Weight loss surgery safe for diabetics: Dr. Thadhani

Dr Thadhani is the Medical Director, Niramaya Hospitals in Kharghar, Navi Mumbai and Chembur, Mumbai. He is one of the few surgeons who are equally skilled in both laparoscopy and therapeutic endoscopy.

He specializes in advanced laparoscopy, single port surgeries, bariatric surgery, varicose vein laser treatment, gastrointestinal endoscopy other than the routine surgeries. He is also founder member of the AMASI.

Dr Thadhani answered Sify readers’ queries related to the above in an exclusive chat. Read the transcript below.

If I want to have gastric bypass surgery, how long do I have to wait?
If you are a suitable candidate, you don’t have to wait. preparation would normally be started by the attending doctor upto 2 weeks before the procedure.

How long should I wait to get pregnant after surgery?
At least a year. preferably 2 years.

What happens to the unused portion of my stomach?
The stomach is always fully utilized. didn’t understand the question.

Is there any special diet to reduce weight?
Good old recommendations. Complex carbohydrates, lean meats, pulses – recommended. Avoid – starchy foods, processed foods, potatoes, refined, oily, fried foods and soft drinks. And exercise very regularly and whenever possible, in whichever way possible.

Will I have to take vitamins?
We do recommend to take vitamins especially if bypass has been done.

Should I exercise after bariatric surgery?
Yes within 2 weeks we should start exercise it is highly recommended, almost mandatory.

What are the risks of this surgery?
The feared complication is leak from the staple line which may require reoperation or other treatments. relatively minor problems such as wound seromas or infection, also may occur. late problems may be related to nutritional deficiencies. chances of serious problems occurring is quite low.

Which is the best hospital in India for Bariatric surgery?
Many good hospitals. the choice of surgeon is more important.

Sir is there no solution to obesity besides the weight loss surgery?
Weight loss surgery is done only if you fail to solve the weight problem by working hard on it with regular exercise and strict self control. it is not for all patients but only those who are on a rule of thumb over 1 1/2 times the normal weight for their height.

Please give your suggestions on the post operative care.
Which condition pl specify

How reliable is a Bariatric surgery in India today?
very reliable.

Does varicose veins in a pregnant woman usually disappear after she gives birth? Or does she require a treatment?
They do disappear in the majority of patients, but if they persist beyond six months after delivery then they may need treatment.

Does obesity also sometimes lead to varicose veins?

Is varicose vein laser treatment painful?
Some amount of discomfort may be experienced, but usually the patient is up and about within a couple of hours.

Doctor I have heard that varicose veins appear again even after the laser treatment. is it true?
The vein which is treated usually wont come back. however, fresh varicose veins can develop which may need separate treatment.

Can a person participate in vigorous exercises or a hike after the bariatric surgery?
Yes but not immediately after, certainly within a couple of months depending on the general fitness of the patient.

Do I need to follow a strict diet throughout my life after the weight loss surgery?
Yes you do, but it becomes much easier to follow the diet post-surgery as the quantity of intake becomes small you get satisfied very easily.

Will there be any side effects after the weight loss surgery?
Nutritional deficiencies may occur if not taking supplements. this is more in malabsorptive procedures such as gastric bypass, rather than in sleeve gastrectomy.

Will I have a loose and sagging skin if I undergo the weight loss surgery?
Yes this may happen if the weight loss is substantial, and can be attended by a cosmetic surgeon if it is unsightly.

Why do you think the prevalence of obesity has grown over the years?
Bad lifestyle is the major reason. a comfortable life which tries to reduce every exertional activity we do to the minimum, is a very important factor along with changed dietary habits.

How is overweight and obesity designations categorized in children?
Same as adults. based on BMI calculations.

Sir how to deal with child obesity?
Change the diet of the child to non-starchy non-junk food, make sure that he/she is getting enough exercise, and limit gadget/tv time strictly.

For what kind of patients is a Bariatric Surgery a strict NO !!
If the patient is medically unfit for surgery. less than 10yrs of age or over 60yrs of age are relative contraindications. also if the patient is unwilling to comply with dietary and lifestyle changes, the procedure should not be done.

Can diabetics also opt for weight loss surgery?
Specially recommended, as in upto 90% of diabetics the sugar returns to normal without medicines following the procedure. Even if weight is not high and patient is resistant to medical treatment this can be considered as an option.

How can lifestyle play an important role in preventing excess weight gain?
All important. Balance of healthy diet and regular exercise, even a brisk walk of 3 to 4km daily, makes all the difference.

My male cousin is 27 yrs and is obese. He has this habit of eating frequently. How to help him overcome this habit?
Change what he eats. For example, an apple instead of the burger.

What kind of risk factors are associated with undergoing an endoscopic procedure?
very minimal for diagnostic procedures and about 1% for therapeutic procedures.

When is gastrointestinal endoscopy conducted on a patient?
upper gastrointestinal scopy is commonly done for evaluation of acidity, vomiting, suspected reflux or cancers etc. lower gastrointestinal scopy is commonly done for evaluation of chronic diarrhoeas / constipation / bleeding / suspected cancers.

Does obesity often lead to heart ailments?

Is the weight loss surgery 100 percent safe?
nothing in life is 100% safe. but it is 99% safe.

My parents or even my grand parents are not obese but I am. So obesity is not related to our genes?
in most cases obesity is simply because we do not burn as much nowadays as our ancestors used to due to hard physical work, but continue eating the same. so yes, obesity is not in most cases due to bad genes.

Can you give some tips to curb obesity?
exercise regularly, if possible every day without fail. reject junk foods completely. avoid potatoes and starchy / sugar rich / processed foods.

I am obese male aged 31 yrs. I want to lose around 40-45 kgs. But I want to lose weight the normal way and not by surgery. Is it possible?
yes it is possible and desirable that you try to lose weight by regular exercise and a healthy diet. only if you do not succeed in this should you consider surgery.

Can one indulge in normal activities or lead a normal life after laparoscopy?
yes. depends on the procedure done.

How much time does a patient usually take to recover after advanced laparoscopy?
The recovery is quick, usually within a few days depending on the procedure done. in most cases we can mobilize the patient on the same day ie get the patient to walk around the wards.

Hello Dr. I want to know when is advanced laparoscopy advised?
Advanced laparoscopic procedures are the technically challenging procedures that are done for specific illnesses for which the patient would usually require conventional open surgery. Most procedures which were earlier done open can now be done by laparoscopy.

What all should I look for in a good bariatric surgeon?
the surgeon should have sufficient experience and should be willing to give enough time for the patient. also the hospital where the procedure is planned should be equipped for the special requirements of these patients.

Is weight loss surgery a one time surgery or does it need a lifetime maintenance medically?
It totally depends on whether the person is willing to adapt to a healthy lifestyle after the procedure. If he/she is very motivated, the weight loss will be permanent. However, a substantial number of patients may need a second surgery if the compliance with instructions is not done properly.

I am 32 yrs obese female. I have been unable to conceive because of obesity. Can I conceive after weight loss surgery?
Yes. Chances of conception become better following weight loss. However, pregnancy is not recommended for at least a year following a bariatric procedure.

Are there any risks involved or are there any scars left after the varicose vein laser treatment?
the risks are quite minimal. it is virtually scarless, there may be one or more tiny mark of 2 to 3 mm only at the site of insertion of the laser.

Do varicose veins if not treated become worse or create complications?
yes, if left untreated it will result in skin eczema, ulcers which may bleed, and eventually deformity of the foot in very chronic cases.

What actually causes varicose veins Sir?
it is usually occupational. standing or sitting for long periods is a major cause.

How much time does it take for one to resume work after he or she undergoes the weight loss surgery?
usually 2 weeks

How much does a bariatric surgery generally cost?
depends on various factors, anywhere between 3 lacs to 5 lacs.

Is there a special or prescribed diet that has to be followed after the weight loss surgery Doctor?
Yes, initially the patient is kept on liquid diet followed by semisolid and soft diets serially after the procedure and it would take upto 2 months for a person undergoing bariatric procedures to reach back to a normal diet in limited portions.

My brother is 5ft 9′, weight 160kgs. He is thinking of going for bariatric surgery. What all he should keep into consideration?
His coexisting medical problems need to be controlled adequately before surgery if present. Prep starts upto 2 weeks before surgery. Also a very regular follow up with the attending doctor is a must, and one multivitamin tablet for life is recommended.

How safe is weight loss or bariatric surgery?
bariatric surgery is as safe as any other surgical procedure, depending on the general medical condition of the patient. the chances of serious problems are usually very low.