Politician Nitin Gadkari isn't the only one resorting to bariatric surgery to deal with crippling type-2 Diabetes and assorted obesity-related complications. As Dr Muffazal A Lakdawala, renowned obesity surgeon, who operated upon the BJP president tells us, Mumbai is waking up to the benefits of this life-saving procedure

Dr Muffazal A Lakdawala is a busy man. Upon his return to Centre for Obesity and Diabetes Surgery (CODS), his Hughes Road clinic, post a seven-hour surgery on a muggy Thursday evening, the renowned bariatric surgeon is juggling phone calls, follow ups with patients and a malfunctioning air conditioner. Finally, coffee cup in hand, he settles down for a chat with us, apologising for the 30-minute delay with, 'It's been absolutely crazy'. That's understandable, given that he just performed a widely-reported bariatric surgery on a high-profile patient, BJP President Nitin Gadkari, last week. Ten minutes into our conversation, he's interrupted by a phone call by one of Gadkari's aides, we presume, who calls to check about the 55 year-old politician's follow-up appointment. Just on cue, we think, considering the doctor was just telling us about the acute importance of post-operative care. Soon, we also learn why India needs to start worrying about obesity, and how the basics -- good food and exercise -- can prevent the nation's almost-inexorable march towards an epidemic that we aren't taking seriously enough.

Is bariatric surgery a cosmetic procedure?

No. It started out as a solution to obesity, but medical studies have now shown that it has more than an 80 per cent cure rate for type-2 Diabetes in obese patients after surgery. Bariatric surgery also acts as a resolution for other obesity-related complications, including hypertension and sleep apnea. It brings blood pressure, sugar and cholestrol under control. In fact, the results are so dramatic that, like in Mr Gadkari's case, insulin medication can be discontinued almost immediately after surgery. It's a life-saving procedure, not a cosmetic procedure. In fact, the International Diabetes Federation guidelines published two months ago said that it is imperative for bariatric surgery to be offered as a resolution to type-2 Diabetes patients of Caucasian origin with a BMI of 35 and above and Asians with a BMI of 32.5 and above.

Why has it become so popular?
In 2005, when we first started performing bariatric surgeries at CODS we did just two in that year. Since then, the growth rate in the number of surgeries has been phenomenal. In India today, surgeons must be performing 200 to 300 such procedures a month. And the reasons are plenty. It cures almost all obesity-related complications, from infertility to joint pains. Women who have been trying for a baby for years miraculously get pregnant after bariatric surgery, while people who have been struggling with sugar can dramatically reduce their insulin intake. Complications are almost non-existent, if there is proper post-operative care, and patients can start walking the very next day. A number of politicians, from Nitin Raut (Congress cabinet minister) to Vinod Tawde (BJP member of legislative council), have had the surgery performed upon them and gone back satisfied.

Has the number of obesity patients in India increased?
Yes. The world now has more overweight than underweight people. About two months ago, a study published by a pediatric journal has pegged 16 per cent of children as overweight and over six per cent as obese in Delhi, Mumbai, Kolkata, Chennai, Hyderabad and Bengaluru. India is staggering under a heavy load of type-2 diabetes patients, second only to China, according to a WHO report published last year. And that's a scary statistic. Obesity is a giant killer today, and government attention needs to be focused on combating it.

What are the reasons for this?
One cause is the Asian gene, also known as the 'thrifty' gene. Over centuries, in times of famine, this gene learnt to conserve whatever little food and nutrition it got, with the result that today, even in a time of plenty, it continues to conserve, leading to weight gain. Having said that, I always say genetics loads the gun, but you pull the trigger. Adolescents cannot continue to pile up junk food onto their plate and then say, 'I inherited Diabetes from my parents' when they start putting on fat around the age of 30. The increased disposable income of the middle class, as well as the easy availability of processed food, combined with the lack of physical activity, has led to this. We're staring at an epidemic.

What consequences does it have?
Type-2 Diabetes caused by obesity attacks people during their prime, productive years -- between the ages of 20 and 40 -- and losing young people to the disease is robbing the nation of manpower and resources. To add to that, Diabetes medication and treatment is an expensive recurring expenditure, which makes no economic sense.

What is the solution?
We need to go back to the basics -- eating right and exercising. Secondly, there needs to be government action. Today, the cost of bariatric surgery is high because the staples we use during the operation are not passed as life-saving equipment, and are therefore expensive. Although the perception is slowly changing, bariatric surgery is still seen as a weight-loss solution by many. It's a life-saving procedure, which can help you do away with years of insulin injections, knee problems and all the other ascending diseases that follow from obesity. It offers the chance of a better, healthier life, and people should take it.

What is bariatric surgery?
Bariatric surgery can be of three types: restrictive procedures that decrease food intake (Gastric Banding) and malabsorptive procedures that alter digestion (Gastric Bypass or Sleeve Gastrectomy). Gastric Bypass is the most commonly performed procedure, while Sleeve Gastrectomy is the only non-reversible procedure.
The surgery is conducted laproscopically and the hospital stay usually does not exceed two nights. 
Post-operative care is imperative to prevent any complications and ensure the success of the procedure in patients.