Dr Kamal K Mahawar, Honorary Consultant Surgeon, Sunderland Royal Hospital, UK, has joined Indraprastha Apollo Hospitals as Senior Consultant, Bariatric & Metabolic Surgery and set up Obesity & Metabolic Surgery Centre. He also highlighted major concerns and called for immediate reforms in treatment of obesity and related disorders.
“Accurate diagnosis of obesity should be done using Body Content Analyzer as BMI is proving out to be unreliable in diagnosing obesity in South Asians. Besides, there is evidence that diabetes and other metabolic problems start in Indians at a lower BMI. So the definition of obesity in Indian context needs to be revised. For diabetics, medical guidelines making body in UK (NICE) are considering revising the BMI down to 30, as a criterion for bariatric/metabolic surgery. Even our endocrinologists should implement this and suggest bariatric surgery to obese diabetic patients with BMI more than 35 for inducing long term remission. It is safe, effective and in patient’s interest,” said Dr Mahawar.
According to Dr Mahawar, bariatric surgery needs advanced laparoscopic skills and is not for part-time surgeons. Just like general surgeons used to perform craniotomies and nephrectomies in the past but now these are being done by neurosurgeons and urologists; they also need to consider giving bariatric surgery away to dedicated bariatric surgeons who take interest in comprehensive obesity management. If they are really interested in the specialty, they must prove adequate training before they start it and also maintain their skills by performing reasonable volume.
Some surgeons and hospitals are promoting robotic bariatric surgery aggressively for bariatric surgery. However robotic bariatric surgery has no established advantages in bariatric surgery. Dr Mahawar advises to roll it out cautiously and wait for the evidence to emerge. Similarly, there are myths about cool sculpting as well. Coolsculpting is not a weight loss method or a treatment of obesity. He says he has come across patients who want ‘laser treatment for obesity’, and that is not true. Coolsculpting is only for remodeling for small areas of fatty deposits and was only approved in 2010; it is not a treatment of obesity.
“Private insurance companies need to be educated about the fact that patients who undergo such a surgery may not require knee replacements and procedures such as angioplasty or bypass, thus reducing the future liabilities of the insurance company. “They could consider giving approval to select surgeons in select centers, who are not only able to demonstrate training and track record but also willing to submit their data for independent audit,” recommended Dr Mahawar.
“Obesity prevention and management needs to be organised at a public level before it becomes an all consuming threat and we need a comprehensive government strategy to tackle this. Public sector hospitals need to be funded to perform bariatric surgery as obesity is rapidly migrating downward to include lower middle and middle classes in India. This will be the only way to create a sustainable work force for tomorrow and also improve results of this surgery. We should develop a national database for record keeping and all surgeons must enter, at least their early data, into it to know surgical safety in India and in due course, this will improve results further,” added Dr Mahawar.
EH News Bureau
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