Dr Vitish Singla, Bariatric Consultant, Minimal Access and GI Surgery at Fortis Hospital, Mohali MBBS, MS, MCh, FMBS- AIIMS Delhi, IBC Fellow (London, UK)
An exceptional Laparoscopic, Bariatric and Gastrointestinal Surgeon, Dr Vitish Singla, Consultant at Fortis Hospital, Mohali, strongly advocates to treat obesity as a disease. In a candid conversation with The Week, he enlightened us about the increasing burden of obesity in our country and the availability of advanced treatments for obesity like the Allurion Balloon.
In India, how rampant is obesity and the concerns arising out of it?
Awareness about obesity is far from adequate in India as the general public is unaware about its risks. Unlike westerners where the fat is spread across the body, Indians are prone to visceral obesity, meaning fat is concentrated around the belly and waist. Operating visceral fat is riskier. Also, the population prone to diabetic and cardiovascular problems is on a constant rise which makes the situation more perilous. There is also a genetic component to obesity in 30-40 percent of the population.
The most common co-morbid risks involved in obesity are Type 2 Diabetes Mellitus (T2DM), Obstructive Sleep Apnoea (OSA), Cardiovascular problems, Non-alcoholic Fatty Liver Disease (NAFLD) and 13 types of cancer, especially breast cancer in women, who are more prone to obesity as compared to men. Obesity also involves capacity intake and output where there is a need to strike a balance between food intake and the calories burnt. Over 135 million individuals in India are overweight and the regions of Punjab, Delhi NCR and Tamil Nadu have a higher prevalence of obesity. A recent update revealed that around 40 percent of women are obese in Punjab and Delhi/NCR region.
Is obesity an ‘urban’ disease?
Earlier, obesity was said to be more of an urban issue, but now it has penetrated semi-rural and rural areas, irrespective of the economic strata. While about 70-75 percent obesity cases are found in urban areas, it is also rising rapidly in rural areas. Modern day lifestyle with easy access to fast food and sweet beverages round the clock is a problem to contend with. Further, the disturbed sleep patterns or insufficient sleep, which again is leading to obesity in the community. Mechanization/automation requiring little or no physical labour has also aggravated the situation as life has become more sedentary.
Could you ally the misconception that bariatric surgery has serious side effects?
Bariatric surgery is usually not the first option for weight loss. The first option is lifestyle and dietary management. Majority of the patients who come to us have already tried and failed lifestyle and dietary measures to control weight. The other option is prescription of the oral drug Rybelsus. It is being used off label for weight loss but is not yet FDA approved. Recently, Allurion Balloon, a non-interventional methodology requiring no endoscopy, surgery or anesthesia has come up as an option for weight loss. It is a small capsule taken orally, and once inside the stomach the balloon is inflated occupying space which gives a feeling of satiety or in other words douses hunger pangs.. Thus, the patient tends to eat less. It helps in 10-15 percent total weight loss in four months’ time. The balloon has a Release Valve which dissolves after four months and the balloon gets expelled out of the body on its own.
Does Allurion Balloon treatment deprive obese patients of vital micronutrients?
We prescribe multi vitamins throughout the Allurion balloon treatment along with regular dietary follow-up. After that, though the amount of food intake is reduced, the patients can eat anything. But having said that, obesity itself leads to some form of micronutrient deficiency because of inflammation, which reduces absorption of nutrients. In an Indian survey, it was found that almost 60% of obese people without any treatment were deficient in micronutrients. The advantage of the Allurion balloon is that the side effects are negligible and it is non-invasive.
At what stage do you recommend bariatric surgery and what are the possibilities of a relapse?
According to the earlier guidelines, bariatric surgery was advised for patients with BMI 35 and above (with co-morbidities) or for BMI greater than 40. In 2022, after a period of 31 years, there has been a recent update in the guidelines by ASMBS and IFSO. Currently, the BMI cut-off for bariatric surgery is greater than or equal to 30 with obesity related co-morbidity or a BMI of 35 or above without any co-morbidity. Further in Asian population Bariatric surgery can be considered at a BMI or more than 27.5 especially if there is poorly controlled Diabetes Mellitus. Bariatric surgery results in around 25-30% weight loss which corresponds to a 25-30 kg reduction for a 100 kg person over 12-18 months. It is the norm to gain some(4-5kg) weight 2-3 years after undergoing bariatric surgery, after which the weight stabilizes and remains so for a long time.
What is the way forward for weight control treatments?
Our focus is on holistic treatment, which involves a bariatric surgeon, dietician, a psychologist and a trained gastroenterologist. The Allurion Balloon treatment is the latest hi-tech treatment available and needs no endoscopy. Laparoscopy has been around for a while and robotic surgery is growing. For the next 10-20 years obesity will remain a problem because people lack awareness about the disease and the treatment options available. As in the west, physicians must direct obese patients to weight loss clinics or specialists.
Fortis Mohali is the first in Tri-city Hospitals (Chandigarh, Panchkula and Mohali) to have recently launched the Allurion Balloon technique in Northern part of India, which is gradually gaining popularity.
FOR APPOINTMENTS CALL 7272872728
Sector 62, Sahibzada Ajit Singh Nagar, Punjab - 160062
