For the common man, being overweight and being obese could mean the same. But there is a subtle difference. Being overweight is 'to weigh more than is normal, necessary or allowed, especially having more body weight than is considered normal or healthy for one's age or build', while being obese is 'having increased body weight, caused by excessive accumulation of fat'.
 
Obesity is a medical condition in which excess body fat has accumulated to the extent that it may have an adverse effect on health, leading to reduced life expectancy and / or increased health problems.
 
While it is true that many people have themselves to blame, what with excessive craving for food or sweets or lack of exercise, it can be caused by other factors also.
 
Obese persons can be the 'butt' of their friends'  jokes. People can have fun at one's 'expanse' besides expense. Obesity at a nubile age can leave one with only a 'fat chance' to get the ideal kind of life-partner.
 
But, obesity, certainly, is no laughing matter.
 
Some can be genetically inclined to put on weight. Hormones or hereditary reasons can cause it or even medical conditions like sleep apnoea or lipid problems. Experts say that many physicians have very little training in nutrition and weight management. Besides, the media tends to promote an unhealthy diet and at the same time fails to highlight helpful health and dietary information. The present-day culture promotes an unhealthy diet and lifestyle, including fast food.
 
It was in this backdrop that the news of a Bariatric surgery, performed in Mangalore on a man from Coimbatore who could lose a neat 45 kgs of weight under Dr Roshan Shetty's care, interested many people and we decided to talk to him.

Dr Roshan Shetty MS FLS (Adv Lap) FACS DNB (GI Surg) hails from a family of doctors. Besides being a consultant surgical Gastroenterologist and advanced laparoscopic surgeon, he is head of the department of Minimal Access Surgery and Surgical Gastroenterological Surgery at the City Hospital Research and Diagnostic Centre at  Pound Garden in Kadri in the city and senior associate professor of Surgery at Yenepoya Medical College, Deralakatte on the outskirts of the city.
 
Dr Shetty completed his MBBS at Kasturba Medical College, Mangalore in 1994 and MS at JJM Medical College, Davangere in 1999. He specialized in keyhole surgery at Coimbatore and pursued a Fellowship in Minimal Access Surgery for two years.
 
His curriculum vitae runs into over a dozen pages. In brief, he is life-member of several medical organizations, examiner for undergraduate studies at the Rajiv Gandhi University for Health Sciences (RGUHS), has authored / co-authored dozens of papers, attended a good number of conferences and seminars and is involved in several voluntary organizations.
 
Dr Shetty answers some frequently asked questions here:
 
Treating obesity requires a multi-disciplinary approach. Can you enumerate a few?

Yes, it does. Primarily the doctor should assess if patient is overweight, obese, morbidly obese or super obese. In case the patient is overweight or borderline obese, then he / she should be motivated to reduce weight by regular exercises, diet etc. But if the patient belongs to other categories, then a thorough evaluation of his / her body habitus, co-morbities like diabetes, hypertension, cardiac status, thyroid profile, body steroid level (cortisol), respiratory status (sleep apnoea is quite common in these patients), peripheral vascular disease(DVT), joint problems (gout, osteo-arthritis) etc . So a dietician, endocrinologist, physiotherapist, intensivist and operating surgeon need to evaluate and plan the procedure. Once the patient has attained sufficient weight loss, he / she has to be evaluated for any cosmetic problems like redundant sagging skin , wherein a plastic surgeon helps to contour the body.
    
Perhaps you would recommend this surgery for only morbid cases of obesity.
   
Yes. Patients whose body mass index (BMI) is more than 30.  But recent studies have shown that Asian patients are considered obese when BMI is around 27.5 and above.  Another new procedure is being standardized in the West, and it is called Ileal interposition / transposition which has helped in curing type 2 diabetes even in normal body weight patients.
     
Slow and sustainable weight reduction is normally recommended, e.g. carefully guided and strictly supervised diet regimens. Hence are there any chances of side-effects of instant or faster-than-normal weight loss?

It is true that you should lose weight gradually, but in patients who are obese it is not possible. It has been found that a lot of hormones play a role in appetite stimulation in these patients. These are reduced only after certain types of obesity surgery. A few side-effects are gall-stone disease, fractures, iron and vitamin deficiency, calcium deficiency and in patients who are super obese, there may be saggy skin which leads to bad cosmesis etc. but no life-threatening side-effects have been found so far.

The risk potential of gall-stone development and decrease in bone density leading to chances of fractures necessitates gall-bladder removal at the same time, especially in patients undergoing gastric bypass and duodenal switch obesity surgeries. These patients need to be put on calcium supplements.
 
Once the weight is reduced this way, if proper care is not taken to sustain the condition, can any lapse lead to reverting to the previous conditions, say, in an irreversible way?
 
No, but there are a few cases reported in literature that there have been cases of renewed weight gain after 4 or 5 years post surgery, especially in sleeve gastrectomy patients and these patients have undergone a completion procedure in the form of gastric bypass.
 
These are the days when there is pressure on time and patience. People want maximum things to be done in minimum time. Now that this kind of surgery has proved to be far from time-consuming and not involving long lying-in stay in the hospital, do you foresee a spurt in demand for it?
 
Not in terms of saving time to lose weight. But obesity is now considered to be an endemic disease which is going to attain pandemic proportion. Already in the US more and more patients are undergoing these procedures and the government has made it mandatory to all insurance companies to provide health insurance to these patients as iit is no longer a cosmetic problem.
 
Preparatory hospitalization, surgery and post-surgical care - in all, how many days does the process entail?
   
Anywhere between a week to ten days. But they need to be on continuous follow-up for a year and a half at least.
 
What exactly is done to reduce the appetite and craving for excessive food  intake in the patient? Something like downsizing or re-structuring of  the stomach?
 
This procedure is a restrictive procedure where in the size of the stomach is reduced, to roughly around 40-50 cc capacity. Also there is a hormone produced by the upper part of stomach (fundus) called Ghrelin. This makes the person feel hungry. So during surgery this part of the stomach is removed as we form the tube, thereby the patient feels less hungry and whenever he wants to eat he / she can eat only small quantities.

Is there any specific requirement, or in other words, who exactly qualifies  for this surgery, in terms of body mass index (BMI)? The western standards  specified for patients could differ from Asians, whose body  structure could be different.

Patients who have body mass index (BMI) of more than 30 are suitable candidates. In Asian patients it is acceptable if BMI is more than 27.5.

Dr Roshan Shetty can be contacted at : shetty4949@gmail.com

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