Mumbai: Neha Sharma,who underwent a successful bariatric surgery at the age of 15 here,is an example of how the obesity epidemic is marching across India and across all age groups.A study published in the Lancet medical journal recently said that almost 1 in 5 Indian men and over 1 in 6 Indian women were overweight.In some urban areas of India,it is believed that obesity is almost 40%.

Doctors contend that some obese people are so traumatized by their inability to lose weight that they turn into social recluses like Neha was until a few weeks back.She returned to school last week with a hope to score well in the Class X examinations.I am happy that I can get into clothes that I had bought two years back and could not wear, said the teenager who visited all her relatives to show off her new figure.She has started stepping out of home and talking to old friends over her mobile phone.We couldnt have been happier, said her mother,who spent over Rs 2.5 lakh for the treatment.We spent an equal sum in trying out various diets and buying medication.

In Nehas case, said Dr Motwani,We have taken into consideration that she will gain

some more height.We expect her weight to stablize around 50-55 kg.

The obesity epidemic has predictably led to a demand for bariatric surgery even though the risk of infection or complications associated with the surgery is higher than with many other surgeries.

Said Dr Ramen Goel,a surgeon who specializes in metabolic surgeries and is the president of the All-India Association For Advancing Research in Obesity,Every three months,one or two children under the age of 18 walk in seeking advice on bariatric surgery. Doctors counsel most of those walking in for surgery to look for alternative ways to lose weight,said Dr Motwani.

Utmost caution should be observed while operating on girls under 16 and boys under 18 because they are still in their growing phase, said Dr Goel.

A doctor on condition of anonymity said an Ulhasnagar-based nine-year-old who underwent bariatric surgery was in ICU for over a month after the stomach developed a leak.He had to undergo another surgery.

However,numbers tell the story of how a growing number of Indians dont mind a drastic cut to lose the extra flab.If the number of metabolic surgeries stood at 1,200 in 2008,it rose to 2,200 in 2009 and grew to 3,000 in 2010.Also,while there were only eight to 10 surgeons who offered weight reduction surgeries until five years back,now there are a 100 surgeons, said Dr Goel.

Three groups of people opt for bariatric surgery,according to information with the Obesity and Metabolic Surgery Society of India.People in the 25-28 age group who opt for the surgery do so under familial pressure to reduce weight before marriage.The second group of people between 35 and 50 years of age are busy careerists who opt for the surgery as a preventive measure while the third group between 45 and 65 years of age undergo the surgery to get rid of chronic diseases such as diabetes or sleep apnea.

But sceptics have a point as well.Endocrinologist Dr Shashank Joshi said,Bariatric surgery can at best be considered an emerging concept.It is only an experimental procedure,especially among children.It can be offered on case-to-case basis for patients if they have other health problems along with obesity.However,it should not be offered to people who are mentally ill or depressed.

Dr Joshi said that youngsters have many options instead of undergoing an irreversible surgery.They can opt for a gastric balloon or a gastric band that are endoscopic procedures.

(Patients name has been changed on request)

WEIGHTY MATTER

Potential risks

Gastritis (inflamed stomach lining),heartburn,stomach ulcers Injury to stomach,intestines,or other organs during surgery Leaking from the line where parts of the stomach have been stapled together Poor nutrition,although much less than with gastric bypass surgery.Patients need to take vitamin supplements Scarring inside the belly that could lead to a blockage in the bowel in future Vomiting from eating more than the stomach pouch can hold Increased risk for gallstones

For children

For children,the procedure is advised only after the epiphyseal fusion of bones occurs (when the growth centre located at the end of most long bones fuses with the end of the bone)
Hence,sleeve gastrectomy is only recommended for girls over 16 years and boys over 18 years of age

For the 18-plus age group

It is only recommended for the morbidly obese group with a Body Mass Index of 40.In case of patients with chronic diseases such as uncontrolled diabetes or sleep apnea,the BMI limit is lowered to up to 35

THE PROCEDURE | SLEEVE GASTRECTOMY

The doctor makes 2 to 5 cuts in the abdomen to pass the laparoscope and other instruments.About 80-85 % of the stomach is removed and the remaining portions are joined together using staples.This creates a long vertical tube or banana-shaped stomach