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Fat & forever eating' Get your tummy stapled

Mumbai, March 2: This surgery gives the severely overweight new hope: a new, tiny stomach.

If you are grossly overweight, your body mass hovering around a three-digit figure in kilograms, and have tried to diet and exercise for years with no result, then you could see an obesity surgeon. He will cut your fat out — by pinching in your stomach.

The practice, gaining ground in the West, is yet to become popular in the country, said Dr Sanjay Borude, secretary, Obesity Society of India, formed about four months ago. But the procedure, he said, is the only long-term solution to severe or morbid obesity.

At the first Obesity Surgery National Congress that started here on Friday, four patients were operated on at Breach Candy Hospital yesterday. The operation was shown live at a city hotel to the gathering of around 200 surgeons from across the country.

Morbid obesity, said Borude, is not just bad health but a disease, recognised by the World Health Organisation as one. It leads to cardiac problems and diabetes, and there is the risk of death at a young age. It also causes great psycho-social impairment as extremely overweight persons become the butt of society’s jokes and start considering themselves outsiders.

This obesity occurs when a patient’s body mass index (BMI) exceeds 35. The index is calculated by dividing an individual’s bodyweight in kilograms by the square of his height in metres. For example, if someone’s weight is 68 kg and height 1.6 m, then his BMI is 68 divided by 1.6 x 1.6.

The normal BMI is 23. A person 1.52 m tall and weighing 53 kg would be close to having the right BMI. The same person would suffer from morbid obesity if he weighed 90 kg.

Obesity surgery is of several types, said Borude, who along with Dr Hari Dhorepatil, president, Obesity Society, has operated on 100 patients across the country over four years.

In one kind of surgery, the patient may get his stomach stapled to leave about 50 ml space in the stomach for food to go in. The rest 1,000 ml is stapled. So the patient feels full after eating as little as a morsel and his body is forced to use up the stored fat, thus reducing the weight drastically. Instead of stapling, the surgeon may use a gastric band to reduce stomach space.

Another technique connects the patient’s stomach to the large intestine, bypassing the small intestine, thus promoting less absorption of food. The excess food passes out with stool.

There are side-effects, too. According to Borude, there has been no mortality, but patients have suffered vomiting, vitamin deficiency, wound infection and resuturing of external wounds. But on the whole, the surgeries have been successful.

After around two years, however, the bodyweight plateaus. A person weighing 160 kg, said Borude, may lose 60 kg, but after that the weight hits a constant. Then, it is up to the patient to try the exercise-and-diet regimen.

Morbid obesity occurs more in women, Borude said. Three of the four patients operated yesterday were women. The surgery costs around Rs 1 lakh; it could also cost more.

Research into obesity surgery started in the West about 50 years ago when doctors realised that for many morbidly overweight persons, diet and exercise did not work.

While morbid obesity remains a specialist’s concern, the rise of obesity in general in India is sparking concern. Generally, women far outweigh men and the upper classes far outweigh the lower.

According to a survey that the Nutrition Foundation of India conducted in Delhi, 32.2 per cent of middle-class men were overweight with a BMI greater than 30, compared with 50 per cent women. In the slums, only 1 per cent of men was overweight and 4 per cent of women.

“Abroad, the pattern is different, with the affluent less overweight than the poor, because the former are more aware. In our country, having money or education doesn’t mean being aware,” Borude said.

“It is the sedentary lifestyle of the affluent classes, especially among women, that is to blame,” he said.

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