Bariatric surgery: The poor man’s burden

One day last year, Syed Rabbani, 38, fed up with his neighbours’ snickers and stares, walked into his house and shut the door. He didn’t come out for six months.

A man weighing 162 kilos draws attention in a small village such as Sanjan Bandar (in the Valsad district of Gujarat). It also drew uncomfortable stares and mockery. Stewing in the gloom behind locked doors, Rabbani’s depression grew worse. His autorickshaw lay outside, abandoned.

Hope came in the form of a friend, Satish Sonar, the chief booking clerk at Umbargaon station, who told him of a miraculous procedure called bariatric surgery. Sonar had undergone bariatric surgery a year ago and lost almost 50 kilos. Rabbani followed suit. But he was only following a trend.

Dr Raman Goel, a well-known bariatric surgeon, who operated on Rabbani and Sonar, recounts how when he started out in 2000, he got two patients to operate on all year. Today he gets 20 cases a month. It’s also an expensive surgery. Goel puts the minimum price at Rs2 lakh. The post-surgery charges, though, push the total cost well over that figure.

Given the costs, it’s no surprise that the well-off constitute the bulk of surgery candidates. However, the numbers of people from lower socio-economic strata who are opting for it despite the high price tag has been growing steadily.

Rabbani spent Rs3.5 lakh on his surgery alone.

For an auto driver making Rs7,000 a month, it was money that he just didn’t have. But in a show of heartwarming solidarity, friends and relatives started a surgery fund in Sanjan Bandar. Generous donations poured in, and Rabbani made the 2-hour trip to Mumbai that would change his life.

Six months after his surgery, he’s 42 kilos lighter but Rs50,000 deeper in debt. And at 120-odd kilos, he’s still fat. His belly flops between his legs as he sits on a hospital chair but he’s happy. “At least I can walk now without gasping for breath. And I don’t fall asleep at the handle of my auto.” At his heaviest, he needed assistance to even get into his auto. Once in, he was unable to leave his seat till the end of his shift. He was dependant on others for little things like starting his auto. So the fact that he can step in and out of his auto without assistance, and that he can walk 10 feet without struggling for air makes him very happy.

It cannot be an easy decision for those struggling to make ends meet to get the surgery done. Especially since it often pushes them in to debt. Rabbani doesn’t regret it though, “It was the only thing I could do.” The perception surrounding bariatric surgery is that it’s an easy way out. A luxury for the lazy. Dr Mufazzal Lakdawala, who’s just done a high profile surgery on BJP president Nitin Gadkari, disagrees. “Morbidly obese people find it very difficult to walk a few feet, much less work out in a gym, and all these fancy diets have failed them time and again. Surgery is the only option for those who’ve exhausted all others.”

The beauty and her belly
Prabhavati K Devendar, 46, agrees with this premise. Her knees would swell up under her 120 kilo girth, and the pain was blinding. When her knee pain became so unbearable that that she couldn’t sleep at night, she knew she had to do something about her weight. Doctors suggested she join a gym. For the wife of a security guard living in a chawl behind Poonam Chambers in Worli, it was a cultural leap too far. She ordered the “golden chai” (a herbal tea claiming effective weight loss) she’d seen on TV. She ordered cartons of weight loss pills. They hardly make a dent. At her wit’s end, she sought out a solution from a famous Bombay doctor. He suggested surgery, and in August 2007, she got a gastric bypass done.

The way to Devendar’s tiny house is a winding path so narrow that she has to walk sideways at times. There’s a small yellow temple outside, decorated with Christmas streamers. A hole in the wall exposes the sea outside. Devendar sits on a tattered office chair outside. She doesn’t invite me in.

“Everyone in my family is jhadi (fat).  My father was overweight. My three sisters are fat, and my daughter is now over a hundred (kilos). She loves butter, she can’t live without it.” Devendar shakes her head ruefully. She takes out a black and white photograph, taken, it seems, a lifetime ago. In the photo a svelte and beautiful young teenager smiles radiantly at the camera. She has flowers in her hair. “That was me when I was 16. I was so thin. So beautiful.”

Then she had children. Four boys and a girl later, she couldn’t recognise herself in the mirror. It wasn’t just her knees that drove her under the surgeon’s scalpel. The taunts of her neighbours hurt even more than her knees.

“They used to taunt my husband. ‘Is she your mother?’ they would ask him. Imagine. He’s six years older than me.”

The surgery cost her Rs1.5 lakh. Her husband, who works at the nearby Poonam Chambers, took a loan of Rs70,000 against his monthly salary of Rs7,000. It took some time but recently he paid it off. It helps of course that all four of her sons are working now.

Occasionally she rues the fact that she can’t eat more than half a chapatti at a sitting. For a woman who used to polish off a 3-egg omlette, 2 maska paos (butter buns), and tea for breakfast, it’s quite a change of pace.

“It’s not that I don’t feel hungry. I do. But if I have anything more ulti ho jaati hai (I throw up).”

Surgery not the only option
Nutritionist Naini Setalvad doesn’t think that surgery is the only option for those who are morbidly obese. She’s not a fan of fad diets either. She should know. She lost 100 kilos through a balanced diet and exercise. “People in India don’t have any knowledge of nutrition or healthy eating. You can lose all the excess weight through a proper balanced diet and discipline.”

Rabbani, though, is convinced that surgery was the only way out. “I tried not eating anything between breakfast and dinner and I almost fainted while driving my auto.” Typical mistake, according to Setalvad. “They either go on unreasonable and ill-advised diets or buy pills off TV. These don’t work.”

Though his surgery has worked out well, it’s not all smooth sailing for Rabbani. He hasn’t even begun to pay his medical debts off. “I already pay Rs5,000 towards my auto-rickshaw loan. And the rest of the money goes for household expenses,” he says. “God knows what will happen. But at least I’m able to stand outside my auto and call out to customers.”