Why is bariatric surgery a viable option for people with uncontrolled diabetes?

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In 1999, Heena Shaikh of Pune became the first woman in the country to have a bariatric operation at the age of 29. “I had just had a Caesarean section to birth my baby.” I began to gain weight and eventually reached a weight of over 125 kg. “My high blood pressure made things worse,” Heena explained. While her mother and brother were originally opposed to the procedure, Heena recalls that her blood pressure levels returned to normal after the surgery. “I recently started using anti-hypertension medications in the last several years,” said the 52-year-old, who weighs 89 kg.

Aneeta Sanas, a 66-year-old Pune resident who teaches meditation and other programmes at her centre, grimaced as she remembered her diabetic condition 14 years ago, when she had to undergo five insulin shots. “Dr. C S Yajnik, my diabetologist, told me about the bariatric treatment, which at the time seemed radical. I weighed 100 kg at the time and chose to have the surgery. My weight is now constant, ranging between 68 and 69 kg. Sanas added, “In addition, my diabetes has been treated and my blood sugar levels are under control.”

Obesity has become a severe health issue in the country, requiring surgical intervention to avoid life-threatening complications. However, the number of bariatric procedures performed to treat this problem has not increased in lockstep. According to surgeons with the Obesity Surgery Society of India, since the country’s first bariatric treatment in 1999, the number of surgeries has increased to over 15,000 each year, despite a demand of nearly four lakh.

“When it comes to the percentage of people who are obese compared to the number of people who have bariatric surgery, India is one of the lowest in the world.” The figures are insignificant in comparison to the importance of the issue. Obesity is not a cosmetic concern, and there are few medications available to treat uncontrolled diabetes. As a result, we can’t just tell the patient to walk, exercise, and eat less. Such patients’ metabolisms are so poor that losing weight through traditional ways is impossible. In such circumstances, bariatric surgery is a lifesaver, and the numbers need to be far higher than they are. Dr Praveen Raj, president of the Obesity Surgery Society of India (OSSI), told The Indian Express that “we should be doing three to four lakh procedures every year but we are only doing a fraction of that right now.”

Liposuction is a cosmetic procedure; bariatric surgery is a life-saving procedure.

Dr. Shashank Shah, a past president of the OSSI and a bariatric surgeon in Pune, couldn’t agree more. Despite the fact that there are a lot of people who need bariatric surgery, he claims that only about 1% of them get it. Furthermore, failed liposuction cases, which were clearly used as a band-aid, illustrate the need to treat severe obesity with bariatric surgery.

Chetana, a 21-year-old Kannada starlet, died of heart arrest while having liposuction recently. She exemplifies how liposuction might be misconstrued with bariatric surgery. Liposuction is used to remove excess fat and sculpt the body’s shape, however it does not address the core cause of obesity. “Bariatric surgeons do not perform liposuction,” Dr Raj stated.

Obesity and accompanying co-morbid diseases can be effectively treated with bariatric and metabolic surgery. The Insurance and Regulatory Development Authority of India included bariatric and metabolic surgery in health insurance for treating obesity in 2019.

A growing public health problem

According to the National Family Health Survey-5 report, the percentage of overweight or obese women in India has climbed from 21% in 2015-16 to 24% in 2019-20, while the percentage of overweight or obese males has risen from 19 to 23%. According to a research published in January in the Indian Journal of Surgery titled “Bariatric and Metabolic Surgery in India: Where Do We Stand,” India ranks third in the world with over 135 million obese people, after the United States and China. Over 1.9 billion persons worldwide are overweight, with 650 million being obese. According to the report, obesity is one of the top causes of death, accounting for approximately 2.8 million deaths worldwide.

Overwhelmed with diabetes

In 1997, the World Health Organization proclaimed obesity to be an epidemic. According to a paper published in the Indian Journal of Surgery, the Asian population is more prone to visceral obesity and is more likely to acquire diabetes and other obesity-related diseases at a younger age. According to the International Diabetes Federation, diabetes affects about 9% of the adult population in India, with certain states reporting rates as high as 21.9 percent. Dr. Srihari Dhorepatil, who performed the first bariatric surgery in Pune, claimed that in other nations, this operation has become a major method of treating diabetes and metabolic syndrome.

“Most European and North American countries, as well as Brazil and even a small country like Taiwan, have embraced bariatric surgery in large numbers because they see obesity as a diabetic issue and treat it accordingly,” Dr Raj said. Dr. Shah believes that the monetary burden has been significantly reduced because medical insurance now covers bariatric surgery as a therapy for obesity in various countries, including India. “We started with roughly 5,000 procedures each year and have increased to over 15,000 in the previous few years.” We’ve also begun training over 400 surgeons to meet the demand,” Dr. Shah explained.

Despite the fact that the OSSI has established a registry to examine various procedures and results of bariatric interventions, doctors admit that there are currently no official statistics. Dr. Raj, on the other hand, cited a 25-year Swedish Obese Subjects experiment that revealed that patients who had bariatric surgery had a lower risk of dying from a heart disease. “There have been studies comparing the safety of bariatric surgery to gallbladder surgery, and both have a death rate of 0.2 percent,” Dr Raj stated. Prasad Kelkar, a Pune resident who underwent bariatric surgery 12 years ago, vouchs for its effectiveness. “At the age of 26, I weighed 145 kg and had a 48-inch waist. Going to restaurants used to make me feel self-conscious. I had extreme acidity and was in excruciating pain. My weight has dropped to roughly 80 kg since the surgery, and instead of six paani puris, I can comfortably have three. “It’s enough to make me feel satisfied,” he stated.