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Bariatric Surgery

Obesity is a metabolic condition due to accumulation of excess fat in the body. It is a chronic, progressive disease which can impair the functioning of various organ systems in the body and significantly reduce life expectancy. In medical terms, a patient having BMI > 30kg/m2 is considered obese.

Body mass index (BMI) is one of the simplest ways to quantify obesity. It is calculated by dividing the weight in kilograms by the (height in meters) 2.

BMI =    Body weight in kg
-------------------------
(Height in meters)2

According to western data, persons with BMI> 25 kg/m2 are considered overweight and those with BMI > 30 kg/m2 are considered obese. Due to certain genetic peculiarities, Indian people show increased tendency for abdominal obesity and visceral fat deposition which makes them prone for metabolic diseases like diabetes, hypertension and dyslipidemia at lower BMI levels as compared to Western people. Hence, BMI > 23 kg/m2 is the cutoff for normal in Indian scenario and those with BMI>27kg/m2 are considered obese.

BMI Table

Category BMI Treatment
Underweight < 18 Supplements
Normal 18-23 ----------------
Overweight 23–27 Diet and exercise
Obese Class 1 27-32 Diet and exercise
Obese Class 2
Obese Class 3
Morbid Obesity
32- 37
>37
Bariatric Surgery

(To calculate your BMI click here. . .)


Obesity is on the rise in India with approximately 5 % of the population falling in the morbidly obese category. Taking into account the total population, this figure is very high in absolute numbers amounting to more than 30 million people making India the third most obese country in the world after USA and China. This situation is much worse in the metropolitan cities with almost two thirds of the population being overweight or obese. The north Indian cities of Delhi and Chandigarh are amongst the top ranked cities in terms of obesity prevalence.

Bariatric surgery is the most effective treatment for morbid obesity and associated diseases. The persons who have BMI > 32kg/m2 with significant associated diseases or those with BMI> 37kg/m2 with or without associated problems are the ones who would greatly benefit for such a procedure.

The choice of the appropriate surgical procedure is determined by many factors including age, gender, comorbidity, diet, lifestyle choices, etc and is finalized after detailed discussion with your bariatric surgeon.

A simple questionnaire has been prepared to help you decide whether you are a proper candidate to undergo bariatric surgery. If the answers to most/all of the questions are yes, then you qualify for bariatric surgery and can expect to significantly benefit from the procedure.

1. Are you morbidly obese (BMI>37 kg/m2) or obese (>32 kg/m2) with significant obesity associated diseases like diabetes, heart disease, osteoarthritis, etc.?
2. Have you tried conventional weight loss methods like diet and exercise or other alternative methods and not able to maintain your weight?
3. Is your weight static/constantly increasing?
4. Is your age between 18 years and 65 years?
5. Do you understand the details of the surgical procedure proposed for you?
6. Are you committed to lifelong changes in diet and lifestyle which are mandatory after bariatric surgery?
7. If you suffering from stress/depression, has it been treated by a psychologist/psychiatrist?
8. Do you have realistic expectations from your bariatric surgery and committed to long term follow up

These are a group of surgical procedures which help in weight loss. It is a laparoscopic surgery which involves reducing the size of the stomach or bypassing part of the intestine to decrease the intake and/or absorption of food. The surgical procedure is carried out under general anesthesia and hence it is painless. The small incisions make it cosmetically appealing and the hospital stay is usually not more than three days.

It is different from liposuction in that there is no fat taken out from the body at the time of surgery. Rather, the restriction of food intake and metabolic changes after the surgery result in caloric deficit which causes a gradual and sustained weight loss.

It has been proved in numerous studies and metaanalysis that bariatric surgery is the most effective treatment for morbid obesity and associated diseases. Though some of the procedures are surgically reversible, the weight loss incurred after the surgery is generally permanent.

The different bariatric surgical procedures have undergone tremendous evolution with time. New procedures are constantly being developed and older procedures are being discarded. There are three different types of procedures – Restrictive, malabsorptive and combined

Restrictive procedures decrease the capacity of the stomach and consequently reduce the amount of food which can be taken at one time by the patient. The common procedures include sleeve gastrectomy, gastric banding and gastric plication.

Malabsorptive procedures decrease the amount of food which is absorbed through the intestine like jejuno ileal bypass. These procedures are usually not performed nowadays.

Combined procedures both reduce the stomach capacity as well decrease the absorption of food by the intestine and hence result in greater weight loss. The examples of such procedures are gastric bypass and bilio pancreatic diversion with duodenal switch.

The choice of the appropriate surgical procedure is determined by many factors including age, gender, comorbidity, diet, lifestyle choices, etc and is finalized after detailed discussion with your bariatric surgeon.


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