While it may sound like an easy way to shed those extra kilos, scalpel-assisted surgery works only for those whose obesity gets in the way of their life and work

DOWNSIZING

While it may sound like an easy way to shed those extra kilos, scalpel-assisted surgery works only for those whose obesity gets in the way of their life and work

Incredible though it sounds, Esther Kapinga, 40, lost 20 kg in 18 days: over one kg each day. The lawyer from Kinshasa in the Democratic Republic of Congo weighed an incredible 241 kg before she got surgery done to reduce the size of her stomach to a third of its natural size.
“The surgery will help Kapinga lose 100 kg in 18 months to two years, along with resolving her medical problems such as sleep apnea, joint pains and breathlessnesss,” says Dr Muffazal Lakdawala at Fortis Memorial Research Institute, Gurgoan, who did her laparoscopic 'sleeve gastrectomy' in October.
Sleeve gastrectomy involves removing two-thirds of the left side of the stomach, which makes the smaller stomach resemble a sleeve or a tube roughly the size of a banana. It limits the capacity of the stomach to 60 cc-150 cc.
“This procedure eliminates the hunger-inducing hormone called 'Ghrelin', which results in the patient feel full after eating a little. This way, they lose 80-85% of their excess body weight over two years,” says Lakdawala, who also heads the Centre for Obesity & Diabetes Surgery in Mumbai.
The other popular weight-reduction surgery is a gastric bypass surgery, where a gastic pouch is created to bypass a part of the small intestine.
Bariatric surgery has grown ten-fold in the last decade, with surgeons doing 4,000 cases a year in 2010 compared to a handful a decade ago when it just started. Over the past two years, Lakdawala has operated on BJP heavyweights Nitin Gadkari, Venkaiah Naidu, NCP’s Nawab Malik and Nitin Raut.

Siddhesh Bhise, 37, a Mumbai-based businessman, incurred huge losses for two years in his manufacturing unit producing carbon brushes, as he couldn't oversee its operation for more than six hours a week. Weighing 179 kg, there was little Bhise could do to change his situation. Simple tasks such as climbing stairs, driving, and even walking or standing for more than 10-minutes at a stretch, left him breathless.
“I saw fear in my five-year-old daughter's eyes,” says Bhise, who eventually underwent a weight-loss surgery in April this year. “She was intimidated by my size and worried that something bad might happen to her dad.”
In India, 13% women and 9% men are either overweight or obese, shows the National Family Health Survey (2005-06). “Apart from the obvious weight loss, it treats obesity-related disorders such as diabetes, hypertension, joint pain, sleep apnoea (interrupted breathing while sleeping), acid reflux and diabetes,” says Lakdawala.
The surgery is usually done laparoscopically, with the surgeon operating through four small incisions in the abdomen. It costs Rs 3-4 lakh and needs up to three days of hospitalisation. The patient is back on his feet immediately after surgery.
Kapinga's life is already inching back to normal, literally. “Her size is a problem. We were forced to request airlines to keep the seat next to her empty and when it was not possible, we booked two seats,” says her nephew Blaise Musemena, 29, who accompanied her to new Delhi for the surgery. Apart from increasing mobility, the weight loss lowered her back and knee pain and helped her sleep better.
Bhise is 72 kilos lighter within seven months, and has resumed work with a vengeance, clocking in 12 hours a day. "I feel so good each time I look in the mirror," he says. His goal is to reach 80 kg in five months, and “fit into his old branded clothes.”
Only last week, Bhise cropped his hair short, after which his daughter insisted that he drop her right at her school gate, so that she could “show off new Papa” to her friends. “For two years, I didn't go to my daughter’s school," Bhise says, smiling. “Looks like I have a lot of catching up to do.”

PROS AND CONS

SLEEVE GASTRECTOMY
New less invasive procedure Purely restrictive procedure, but also reduces appetite
Wide variation in weight loss (50-80% excess weight)
Quicker procedure (45-60 mins), no cutting of bowel Dumping syndrome unusual, Less risk of nutritional complications because no malabsorption Early complication rate 3-7% Hospital stay usually 1-2 nights

GASTRIC BYPASS

Well established, "gold-standard" with decades of experience
Restrictive and malabsorptive procedure
Generally more predictable and consistent loss of around 70% excess weight
Usually 1½ - 2 hours and involves dividing stomach and bowel Dumping syndrome common Nutritional deficiencies common without lifelong vitamin and mineral supplementation Early complication rate 3-10% Hospital stay 2 nights

FAT-LOSS SURGERY 
Bariatric surgery or stomach bypass is recommended for the very obese - BMI of over 35 and BMI 32.5 - who have not been able to lose weight through diet and exercise. It should not be done in children, people over 65 years, and people at risk of blood clots, lung problems, and bed sores.

WATCH THAT WEIGHT

Body Mass Index (BMI) is an accurate indicator of healthy weight. It is calculated by dividing weight (in kg) by height squared (in metres). BMI = Weight (in kg) / Height (in metres) x Height (in metres)

INDIAN CUT OFFS
Below 18.5 kg/m2: Underweight
Between 18.5 kg/m2 and 23 kg/m2: Normal
Between 23 kg/m2 and 24.9 kg/m2: Overweight
Over 25 kg/m2: Obese