What is Bariatric Surgery? Risk, Complications, and Side Effects

What is Bariatric Surgery? Understanding Gastric Bypass and Its Benefits

Bariatric Surgery or weight loss surgery is done to help you lose excess weight by making changes to your digestive system.

Gastric bypass is one of the most common types of bariatric surgeries or weight loss surgeries being performed all over the world. Gastric bypass surgery is also done to reduce your risk of life-threatening weight-related health problems, including:

Type2 Diabetes Mellitus
Heart disease
High blood pressure
Severe sleep apnea

The Gastric bypass and other weight-loss surgeries are typically done only after you’ve tried to lose weight by improving your diet and exercise habits.

In general, gastric bypass and other weight-loss surgeries could be an option for you if:

Your body mass index (BMI) is 40kg/m2 or higher.
Your BMI is 35 to 40 kg/m2 and you have a serious weight-related health problem,
such as type 2 diabetes, high blood pressure, or severe sleep apnea. In some
cases, you may qualify for certain types of weight-loss surgery if your BMI is
30 to 34 and you have serious weight-related health problems.

This surgery requires permanent changes to lead a healthier lifestyle and long-term follow-up plans that include monitoring your nutrition, your lifestyle and behavior, and your medical conditions.

Risks of Gastric Bypass Surgery:

Risks associated with the surgical procedure are few and rare. They might include:

Excessive bleeding
Infection
Blood clots in your legs
Lung or breathing problems
Leaks in your gastrointestinal system

All the above-mentioned risks and complications can be identified early and taken care of only at a high-volume and experienced center with staff specially trained in Bariatric Surgery.

Long-term risks and complications of weight-loss surgery vary depending on the type of surgery. They can include:

Bowel obstruction
Dumping syndrome, causing diarrhea, nausea, or vomiting
Gallstones
Hernias
Low blood sugar
Malnutrition
Ulcers
Vomiting

After gastric bypass and other types of weight-loss surgery the diet begins with liquids only, then progresses to ground-up or soft foods, and finally to regular foods.

You’ll also have to undergo frequent and regular medical checkups to monitor your health in the first several months after weight-loss surgery. You may need laboratory testing, blood work and various exams at fixed intervals to monitor the nutritional profile.

You have to keep all of your scheduled follow-up appointments after weight-loss surgery. It is mandatory to see your doctor immediately for any unusual symptoms or complications. You don’t need to weigh yourself frequently. Weight is monitored by the bariatric nurse and dietician at regular intervals. You might not lose enough weight or regain weight after any type of weight-loss surgery, even if the procedure itself works correctly. This weight gain may be due to loss to follow-up or excessive liquid calorie intake. To help avoid regaining weight, you must make permanent healthy changes in your diet and get regular physical activity and exercise, and follow all the instructions by your bariatric dietician.

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Do I qualify for bariatric surgery?

Growing Importance of Bariatric Surgery: How to Qualify for Bariatric Surgery

Growing Importance of Bariatric Surgery

Since, progressive generations are growing heavier with increased association with other metabolic disorders – diabetes, hypertension, and dyslipidemia. There has been an increasing role of bariatric surgery in the management of obesity and its associated co-morbidities. Technological leaps in the field of Laparoscopic Bariatric Surgery as well as Robotic Bariatric Surgery have led to the evolution of bariatric surgery from a major, uncommon, and often dangerous surgery with doubtful outcomes to a much safer, routine procedure with assured results.

Evolution of Bariatric Surgery Criteria

Initially, it was a difficult task to elect candidates who could undergo bariatric surgery. In 1991 the National Institutes of Health (NIH) consensus statement for the first time defined clear universally acceptable criteria for patient selection. This statement was revised and re-defined as more and more data began to be analysed subsequently. The cut-off BMI to undergo surgery was lowered over a period of time.

Types of Bariatric Surgery

Starting with Gastric Bypass surgery, in which Roux-en-Y gastric Bypass being the gold standard, nowadays Gastric Sleeve Surgery is becoming more and more popular among surgeons since it is relatively simple to perform with similar post-operative outcomes.

Shift from Weight Loss to Metabolic Surgery

With the understanding of the metabolic syndrome, of which obesity was just one part, there was increasing interest in the role of surgery in the resolution of co-morbidities, particularly diabetes and dyslipidemia.

The increasing incidence of diabetes and cardiovascular disease even at lower BMIs, particularly in specific populations such as Asians led to a demand to consider these surgeries for selected candidates with low BMIs also. The emphasis shifted from ‘weight loss’ surgery to ‘metabolic’ surgery. It was suggested that perhaps action points for Asians should be 2.5 BMI points lower i.e. at 32.5 and 37.5.

New Eligibility Criteria and Recommendations

With this background, the International Diabetes Federation (IDF) released a position statement on 28^th March 2011 supporting surgery to treat Type II diabetes in obese patients. It defined new lower BMI criteria for patient selection as explained in the table below.

Eligibility and prioritization for bariatric surgery based on failed non-surgical weight loss therapy ⁺, BMI, ethnicity ⁺⁺, and disease control.

BMI range	Eligible for surgery	Prioritised for surgery
< 30	No	No
30 – 35	YES – Conditional ⁺⁺⁺	No
35 – 40	YES	YES – Conditional ⁺⁺⁺
> 40	YES	YES

+ In all cases, patients should have failed to lose weight and sustain significant weight loss through non-surgical means, and have type II diabetes that has not responded adequately to lifestyle measures (+/- metformin) with HbA1c < 7%.

++ Action points should be lowered by 2.5 BMI points for Asians.

+++ HbA1c > 7.5 despite fully optimized conventional therapy, especially if weight is increasing, or other weight-responsive co-morbidities not achieving targets on conventional therapies.

Impact and Endorsements

The new recommendations significantly lowered cut-off BMIs making many more patients eligible for surgery. Theoretically, an Asian patient with a BMI as low as 27.5 could be a candidate for metabolic surgery, provided other conditions are met. This is a significant shift from the previously recommended cut-offs.

These have received widespread attention in the medical community and have been endorsed by several medical bodies – The American Heart Foundation (AHA), the American Medical Association (AMA), The American Society of Metabolic and Bariatric Surgeons (ASMBS), and The American Association of Clinical Endocrinology (AACE).

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Side Effects of Bariatric Surgery

Understanding the Side Effects of Bariatric Surgery: What You Need to Know

Overview of Bariatric Surgery

Bariatric surgery is increasingly being accepted as a viable option for treating morbid obesity and its associated diseases such as diabetes mellitus and hypertension. Surgery provides long-term sustained weight loss as well as resolution of co-morbid conditions.

The benefits of bariatric surgery are numerous but there are also a few risks and side effects associated with various bariatric surgical procedures.

Common Bariatric Procedures in India

The most common bariatric surgical procedures performed in India are:

laparoscopic sleeve gastrectomy,

laparoscopic roux-en-y gastric bypass, and

laparoscopic mini gastric bypass.

Immediate Side Effects of Bariatric Surgery

There are a few immediate side effects that can happen after bariatric surgery like bleeding, leak, intestinal obstruction, and venous thromboembolism. The side effects due to malnutrition or undernutrition are seen in the long term, particularly after laparoscopic gastric bypass surgery.

The incidence of bleeding is less than 4% in patients undergoing bariatric surgery. Most cases can be managed by blood transfusions alone. Some cases might require laparoscopy to stop the bleeding. A leak from the anastomosis site or sleeve staple line occurs in about 0.7% to 5% of the patients. If the leak is early, re-laparoscopy with identification of the leak and its closure is done with adequate drainage, bowel rest, and antibiotics.

Similarly leaks after a mini gastric bypass can be managed early by drainage and conversion of the procedure to Roux-en-Y gastric bypass along with a feeding tube in the intestines. The other rare immediate problem can be that of wound infection which is managed by dressing and antibiotics. Obesity is an independent risk factor for thromboembolism which is the clotting of blood in the veins of the body particularly the legs. This is best avoided by taking heparin injections for the first few days after the surgery and wearing graded pressure stockings for a few weeks. Early active mobilization is the best precautionary method.

Long-Term Side Effects and Nutritional Deficiencies

Lately, there can be obstruction of the intestines due to various factors which result in pain and distension of the abdomen along with vomiting. The possible causes usually are smoking, and the formation of ulcers. This can be identified by doing an endoscopy or a CT scan. Treatment of the possible causes can be done immediately.

After bariatric surgery, iron, vitamin B12, and other micronutrient deficiencies can occur. Iron deficiency occurs in patients within 2 to 5 years after surgery. Supplementation with iron can reduce iron deficiency significantly. Calcium and vitamin D absorption are impaired after gastric bypass as well. We obtain a complete blood count and iron, B12, calcium, folic acid, vitamin D, levels before surgery, 6 months and 1 year after surgery, and yearly thereafter. We recommend routine daily supplementation with a multivitamin, iron, vitamin B12, and calcium along with vitamin D supplementation depending on the serum levels.

Dumping Syndrome

Dumping syndrome is a common side effect after Roux-en-Y Gastric Bypass (RNYGB) surgery. This usually occurs due to poor food choices. It is related to the ingestion of refined sugars (including high fructose corn syrup) or high glycemic carbohydrates. It can also occur with dairy products, some fats, and fried foods.

The fact is that these foods will interfere with long-term weight loss and should not be eaten anyway.

Symptoms start typically 20-30 min after the food. It includes sweating, flushing, lightheadedness, tachycardia, palpitations, desire to lie down, upper abdominal fullness, nausea, diarrhea, cramping, and active audible bowel sounds.

Conclusion

In summary, although bothersome and sometimes worrisome, dumping syndrome is not a life-threatening problem. Patients need to learn about and read basic nutrition labels. The benefit is that it teaches patients quickly that certain foods and additives cannot be tolerated. Patient compliance and commitment to long-term follow-up are mandatory.

In short, the side effects of bariatric surgery are rare. Timely
identification and intervention are the keys to preventing serious complications.

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Obesity in Metros

Addressing the Growing Concern of Obesity in Metros: Causes and Implications

Obesity is a medical condition when a person carries excessive weight. It increases the risk of various non-communicable diseases like type 2 diabetes, hypertension, etc. For weight maintenance, energy intake should be equal to energy expenditure. Imbalance leads to underweight and obesity.

Adults residing in Metropolitan cities are increasingly becoming obese. Even Childhood obesity is also emerging as a major health concern in metros. The reasons being excess consumption of calorie-dense fast food, processed food, ready-to-eat food, etc. Portion sizes that fast food restaurants offer contribute to excessive energy intake. As most of the fast foods are made of refined cereals, fat, and sugar. There is a drastic decrease in energy expenditure owing to reduced physical activity as people use motorized means of transport and spend most of their awake time sitting glued to Television, mobile phones, and Laptops. The present work culture in the corporate and public sectors is also responsible for obesity in adults. Long working hours, late night shifts, sitting jobs, sleep deprivation, excessive tea and coffee consumption, and unhealthy snacking in offices predispose obesity.

Obesity surgery in India is being performed to facilitate weight loss in children and adults when non-surgical treatment strategies fail. Although GI surgeons and general surgeons in India are performing obesity surgery specially trained bariatric surgeons are now available. Bariatric surgery is growing as a specialty in itself. as surgery constitutes only a small part in overall management. A fully equipped, and well-staffed department is a must for the dedicated follow up which is so essential for good outcomes. A dedicated high-volume Bariatric surgery unit in a tertiary care hospital is your best bet if you are seeking bariatric surgery.

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Bariatric Surgery Hospital in Delhi

Choosing the Best Bariatric Surgery Hospital in Delhi for Effective Weight Loss

Delhi is the popular destination for medical tourism. Patients from every corner of the world come to Delhi, India for bariatric surgery. Many hospitals in Delhi are currently performing the surgery. Bariatric surgery hospitals in Delhi are specialized centers with trained and expert surgeons and specialized paramedic staff. In Delhi, both private and government hospitals are performing bariatric surgery. To name a few, private hospitals like Indraprastha Apollo hospitals, Max Healthcare, BLK super specialty, Fortis, Medanta hospital are performing bariatric surgery in Delhi. Premier government hospitals like All India Institute of Medical Sciences (AIIMS), Ram Manohar Lohia (RML), Lok Nayak Hospital (LNJP) are also performing bariatric surgeries.

Roux-en-y- gastric bypass surgery is the “gold standard” procedure. It refers to a type of bariatric surgical procedure in which the stomach is divided into a small pouch and then the small intestine is rearranged and connected to the newly created pouch. Roux-en-y- gastric bypass surgery is used to promote weight loss and also improve weight related issues like type 2 diabetes, hypertension, high cholesterol, arthritis, sleep apnea, infertility, hypothyroid, joint pain, backache etc.

Obese patients have a compromised vitamin and mineral intake due to excess energy consumption. Drastic weight loss post roux-en-y-gastric bypass surgery compounds the already present vitamin and mineral deficiencies. Patients who undergo Roux-en-y-gastric bypass surgery should attend regular follow-up sessions with a registered dietician so that deficiencies could be identified and treated at an early stage.

Behavioural Disorders in Obese: Important to Evaluate before WLS

Addressing Behavioral Disorders in Obese Patients: The Role of Laparoscopic Bariatric Surgery

Laparoscopic Bariatric Surgery and Its Effectiveness

Laparoscopic Bariatric surgery is one of the most effective treatments of morbid obesity, resulting in significant and sustained weight loss as well as improvement of various other related co-morbidities and quality of life.

Prevalence of Psychosocial Disorders in Morbidly Obese Individuals

Along with all other co-morbid conditions like Type 2 Diabetes Mellitus, Hypertension, and PCOD, etc., the prevalence of psychosocial disorders, including suicidal behavior, as well as substance abuse or eating disorders, is quite high among morbidly obese individuals.

Importance of Psychiatric Evaluation Before Bariatric Surgery

That is why, while evaluating for bariatric surgery, a psychiatric evaluation of individuals undergoing bariatric surgery is a must nowadays, since one might miss a pre-existing mental illness leading to inadequate treatment before and after surgery.

Factors Contributing to Suicidal Behavior Post-Surgery

Some of these issues like lack of physical activity before and after surgery, lack of improvement in quality of life, persistence or recurrence of sexual dysfunction, and history of ill-treatment in childhood might contribute to suicidal ideas if not assessed preoperatively.

High Expectations and Potential Disappointments Post-Surgery

These patients might have very high expectations of body appearance post-operatively and might be disappointed by the physical outcomes of the surgery. Sometimes weight regain might also lead to suicidal behaviors.

Increased Alcohol Sensitivity Post-Bariatric Surgery

It has been found that after bariatric surgery, the alcohol sensitivity of certain individuals might rise. Alterations in the GI tract after surgery lead to altered absorption of alcohol. It has been seen on several occasions that certain individuals continue alcohol consumption after surgery. Therefore all candidates of bariatric surgery are counseled and educated about the ill effects of alcohol after bariatric surgery and to minimize the use of it.

Compulsive Eating Disorder and Its Persistence Post-Surgery

When undergoing the dietary pattern of morbidly obese patients, there is a high prevalence of compulsive eating disorder. These problems can also persist after bariatric surgery. Few patients may develop ‘loss of control’ eating, and even self-induced vomiting. These conditions are associated with less weight loss and increased fear of weight regain.

Importance of Comprehensive Follow-Up Programs

According to Dr. Atul NC Peters, one of the pioneers of weight loss treatment in Delhi and among the top 10 obesity surgeons in India, it is important that such follow-up programs are developed, that address these types of problems focusing on psycho-social factors as well as eating disorders for a successful outcome.

Obesity in Children and Adolescents

Addressing Obesity in Children and Adolescents: Causes, Risks, and Effective Interventions

The prevalence of obesity is increasing in both children and adolescents, in both sexes and in various ethnic and racial groups.

Many factors, including genetics, environment, metabolism, lifestyle, and eating habits, are believed to play a role in the development of obesity. However, more than 90% of cases are idiopathic; less than 10% are associated with hormonal or genetic causes.

Defining Obesity in Childhood and Adolescence

There is no single definition of obesity in childhood and adolescence.

Consensus committees all over the world have concluded that children and adolescents be considered overweight or obese if the BMI exceeds the 85th or 95th percentiles, on curves generated from the 1963-1965 and 1966-1970 NHANES, or exceeds 30 kg/m² at any age.

Energy Intake and Sedentary Lifestyle

During childhood and adolescence, excess fat accumulates when total energy intake exceeds total energy expenditure. Reduced energy expenditure is attributed to modern-day sedentary lifestyles. This is particularly associated with excessive television viewing, excessive computer use, and insufficient physical activity. Also, this is often seen when feedings are supplemented with additives such as carbohydrates or fat.

Hormonal Dysfunction and Familial Obesity

Some hormonal dysfunction like that in ghrelin leptin hormonal axis may be the causative factor in as many as 10% of obese children, particularly in those who appear to manifest familial morbid obesity.

Race and ethnicity are also associated with increased rates of obesity in children and adolescents.

Childhood Obesity as a Predictor of Adult Obesity

Childhood obesity is predictive of adult obesity such as with 80% of teenagers who are obese continue to be obese as adults.

This is associated with an increased incidence of type 2 diabetes, hypertension, gallstones, and hypercholesterolemia.

Chest Conditions Associated with Childhood Obesity

There are serious chest conditions associated with childhood obesity like reactive airways, poor exercise tolerance, increased work of breathing, and increased oxygen consumption.

They might develop obesity-hypoventilation syndrome and experience right-sided heart failure with right ventricular hypertrophy.

Acute Complications of Childhood Obesity

Acute complications of childhood obesity include hyperlipidemia, accelerated growth and bone maturation, ovarian hyperandrogenism and gynecomastia, cholecystitis, pancreatitis, and pseudotumor cerebri.

There is an increased incidence of fatty liver and they might develop liver cirrhosis and kidney disease.
Obstructive Sleep apnea and sleep-disordered breathing are common in children and adolescents with obesity which might lead to neurocognitive dysfunction.
Excess weight in children can cause numerous orthopedic disorders, including genu valgum, slipped capital femoral epiphysis, with bowing of the long bones.
Emotional and psychosocial sequelae are also widespread in obese children.
Social isolation, peer problems, and lower self-esteem are frequently observed.
Gout and colorectal cancer rates are found to be increased among men who had obesity as adolescents as well as arthritis.

Therapeutic Interventions for Childhood Obesity

Any therapeutic intervention in the child with obesity in aimed to achieve control of weight gain and reduction in body mass index (BMI) safely and effectively and to prevent the long-term complications of obesity in childhood and adulthood.

These might also require psychiatric assistance for unusual eating disorders or severe depression. It involves a team involving nurse educators, nutritionists, exercise physiologists, and counsellors.

Parental Involvement and Lifestyle Changes

Parents must advice children to walk at least 20 to 30 min daily. Limit their television timings and must indulge in vigorous exercise with children. Low-calorie balanced diet, in association with patient and parent education, behavioral modification, and exercise can limit weight gain in many patients with mild or moderate obesity. Reductions in total and saturated fat may be particularly useful in adolescents who consume large quantities of high-fat, snack, and packaged fast foods, including french fries, pizza, chips, and crackers. Also, they might sometimes require and care if evidence of psychopathology or dysfunction is present.

Bariatric Surgery for Childhood Obesity

According to Dr. Atul NC Peters, one of the pioneers of weight loss treatment in Delhi and among the top 10 obesity surgeons in India, various bariatric surgical procedures have been performed in “carefully selected” patients with a body mass index (BMI) >40 kg/m ² who have severe comorbidities such as nonalcoholic fatty liver disease. It is important to consider several other factors before deciding whether a child or adolescent should undergo bariatric surgery like previous attempts at weight loss, and ability to adhere to follow-up care. Laparoscopic sleeve gastrectomy is the most widely performed procedure in childhood obesity nowadays.

Evidence suggests that bariatric surgery can decrease the grade of steatosis, hepatic inflammation, and fibrosis in Non-Alcoholic Fatty Liver Disease. With more and more people opting for various bariatric surgical procedures, weight loss surgery cost in Delhi has been such that it is becoming affordable day by day and several finance and loan schemes are also available in special circumstances.

Bariatric Surgery in Delhi

The Rise of Bariatric Surgery in Delhi: A Comprehensive Solution for Obesity and Type 2 Diabetes

Increasing Prevalence of Obesity

There is a dramatic increase in prevalence of obesity. The traditional approaches like dietary and lifestyle modification, physical activity, and pharmacotherapy fail to facilitate weight loss and treat obesity. So, bariatric surgery is the most sustainable treatment option. Bariatric surgery also promises improvement in obesity-related comorbidities like type 2 diabetes, hypertension, dyslipidemia, arthritis, etc. so, the term bariatric surgery is now replaced with bariatric and metabolic surgery. These days metabolic surgery for diabetes has emerged as a proven tool for the resolution or control of type 2 diabetes. This weight loss treatment in Delhi is being done only at specialized centers, by adequately trained and expert surgeons. Thus it gives a permanent cure to this traditionally regarded as a progressive, unrelenting disease called type 2 diabetes.

Bariatric Surgery in Delhi

In the last few years, there has been an increase in weight loss treatment in Delhi. Many centers are currently performing bariatric surgery. Patients from every corner of India prefer to come to Delhi for bariatric surgery owing to the availability of the best medical facilities, trained and experienced bariatric surgeons, and specialized paramedic staff. Even International patients prefer Delhi, India for bariatric surgery.
Sleeve gastrectomy and roux-en-Y gastric bypass are the most commonly performed weight loss procedures. Metabolic surgery for type 2 diabetes targets patients with uncontrolled diabetes who are currently on oral drugs and insulin. Scientific literature reports that bariatric and metabolic surgery results in weight loss, improvement/ normalization of blood sugar levels, reduction/ withdrawal of diabetes medications, and decrease in cardiovascular disease risk factors. It is a simple procedure and the patients may be able to leave the hospital in one day or even the same day in selected cases.

Comparing Surgical Procedures

In patients with reflux disease and type 2 diabetes, the results of sleeve gastrectomy may be inferior to the roux-en-Y gastric bypass but the excess weight loss of both the procedures may be comparable in a select subgroup of patients.

Nutritional Considerations Post-Surgery

Nutritional deficiencies are present in obese patients as consumption of a high-energy diet compromises on protein, vitamin, and mineral intake. As Sleeve gastrectomy and roux-en-Y gastric bypass involve removal or bypassing of some parts of the stomach and /or small intestine, so, macronutrient (protein) and micronutrient deficiencies (calcium, iron, B12, vitamin D, folate, etc.) are very likely to occur post-operatively in the patients. Nutritional assessment remains the key component pre-operatively and post-operatively to identify, prevent, and treat nutritional deficiencies at an early stage. Nutritional assessment involves taking physical measurements of the body (height, weight, etc.), analyzing blood and urine samples, identifying deficiency signs and symptoms, and performing a comprehensive dietary assessment.

Ensuring Surgical Success

Consuming a well-balanced energy-restricted diet with vitamin and mineral supplements and timely follow-up with the bariatric team promises success of the surgery.

Weight loss surgery in India

Why India is Emerging as a Top Destination for Weight Loss Surgery

Rising Obesity Rates in India

With the persisting need to address the problem of malnutrition, India has developed another nutritional problem, obesity. According to the National Family Health Survey 4, the number of obese people in the country has doubled in the last decade.

Obesity and Type 2 Diabetes

It is a known fact now that obesity is the major reason for developing Type 2 Diabetes. Several studies have revealed that obesity accounts for 80-85% risk of developing type 2 Diabetes. Moreover, most of the world’s population lives in countries where overweight and obesity kill more people than underweight.

Bariatric Surgery as an Effective Solution

Bariatric surgery is now more efficacious than lifestyle changes or medical treatment for sustained weight loss and remission of Type 2 Diabetes.

Cost-Effectiveness of Bariatric Surgery

The cost of weight loss surgery versus the cost of medicines and lifestyle changes has been debated extensively. Similarly, not only savings but also cost-effectiveness of weight loss surgery have also been discussed. Various studies have demonstrated cost-effectiveness and cost savings for bariatric procedures compared with usual medical care or intensive lifestyle interventions. All of these studies have been carried out in setups where weight loss surgery has been expensive as compared to the eastern world.

Delhi: A Hub for Medical Tourism

New Delhi, the capital city of India has now become a popular destination for medical tourism. Millions of foreign tourists visit India annually for their medical needs. There are many world-class and reputed hospitals in Delhi, which provide exemplary services in the field of medical care. The presence of highly qualified and experienced weight loss surgeons along with institutions of international repute have made Delhi a prime city for weight loss surgeries in India.

Reasons to Choose India for Bariatric & Metabolic Surgery

According to Dr. Atul NC Peters, Senior Consultant and Head of Apollo Institute of Bariatric and Metabolic Surgery, Indraprastha Apollo Hospitals, New Delhi, more and more patients are flying from the Western world for bariatric surgery in India. Not only for weight loss surgery, but people have also started travelling for metabolic surgery for Diabetes in India. Reasons for choosing India as a favorite destination for Bariatric & Metabolic Surgery are innumerate, a few of them being:

Bariatric Surgery cost in India is approx. half to one-third of the cost of the Western world.
There are no long waiting lists, as patients seeking weight loss surgery in Delhi are given almost immediate treatment.
International accredited hospitals and surgeons.
Dedicated bariatric surgical program which includes a team of expert surgeons, nurses, dieticians, and bariatric care specialists.
Fully equipped operation theaters with trained anesthetist.
Dedicated intensivist with exposure to more than a thousand operated bariatric surgical patients.
Safe and effective results.
Long-term follow-up schedules.
Options for single incision surgery.
Options of Robotic Surgery.

Hence India is now a preferred destination for weight loss surgery as well as metabolic surgery.

Bariatric and Metabolic Surgery Centre: Essential Components

Key Components of a Leading Bariatric and Metabolic Surgery Centre

Rising Incidence of Morbid Obesity

As the incidence of Morbid Obesity is rising day by day, more and more hospitals have started bariatric surgery programs. However, managing a morbidly obese patient is challenging in the way that obesity brings a lot more other diseases with it. Obstructive sleep apnea, Diabetes Mellitus type 2, Hypertension, and Hypothyroidism are a few of them.

Therefore it’s mandatory to set up a comprehensive management program for treating these patients in the best bariatric and metabolic surgery centre.

The decision to recommend bariatric surgery requires a multidisciplinary approach to evaluate the indications for surgery and to define co-morbidities properly.

Key Components of a Bariatric and Metabolic Surgery Centre

The surgeons at the best bariatric hospital must demonstrate the necessary training skills, experience, and leadership. The essential components of a bariatric surgical center include a Director, critical support, appropriate equipment and instruments, 24-hour qualified call coverage, continuous care, long-term follow-up care, and most importantly regular support groups. There must be facilities for data collection and maintaining a database. By collecting and sorting data, a well-maintained database would demonstrate past performance and help in directing future trends. Periodic evaluation and comparison will allow centers to develop improvement plans.

Role of the Bariatric and Metabolic Committee

There must be a bariatric and metabolic committee which is headed by the program director and includes the coordinator, clinical reviewer, and hospital administration staff. All the surgeons included in the committee must focus on quality improvement which includes a reduction in variation, standardization of practice, establishing selection guidelines, and quality improvements. This can result in decreasing rates of complications, re-admissions, length of stays, surgical site infections, etc. The committee also establishes pathways of care for pre-operative and post-operative management. All relevant staff must be educated in patient safety and complication recognition. The goal of the pathways is to prevent failure to rescue situations which means early recognition and treatment of the post-surgical complications.

Responsibilities of the Bariatric Surgical Care Coordinator

The Bariatric Surgical Care coordinator assists and reports to the director of the committee. The coordinator assists in center development, managing the accreditation process, maintaining relevant policies and procedures, patient education, outcomes and data collection, quality improvement efforts, and education of relevant institution staff. The coordinator supports the development of written protocols and education of nurses to recognize the critical vital signs required to minimize delays in the diagnosis of serious adverse events.

Data Management and Accreditation

The clinical reviewer enters data into relevant platforms. The reviewer should not be contributing to patient care to avoid bias.

The hospital must be accredited by relevant authorities to ensure that the care for metabolic and bariatric surgery patients is provided in a safe environment. In this respect, Apollo Hospitals New Delhi has been accredited by the JCI.

Certifications and Training

The director or the chief surgeon must have obtained a verification certificate to operate on morbidly obese patients by relevant governing bodies. These certificates are purely based on the volume of surgeries and quality of care and dedication to the practice. Similarly, there must be 24-hour call coverage for the patients attended by qualified persons.

The bariatric surgical nurse must obtain specialized training such as the Certified Bariatric Nurse certification.

Essential Support Services

There must be dedicated physicians, dieticians, psychologists and psychiatrists, social workers, and physical therapists.

Registered dieticians are absolutely essential for the success of any bariatric surgical center.

They do all the nutritional counseling and follow-up.

Psychologist and psychological evaluation is a must before any bariatric and metabolic procedure. These patients are often suffering from depression, anxiety, and other stress-related disorders. Psychological education, evaluation, and preparation are useful in achieving overall patient stability and emotional well-being.

Facilities and Equipment

Morbidly obese patients must feel welcome upon entering an institution. There must be appropriate furniture to accommodate them in the waiting room as well as the examination room. The plus size hospital clothes, beds wheelchairs, and floor-mounted toilets are a must. There must be dedicated beds or floors for bariatric surgical patients. Similarly, operating room tables and equipment are accordingly sized to the needs of such patients.

Critical Care and Anesthesia

The critical care support providers must be trained in identifying early signs of potential complications. The anesthesia team must be trained to give anesthesia to such patients taking care of DVT prevention and obstructive sleep apnea to name a few.

Various specialty consultants are also asked to give preoperative clearances to the patient in view of the existing co-morbid conditions.

Support Groups and Electronic Media

A pediatric and adolescent medical advisor is also a part of the team at the center. He/she operates on adolescent patients.

Support groups are designed for the patients who are in the recovery phase. These are primarily organized to take care of the medical, nutritional, psychological, and social issues experienced by the patients.

The development of electronic information media such as dedicated websites is an essential part of addressing various issues and reaching people in remote places.

Future Trends and Institutional Commitment

As more and more people are undergoing bariatric surgical procedures these days, the demand for safe treatment facilities will grow. According to Dr. Atul NC Peters, Senior Consultant and Head of Apollo Institute of Metabolic and Bariatric Surgery, Indraprastha Apollo Hospitals, New Delhi, India, the most important element in the best bariatric surgery center is leadership from the surgeon and integrated medical staff. They require dedication, strong fundamental infrastructure, and total institutional commitment.