Bariatric surgery in India has got an ardent follower in veteran playback singer SP Balasubrahmanyam (SPB), who has been crooning praises of the weight loss procedure.
At the recent launch of the Happy Losers’ Club, a weight loss and healthy living initiative by a Chennai hospital, the 70-year-old revealed that in 2012 he underwent the surgery that changed his life for the better.
"I am a happy loser," a proud SPB announced.
Prior to the surgery, he weighed 126 kg and maintaining a diet and exercise proved to be of little help.
Further panegyrizing, the six-time National Award winner and Guinness World record holder was quoted by The Times of India as saying, "Most people from the cinema industry will never admit to having undergone bariatric surgery. But not me. I lost 35 kilos in the surgery and it has made me a better singer, and given me a better quality of life."
Obesity and its effects
India is reportedly home to the third-highest number of obese and overweight people.
Obesity brings with it an increased risk of developing several major health complications including heart disease, high blood pressure, Type II diabetes, cancer, sleep apnea and can also disrupt people's sex and social lives.
Furthermore, persons with obesity also face ridicule and stigmatization from the society. A recent study, funded by the American Society for Metabolic and Bariatric Surgery, found that Americans blame obesity on willpower, despite evidence it’s genetic.
Cosmetic surgery or a necessary procedure?
Dr V Amar, a senior consultant and Minimal Access Metabolic and Bariatric Surgeon based-out of Hyderabad, says he performs over two dozen such surgeries every month.
Persons with Body Mass Index or BMI of 23-24.99 per metre square (pms) qualify as overweight, where as those with a BMI of 25 and above, and 30 and above fall in the obese and severely obese categories respectively. Bariatric surgery is usually performed on those who are severely obese, he states.
He explains that traditional methods such as dieting and exercising do not bring about permanent weight loss in severely obese people.
When we consume food, some of the energy is used for metabolism, some amount is converted to heat, and the remaining is stored as fat.
"Body fat is under the control of guts hormones like Gherlin (stimulates appetite) and GLP-1 (suppresses) appetite. How much fat should be stored, where should it be stored and where will it be distributed is decided by our hormones," Dr Amar states.
Food and lifestyle habits often influence these hormones.
While persons with BMI lesser than 30 can permanently reduce weight with the help of dieting, exercise or naturopathy and even liposuction, Dr Amar says, this will not work for 96 out of 100 severely obese people. "Even if they do lose weight, it will just be temporary. Because when you fight against hormones, they will fight back."
Another doctor, a Chennai-based plastic surgeon who wished to remain anonymous, however said that only those with BMI 40 or above could be considered for bariatric surgery.
"Not everyone can qualify it. Those with morbid obesity or BMI of 40 and over, or those suffering from life-threatening conditions related to obesity will need the surgery," he said.
The National Health Service in England states that "Weight loss surgery is only recommended for people with a body mass index (BMI) of 40 or more, or a BMI of 35-40 and a serious health condition that could be improved if you lose weight, such as type 2 diabetes or high blood pressure."
Other prerequisites may also include the age, medical and psychological condition of the patient and whether or not they are ready to make permanent lifestyle changes after the surgery.
Researchers over the years have argued that BMI is not the most accurate way to measure body weight.
This is because BMI does not differentiate between fat and muscles. So, an individual with more muscle mass but less fat in their bodies, like wrestlers, could have a high BMI and yet may not be obese.
Similarly, as Martin Binks, an associate professor of nutritional science at Texas Tech University, told USA Today, a low BMI is not always a sign of good health. "If Arnold Schwarzenegger is sitting in my office, I’m not going to tell him he’s suffering from obesity.”
"Likewise, a frail, elderly person who has lost muscle and weight because of aging, illness and inactivity may have a low BMI but high body fat and many health risks," the report states.
It has also been contended that BMI does not distinguish between the different types of fat in the body, some of which is harmful while others are not.
Bariatric surgery falls under two main categories- Procedures that restrict food intake by reducing the stomach size, and "physiological operations that alter several hormone levels in the body resulting in reduced fat set point".
Some of the side effects include hair fall, vitamin deficiency risk, and gall bladder stones.
"But those can be treated and are minimal as compared to the advantages," Dr Amar says.
Depending on the kind of surgery, the procedure can cost anywhere between Rs 2.5 lakh to Rs 5.5 lakh.
A personal choice
Gayathri Asokan, a Kochi-based dietitian and nutritionist, says that opting for bariatric surgery is a "personal choice".
"People can first try a balanced diet plan and if that does not work, they can choose to undergo the surgery."
She adds that many of her clients have lost weight by following a modified diet plan but that it is the "follow-up" later that matter most.
According to Rachit Dua, a Delhi-based advanced certified fitness coach and nutritionist, "The best way to overcome obesity is by making certain positive lifestyle changes, exercising and adopting a proper fat-loss diet. A healthy lifestyle eventually helps to overcome diseases and enhances the quality of life."
"Saturated fats do not make you fat, excess of sugar and carbohydrate does. So it is generally advised to strictly stay away from sugars and trans fats. Also, do not over-exert your body with exercise, gradually increase the intensity," Dua told IANS.