A 16-year-old boy, weighing 160 kg, cannot go to school as he struggles to move around; a middle-aged woman on an airplane requires a seat-belt extension… Dr Kenneth D'cruz, Head of Department, Surgical Gastroenterology, Oncology and Minimal Access Surgery at Bangalore's Narayana Hrudayalaya Multi-speciality Hospital, sees many patients like these every month, with the rising incidence of morbid obesity in India.
Morbid obesity is an irreversible stage of obesity, and any weight loss through medication and crash dieting is temporary, explains Dr Pradeep Chowbey, Director, Max Institute of Minimal Access, Metabolic and Bariatric Surgery.
Anvesha Soni, 23, says she was obese since eight. “I quit studying hotel management because my weight came in the way of selections for training, with recruiters telling me to my face that I was too fat,” she recalls. Finally, she opted for surgery after she hit 99 kg. Today, Anvesha weighs 61 kg and is happy she gets ‘clothes her size' more easily.
“In India, people who are morbidly obese will have a body mass index (BMI) exceeding 32.5. We get about 35-40 morbid obesity cases a month,” says Dr Chowbey.
As the name indicates, life expectancy decreases in those with morbid obesity. As Dr Chowbey says, “…you'll rarely find old morbidly obese people because they die prematurely”.
Apart from genetic factors, environmental and lifestyle changes are believed to play a leading role in the rise of obesity.
“In India, obesity has become a disease of the rich and upper-middle class. While in the US, it is a disease of the poor,” says Dr Muffazal Lakdawala, founder of the Centre for Obesity and Diabetes Support (CODS) in Mumbai.
Childhood obesity
A survey of more than 4,000 children across 15 cities conducted last year by Bangalore-based Edusports indicates that obesity is setting in earlier than adolescence, with 23 per cent of the children showing a higher BMI.
Dr Chowbey blames this on the growing preference for eating out and junk food. Parents who are in a mood to indulge their children should take them to a gym instead, he jokes.
The dangers of unhealthy eating are compounded by a sedentary lifestyle for an increasing number of children. In space-starved cities, shrinking play areas mean less physical activity for growing children. Many schools don't have a playground. So children end up spending their play hours in front of the TV or with videogames.
Health risks
When Abha Suchak weighed 110 kg, her weight was only one of her many problems. She used a wheelchair as her knees could not support her weight. Abha, now 40 kg lighter after surgery, says: “Because of my weight, I suffered from hypertension, osteoarthritis, sleep apnoea, hyperinsulinemia (which made me eat a lot) and depression. With weight loss, all my medical problems went away.”
The health risks of morbid obesity are many. “Anyone who is morbidly obese is inherently unhealthy. They have a greater chance of complications with any illness — whether it's treated medically or surgically,” says Dr D'cruz. Other common health risks associated with obesity include diabetes or ‘diabesity', high blood pressure, heart problems and liver failure.
Loss of self-esteem
Before opting for surgery, Abha battled with obesity for 20 years: “I stopped going to weddings and parties because people were ‘over concerned', always asking me to diet.”
She says obesity also has a ‘mental casualty'. “Obesity gives rise to depression, and it works the other way round as well. It's a vicious cycle.” Dr Chowbey agrees, “Most obese people have anxiety and depression, and many find comfort in food.”
Recalling the dark moments, Abha says, “I didn't want to pass, or look into a mirror. I felt like a prisoner in my own body… I reached a point where I used to think it was the end of life and there was no way out.”
Treatment
According to Dr Lakdawala, while yoga, diet and exercise may work for those who are overweight, it may not be enough for morbid obesity.
“The only permanent way to help morbidly obese people from 18-60 years of age is through surgery — such as gastric bypass, gastric sleeve, gastric band, which are done through laparoscopy,” says Dr Chowbey.
Although doctors say there are no side-effects from the surgery, once a patient starts losing drastic amounts of weight, the skin becomes loose and saggy, and many opt for plastic surgery to correct this.
Dr D'cruz does not recommend surgery for morbid obesity caused by thyroid or adrenal problems.
As far as medication is concerned, Dr Lakdawala says currently there are only two FDA approved drugs in the market for weight loss, while the rest have been banned because of side effects.
Despite the many challenges and mental trauma faced by those with morbid obesity, Dr D'cruz chooses to focus on the success stories. “I once treated a 65-year-old woman from Orissa who became breathless when she walked just 4-5 steps,” he says and recalls her husband's uncontrolled happiness when, ten days after surgery, she walked from the entrance of the hospital to the out-patient department.