To Stomach The Scalpel

he discreet little office in south Mumbai could pass for just another corporate MNC headquarters. But for two incongruencies: the extra wide chairs in the waiting area and the comically large cutouts of a fat man with mysterious objects sticking out of their tummies. We are at bariatric surgeon Dr Muffazal A. Lakdawala’s Centre for Obesity and Diabetes Surgery (CODS), the frequent refuge of high-profile celebrities. Today, Lakdawala is a celebrity himself, the fame of his clients—mostly political heavyweights—having rubbed off. Nitin Gadkari is his latest catch. The BJP chief hopes to lose forty kilos after having gone under the knife. And he isn’t alone. Bariatric surgery is all the rage now. “I think I have operated on every overweight builder in Mumbai in the last year,” laughs Lakdawala. Not to mention 20 to 25 ministers, from the ncp’s Nawab Malik to state cabinet minister Nitin Raut to the BJP’s Vinod Tawde and other patients who prefer to remain nameless.

Photograph by Sanjay Rawat

But back in ’05, he was just another laparoscopic surgeon. “In 2005, we started cods and did just two cases. In 2006, it jumped to 1 to 2 cases a month. Now, we do about five cases a day,” he says. So far this year, there have been 4,000 bariatric surgeries performed in India. But it’s still at a nascent stage. In the US, they have about three lakh surgeries a year. “There is a huge potential in India, where we are facing an obesity epidemic,” says Lakdawala. Right now, the surgeries cost about Rs 3.5 lakh. Many people are happy to pay, but if the government declares the staples used in the surgeries life-saving equipment, the cost can be halved. Lakdawala has already made bariatric surgery an option for more Indians by arguing successfully that Asians are more prone to obesity-related disorders at lower BMIS (Body Mass Index) than are other races and that endocrinologists should offer the procedure as a treatment option for diabetics, with insulin and medicines.

But for all the good this “miracle surgery” purports to do, the benefits are yet to be studied through randomised control studies. Its popularity seems to be a purely word-of-mouth phenomenon. After giving dieting and exercising a try without success, patients of means are looking to the procedure as a way to lose weight quick. But does it really work; is it truly a miracle cure? No, says nutritionist Rujuta Diwekar who has had “relapsed” bariatric cases come to her. “When the procedure first arrived, it was mostly rich industrialists, bored housewives and politicians who did it. Now, even young people, especially girls, in their 20s opt for this procedure,” says Diwekar. She narrates the harrowing case of a 23-year-old girl, who couldn’t eat anything for four months except four sips of cold coffee six to seven times a day. They had to undo her surgery. She weighed 85 kilos before the surgery, but shot up to 130 kilos after her stomach was unstapled. The procedure, she says, is becoming a money-making racket, like everything else in the “weight loss industry”. “What surgeons don’t tell you is that post surgery, it becomes difficult to eat normally. If they don’t follow diet and exercise guidelines, they can put on weight again.”

It’s only been seven years since the first Indian patients went under the knife. “Bariatric surgery is still an experimental procedure. The long-term effects—after 10 years—are not known. It is one of the options to treat diabetes and should be tried only after medication, diet and exercise have failed in the morbidly obese,” says endrocrinologist Dr Shashank Joshi. He says eating right and regular exercise have better long-term impacts than surgery. In an age of “evidence-based” medicine, Dr Joshi points out, the long-term effects of bariatric surgery have not really been studied rigorously, even though the short-term effects—within six months to two years—seem promising. “It is an emerging option and we need to do studies that follow up on patients. I have seen patients regaining weight in two to three years,” he argues.

Bariatric surgeon Dr Shashank Shah of Pune’s Laparo-Obeso talks about how it has come to be a fad among a section of society to rush for the surgery. “We only operate on patients with ailments like diabetes, insulin resistance, high blood pressure, joint problems or on patients with BMIS of 38 and above,” says Shah. He emphasises the importance of “after surgery” care. Which is why his clinic has a Dream Slim Club that meets with the patients every month to prevent “extreme” behaviour like not exercising at all or consuming high-calorie colas.

But for now, Lakdawala’s patients will hear none of it. Some of them are deliriously happy, even if they aren’t quite sure what surgery they have had. Kavi Kumar, ‘Dr Haathi’ to TV viewers, went for it last year and lost 75 kilos. Unsure of exactly which version of the surgery he has had, Kumar is also secretive about what his daily diet consists of now. But he is unequivocal in praising Lakdawala for his weight loss “miracle”. Far more forthcoming is Nawab Malik, who underwent the procedure three years ago and has maintained a stable weight between 78-80 kilos. “I was 110 kgs before. Now, I feel good. My blood pressure is under control now and I had a borderline sugar condition that has disappeared,” he says. Of course, fried food and sweets are off his diet plan and he exercises every morning. “The point is, I tried exercising and dieting before the surgery and it didn’t work. After the surgery, I have kept the weight off. I have no problems recommending it to other people. It works,” he says. The jury may be out on stomach staples, but the patients are firmly under.