Ozempic and other weight loss medicines’ popularity has changed conversations around obesity.
Yet, according to Dr Ashish Gautam, principal director, robotic and laparoscopic surgery, Max Super Speciality Hospital, Patparganj, New Delhi, bariatric surgeons continue to see patients with severe obesity every day.
“The concern is not the number on the weighing scale alone. Severe obesity can affect blood sugar, blood pressure, sleep, mobility, liver health and several other systems,” he explained. This is one reason Indian obesity guidelines use different thresholds when assessing the need for treatment. Dr Gautam further explained that although the term ‘bariatric surgery’ may make the treatment seem primarily related to weight, in practice, the metabolic benefits are equally important: “Procedures such as sleeve gastrectomy and gastric bypass reduce the amount of food the stomach can accommodate and alter hormonal signals involved in hunger, satiety and glucose regulation. “Patients with severe obesity and co-morbidities such as diabetes, sleep apnea, fatty liver disease, hypertension or joint problems often need to lose a large amount of weight to improve their health. Bariatric surgery can result in significant and sustained weight loss and improvement in metabolic health in appropriately selected patients,” Dr Gautam explained.
He cited the ICMR study published in The Lancet Diabetes and Endocrinology in 2023, which estimated that around 35 crore adults in India have abdominal obesity, while about 25 crore have generalised obesity. The clinical assessment, therefore, goes beyond body weight, he stressed.
“BMI, waist circumference, diabetes, hypertension, sleep apnea, fatty liver disease, joint problems, previous treatment response and overall health all matter,” Dr Ashish stated, adding that for Asian populations, metabolic complications can also occur at lower BMI levels. “A patient with severe obesity and type 2 diabetes, for example, may need a treatment capable of producing substantial and sustained weight loss as well as improving metabolic control,” he explained.
