In Dec 2006, the Indian Health Ministry declared that it needed to wage a battle on two fronts, simultaneously fighting hunger and obesity. The health minister acknowledged that there is the problem of under nutrition on one side and over nutrition on the other side. The alarm bell started ringing over the past year he said. We have to look at this new generation of Indians; otherwise we will see a whole new generation of people at severe risk of diabetes.

India is one of the fastest developing economies. This economic boom has led to overall growth in consumer spending. The growth in malls and retail outlets has spread the 'fast food culture' from metros to tier 2 and tier 3 cities. 

India has the distinction of being in the top 10 fat countries in the world wherein 15% of the country's population is obese, 43% of adults in big towns are overweight and 17% of adolescent population is obese! These are some startling flab statistics. In spite of this we are still struggling to give 'obesity the status of a 'disease'. It is still considered as a cosmetic problem of people with low will power.

Obesity and diabetes are twin diseases with the risk of diabetes becoming higher with increase in body fat content. India is on the verge of becoming the diabetic capital of the world. By 2025, India will be home to more than 170 million diabetics. Heart problems, high blood pressure, high cholesterol, sleep apnoea, gastric reflux disease, joint pains, deep vein thrombosis, infertility psychological problems and social discrimination are various other problems which are a direct result of obesity'.

There are multiple treatment options in the form of diet and exercise, weight reduction pills and anti obesity (bariatric) surgery. Surgery is usually recommended for people with:

Body Mass Index (BMI) of 37 or over

BMI of 33-37 with other health problems like diabetes and heart problems etc

failed multiple dietary attempts to lose weight.

(BMI=weight in kgs / height in meter square)

According to the NIH conference in 1991, surgery is the only proven method of long term sustained weight loss for the patient with severe clinical obesity.

There are two basic types of surgery, the restrictive type and the malabsorptive type. All procedures are done laparoscopically (keyhole surgery). The restrictive type mainly consists of the popular gastric band and the newer sleeve gastrectomy. In the banding procedure an inflatable silicon band is placed around the upper part of the stomach. This restricts the quantity of food intake. In the sleeve gastrectomy two third of the stomach is removed surgically using staplers. This reduces the food intake and also leads to loss of appetite.

The other type is malabsorptive surgery which includes the gastric bypass and the biliopancreatic diversion (BPD). In a gastric bypass a small pouch of stomach is created using staplers and a loop of intestine is attached to it. The stomach and first part of intestines are bypassed. This leads to restriction of food intake coupled with malabsorption of nutrients. A gastric bypass is considered as gold standard surgery. It leads to resolution of diabetes within a week to 10 days.

These surgeries will lead to optimum weight loss within a year and a half. Along with weight loss there is resolution or control of all the obesity related problems like diabetes, high blood pressure etc. The complication rate of these surgeries is comparable to any other surgery like hip replacement or gall bladder surgery.

The flip side is that the patient cannot eat as much as they were used to consuming before. They need to relearn how to eat. Patients have to be on liquid diet for two weeks after the surgery and gradually progress to semisolids and then solid foods. Lifelong nutritional supplements like iron, vitamins and calcium are needed with a gastric bypass surgery. The follow up after surgery has to be stringent.

As all these surgeries can be done laparoscopically patients are usually up and about on the same evening and can resume normal activities within a week's time. India is slowly but steadily becoming a favorite medical tourism destination. Obesity surgery costs five times in the western countries and is coupled with a long waiting period.

It is high time that we recognize that obesity is not only a cosmetic problem but a silent kaleidoscope of deadly diseases which warrants treatment like any other disease in the world.