care of your diabetes, cholesterol, blood pressure and other medical issues. So bariatric surgery has become more effective and safer if done in experienced hands.Maintaining Weight loss- Post Bariatric Surgery
This surgery is being effective to maintain whatever weight you have lost over a long period of time. Studies have shown that even after 15-16 years of bariatric surgery patients have maintained up to 75-80% of their lost weight. Yes, some regain is expected after 10-15 years because the stomach that we create, the small stomach pouch, it tends to expand with patients eating and lifestyle changes and they gain 10-20% weight back but then it’s still not 100% of what they have lost, they still maintain a lot of weight of their body for a long period of time.Current challenges in Bariatric Surgery
The current challenges are multiple: One is, bariatric surgery everywhere else in the world is covered by insurance, the Indian insurance regulators need to understand that this is not a cosmetic procedure, this is a life saving procedure, it is done for patients with co-morbidities like diabetes, blood pressure which themselves are life-threatening. This surgery actually cures these symptoms and these diseases, and gives patients a longevity, these patients tend to live a longer life and a healthier life. Some of the companies now in India have started accepting insurance claims; some of my patients have got them.
The other challenge is lack of training in our medical curriculum; in the medical colleges there aren’t any bariatric surgeons to train young budding surgeons. Just to give you a heads up, out of 20,000 general surgeons in the country we are about 6000-7000 laparoscopic surgeons, out of these 7000 laparoscopic surgeons there are hardly 100 active bariatric surgeons. So the numbers are very few precisely because of lack of training, not enough training centres and these need to be looked into, most training centres have to be setup.
Third are the challenges of the infrastructure. In bariatric, 250-300kgs patient require a special equipment; special OT table, special bed, special sitting area. So these hospital infrastructure needs to be geared up for a bariatric clinic.
The other challenges are the acceptability amongst the patients. Today in our country if a patient is diagnosed with diabetes, for e.g.; they try every other remedy, alternative therapies or Ayurveda, I am not saying that they don’t work but that is not the first line of treatment. They delay their diseases and come to visit the surgeon or diabetologist much later during the course of the disease. The acceptability for these procedures does work. I am not saying that metabolic surgery for every diabetic across the country, it is for those for few diabetics who are uncontrolled diabetics, and in spite of the best medical and other active therapies they are not able to control their diabetes. This surgery works wonders for them because it will save their organs from the damage.