Dr Muffazal Lakdawala
The story of Eman Ahmed Abdelaty, 36, who was brought to India a few weeks back for bariatric surgery under Dr Muffazal Lakdawala, the famed bariatric and laproscopic surgeon, has inspired hundreds of people to talk about their weight issues and seek help.
Suddenly — and thankfully -- obesity has became a concern once again in the country.
Gunjan Sharma caught up with Dr Lakdawala at his Mumbai hospital to talk about causes and consequences of obesity, which is acquiring epidemic proportions in India.
According to a recent Lancet report, India is among the ten countries to have the maximum number of obese people. Why is obesity gaining epidemic proportions in the country?
We are 1.3 billion people, even a small percentage makes for a huge number. Obesity is a leading cause of so many diseases, and so a serious threat.
There are several causes for obesity in India: food is an essential part of our culture, it is at the centre of all our celebrations.
In India , most women gain weight around pregnancy and most fail to go back to their original weight after giving birth to the child.
We are also genetically predisposed to obesity.
Besides, India does not have many open spaces. Most modern cities across the world are walking cities and people walk. Here it doesn't happen. We are always too busy with our daily routines, and don't have much time for ourselves. We don't mind putting a few kilos. What we don't understand is that though gaining weight is easy, it is tough to shed it.
And what are the consequences?
There several serious consequences. Obesity and diabetes are closely linked. In fact, we are second to China in diabetes, which is killing thousands in our country.
Obesity has its effect from head to toe. Take for example, Eman from Egypt, who we recently operated upon. She suffered a stroke three years back.
Obesity leads to intracranial hypertension, thyroid imbalance, restrictive lung diseases, obstructive sleep apnoea, gastro-oesophageal diseases, etc. There is also the possibility of gall stones, hernia, pancreatitis. Obesity puts pressure on pancreas and liver. An obese person may face urinary stress incontinence. Obesity is also a major cause of infertility. It can also lead to joint problems, varicose veins, etc.
Obesity puts men at a nine per cent higher risk of prostrate and lung cancer and women at a 20 times higher risk of uterine and breast cancer.
Then of course, there is hyper tension, type-2 diabetes, coronary artery disease, etc. We need to take stringent measures to tackle obesity.
There is a growing problem of obesity among children under five years of age. Why?
It is a serious concern. In most cases, this is due to genetic or hormonal issues. Eman's case has brought many such kids to me. Now we are working to find out the genetic causes of obesity in these kids.
In fact, we have three kids in the age group of 2-4 years who are obese because of leptin deficiency. We are going to manage their obesity by giving them leptin replacement therapy. We need to find out other possible causes for childhood obesity. Many such causes can be managed with medicines.
How has Eman’s much-publicized case changed things for you?
I am a bit scared with the kind of publicity that Eman's case has got. It is one of the most 'high- risk' cases in the world, and currently it is so closely watched by the media.
But one good thing that has come out of this case is that there is a sudden awareness about obesity. I have already been contacted by three people from Bulgaria, Russia and Saudi Arabia--all are more than 350 kilos. They feel there is a hope for them. Suddenly, I am getting lots of people from across the country who weigh over 100 kg and want to shed weight.
How is Eman recovering? What are your expectations?
Apart from obesity, we have to manage a number of other health problems related to her heart, kidneys, brain.
She has already lost 150 kilos and she looks so different. She is happy and enjoys Arabic music.
I want her to be able to sit and eat with her own hands soon. I will be really happy if she could go to washroom on her own, if she could wear her clothes herself. These are my realistic expectations.
My dream is to see her walk, chances of it happening are remote but there is nothing that is impossible. We have achieved impossible by operating upon her. We never thought we would be able to do so.
Eman was around 500 kilograms. What causes this kind of obesity?
It is mostly genetic. Such people suffer from obesity since their early childhood.
When is surgery an option?
People with BMI of more than 40 may require surgery. We may also consider surgery as an option for someone with BMI of 35 and has diabetes and other complications. In India, however, we may suggest surgery to people with BMI of more than 30 if they have serious associated illnesses.
People who need to lose 20 kilos don't need surgery. Surgery is an option only after a person has tried every other means to lose weight.
You have to start when you are overweight. The moment your trouser gets tighter, the moment you feel a little uncomfortable, you should become conscious of what you eat.
Is obesity a result of physiological or psychological problems?
Psychological component is important. People generally eat more when they are depressed. People who are depressed, eat to feel better and put on weight and when you put on weight, you are more depressed. It is a vicious cycle.
Prevention is better than cure. I feel 90 per cent of people can control their body weight, if they do it at the right time. You have to start when you are overweight. The moment your trouser gets tighter, the moment you feel a little uncomfortable, you should become conscious of what you eat. Stay away from that one extra piece of dessert. Walk around, exercise a bit and you will be able to control it.
As you grow older, you need to understand that your metabolic rate slows down. You can't eat the same amount of food at 40 that you have been eating all these years.
A maximum of five kg weight gain is acceptable for every ten years of life. So, if you are 50 kilos in your teens, you could be 55 in your 20s, 60 in your 30s. But the problem is most people gain maximum weight between 30-45 years.
How can we control obesity?
We need to inculcate healthy eating habits in school children, that's the age when they should learn that too much sugar, oil, salt is not good for health.
You know, we decided that we will not give our son sugar and so we didn't give any artificial milk, candies, chocolates to him. We make a fruit pulp candy for him and he likes it. He eats all vegetables. If you give him candies now, he will not have it. These are all acquired tastes.
How do you keep fit?
I gave up sugar 20 years back. I take steps to go up and down. I get up at 7 in the morning, eat two walnut and 2-3 almonds soaked in water overnight. Then I have muesli with banana or apple and fresh milk for breakfast.
My tea is either green or black.
For lunch, I take two rotis, some chicken, salad, soup and curd. I take three-four cups of green tea during the day. I try and avoid carbs -- roti or rice-- at night. But if I feel exhausted some days, I take some carbs. My favourite food is sushi.
If I get time, I run but I don't get much time. So my workout is up and down stairs in the hospital. But whenever I travel, I put on my running shoes and run.