Pune–based Dr Shrihari Dhorepatil, the first surgeon to conduct an open bariatric surgery in India in 1997, has watched how bariatric (weight loss surgery) surgery in India has evolved from being a life saving procedure to a treatment method. The surgery is now considered to treat obesity related to diabetes and other lifestyle-related disease. Dr Shrihari Dhorepatil, who was recently awarded the Lifetime Membership for International Federation For The Surgery of Obesity and Metabolic Disorder (IFSO), a rare feat as he is the only Indian lifetime member of the prestigious international body, which has surgeons from 40 countries as members, speaks to Alifiya Khan on how bariatric surgery has changed over 20years, new challenges and recent bad press.
Over the two decades, you have seen the bariatric surgery field evolve. Could you share your views on this transformation?
The two most perceivable changes are the change in surgical methods and people’s reception to bariatric surgery. When we started practice about two decades ago, bariatric surgery was not very popular. It was an open surgery fraught with risks and complication rate was high and strictly considered as a life saving procedure. Today most of the surgery are Laparoscopy or key hole surgery with less complication rate and a safer surgery with less side effects. This automatically translated into better patient response and with positive outcome, word spread faster. Comparatively the awarenes towards bariatric surgery and the positivity shown by patients is much better than yesteryears.
Last year, the American Medical Association voted to recognise obesity as a disease. Do you think such recognition will help better the cause of obesity surgery?
Firstly the World Health Organisation had classified obesity as a disease nearly 20years ago. However, I feel that the greater the awareness about obesity not being just another lifestyle disorder but a serious disease, will help, as it will make people to be alert and also reduce the stigma and myths surrounding obesity. Greater the emphasis laid that obesity is a disease, it will make family physicians also regard it more seriously and recommend intervention. And now we are seeing that it is also helping in getting reimbursements from insurers for such treatments.
Obesity surgery is being regarded as a quick fix for all weighty issues, is it that simple?
No, it’s not that simple and it’s definitely not an alternative for those who wish to lose weight quickly. Only if a patient fits into the parameters of being obese patient requiring surgery for health reasons, can they be considered. If one thinks that a surgery will allow them to lose weight and they don’t need to make any lifestyle modifications, they are wrong. Following such surgeries, a person has to be on a specific diet/exercise regime for months and in most surgeries, it follows automatically as person will not be able to eat beyond a certain limit or certain things. Obesity surgery is making a lifetime commitment to fitness and health.
What are the newer applications/methods of bariatric surgery to be expected in coming years?
During obesity surgery we observed that those patients who were obese and were diabetic, benefited post surgery as their diabetes also came under control. So it was well known that losing weight could help control diabetes. But off late in a few centres across the world, bariatric surgery is being clinically tested on a few non-obese diabetic patients who can undergo bariatric surgery for diabetes, but this is yet to be ratified. Besides that the exciting surgical methods being carried out in few centres are endoscopic sleeve where a plastic tube is passed in stomach so that only a certain amount of food comes in contact, which limits the amount. Also a surgery called gastric pacemaker which in simple terms means a device put over stomach which helps in remote controlling hunger are two very exciting new things in bariatric surgery that we look forward.
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