As obesity rates in India continue to rise, more and more people are seeking surgery for weight loss. And while the procedure is safe and effective for most people, complications can occur as in the case of a senior cabinet minister who was recently hospitalized due to an infection that developed after undergoing a gastric bypass in Delhi.
But are patients and their relatives getting enough warning before they opt for the surgical route to weight loss? Gopal Agrawal, a Mumbai-based banker, says he wasn't aware of these risks till he lost his father in 2012 to a complication developed after undergoing a sleeve gastrectomy. Agrawal alleges that the surgeon — a reputed name in Mumbai — did not brief his family about risks of the surgery. "The surgeon never mentioned to us that there are chances of infection or complications with this surgery," says Agrawal. His 56-year-old father who suffered from high blood pressure, knee pain and sleep issues was operated in a private hospital in Mumbai. Within 48 hours of surgery, Agrawal's father — who weighed 116kg — developed breathing problems due water accumulation in lungs. He never recovered from this complication and died four months later. Agrawal has filed a case in consumer court and with the Maharashtra Medical Council against the bariatric surgeon as well as a physician and an endoscopist.
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Earlier this year, 48-year-old TV actor Rakesh Diwana also succumbed to complications after undergoing weight-loss surgery at a hospital in Indore. There are more such cases of weight-loss surgery gone wrong, and they all raise worrying questions about its safety.
"The way bariatric surgery is promoted as 'cure' for diabetes is unethical," says Dr Arun Bal, a diabetic foot surgeon and member of the Indian Journal of Medical Ethics. "It is a fairly new technique and we still don't know its long-term effects on the body. This surgery should be considered as just one of the treatment options, that too only for patients who have uncontrollable diabetes and the risk of developing co-morbidities," adds Dr Bal. He further warns against unscrupulous surgeons who advise this surgery, which costs up to Rs 3 lakh or more, to obese, diabetic patients who don't have the time or patience to make lifestyle changes like diet correction to manage their condition.
Even teenagers below the age of 15 are undergoing this surgery despite international guidelines against this. Short-term risks associated with the surgery include respiratory problems, infection, lung collapse, haemorrhage etc while long-term risks include nutritional deficiency and complications that may require future surgery.
But there are many in the medical community who favour this method. Dr Mufazal Lakdawala, a well-known metabolic surgeon claims a 96% remission rate in his diabetic patients who have undergone surgery.
Dr Satish Kumar, consultant endocrinologist at Bangalore's Narayana Health City, says trials to test the safety of this procedure are ongoing. "We can't say what will be its long-term effects until we get confirmed results," says Dr Kumar. Patients above the age of 65 and below 18 should not be advised this surgery as well as those with untreated thyroid condition, hormonal imbalances and depression, he cautions. "The patient should be emotionally stable and not have eating issues," he adds. Dr Kumar is currently treating patients who underwent bariatric surgery three to five years ago and now are again putting on weight. "These patients were not able to follow the strict nutritional guidelines associated with bariatric surgery and hence are now back to battling weight," says Dr Kumar.
While the jury is still out, it may be best to exercise caution. Dr Bruce M Wolfe, a digestive health surgeon at Oregon Health and Science University, sums it up in a 2013 editorial published in JAMA: "Bariatric surgery does result in substantial weight loss with excellent diabetes control but is offset by initial high cost and risks for surgical complications. The optimal approach for treatment of obesity and diabetes remains unknown. The answer will only come from more well designed, randomized trials."
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