ABSTRACT
Obesity is a global epidemic. Its prevalence is increasing rapidly and India is no exception.1 Obesity is not only a cosmetic problem but is associated with a number of diseases including type 2 diabetes mellitus (DM), hypertension, obstructive sleep apnoea syndrome (OSAS), polycystic ovarian disease syndrome (PCOS) and non-alcoholic fatty liver disease (NAFLD). It is also a risk factor for a number of malignancies. Obese persons tend to have a shorter life span when compared to an age-matched normal population. Among the options for weight reduction, dietary and lifestyle modifications are generally advised as the first line of treatment. A large amount of scientific literature has suggested beyond doubt that non-surgical treatment of morbid obesity does not lead to a meaningful weight loss.2–5 Almost all (90%–95%) those who do lose significant weight regain it.3 As far as pharmacotherapy is concerned, there is almost nihilism. Most of the drugs have been withdrawn due to side-effects. Even after discounting for side-effects, these medicines lead to a nominal weight loss of only 5–10 kg. In 10-year data reported by the Swedish Obese Subject (SOS) study, weight loss in the nonsurgical group was minimal compared to that in the surgical group (1.5% v. 25%).4 This non-randomized study included over 4000 patients and the 5-year mortality rate in the surgical group was significantly lower than that in the non-surgical group (0.68% v. 6.17%).4 We often come across patients who initially refuse surgery due to fear of complications but later seek surgery. During this period they gain more weight and the comorbid conditions worsen. Bariatric surgery provides a means for considerable weight control and has also been effective in the resolution of obesity-related comorbid conditions.5 The long-term mortality due to obesity also decreases after bariatric surgery.4