Myths & Facts

Reality: There are many different types of gastrointestinal procedures for weight loss, some of which reduce the functioning size of the stomach and others that bypass parts of the digestive tract, reducing absorption of calories and nutrients. Different types of surgeries offer different results, and some are more suitable for particular people than others.

Reality: Obese and morbidly obese people suffer from a disease called obesity. Most have tried numerous ways to lose weight and get healthy, but were unsuccessful. Weight loss surgery is usually a last resort, but a necessary option. Unfortunately many obese people suffer discrimination and unwarranted scrutiny and judgment due to their excess weight.

Reality: Any type of surgery has associated risks, such as complications or even death. But a number of recent advances have helped to minimize risks. Surgeries performed at Asian institute of gastroenterology are done laparoscopically with mini-incisions that result in faster healing, less pain, and less scarring. In addition, having the procedure may assist patients in overcoming otherwise life-threatening conditions associated with obesity, including Type II diabetes, hypertension, high cholesterol and sleep apnea.

Reality: You are still a candidate for laparoscopic surgery even if you have had prior “open” surgeries or other minimally invasive surgeries. Of course each individual case is different and a proper evaluation is needed.

Reality: It is true that most patients must take supplements after certain weight loss operations because the procedure inhibits proper absorption of vitamins and minerals. However, patients who follow their doctor’s advice about meal planning can enjoy a nutritionally balanced diet. In many cases, their overall health and well-being is dramatically improved after the operation.

Reality: It is true that most patients must take supplements after certain weight loss operations because the procedure inhibits proper absorption of vitamins and minerals. However, patients who follow their doctor’s advice about meal planning can enjoy a nutritionally balanced diet. In many cases, their overall health and well-being is dramatically improved after the operation.

Reality: To be the most successful follow-up care for at least one year is critical. Patients usually meet two to four times with a health care team member. Team members work to help patients make long-term lifestyle changes.

Reality: unfortunately Insurance coverage for weight loss surgery is not widely included in India, but many companies provide Zero percentage EMI loan for bariatric surgery. If you are considering weight loss surgery, the first step is to contact your bariatric surgeon to find out if the procedure is covered and what, if any, exceptions may exist. One important point to keep in mind is that obesity and morbid obesity are considered two different health conditions. Many plans will exclude treatment for obesity but will cover treatment for morbid obesity.

Reality: obesity is a life style disorder so even after surgery patient has to follow diet plan do exercise. Many a patient does not follow with their surgeon and gain weight. If patient does not follow instruction than yes there is dilatation of stomach or pouch leading to weight regain

As per the IRDAI’s (Insurance Regulatory and Development Authority of India) latest guidelines, bariatric or weight loss surgery will be included under health insurance cover with effect from 1st October 2019, offering some relief to morbidly obese people suffering from the disease. The inclusion will help lakhs of patients in India who cannot afford the treatment, that is spread 8-38% in rural areas and 15-30% in urban areas. As per the experts, “Barring a few, the surgery was not covered by many insurance firms as it was considered a cosmetic procedure rather than a life-saving treatment.”

Anyone who is morbidly obese or those who tip the scales at 100 kg or more over their normal body weight. Also, if anyone has a history of obesity in the family or has a tendency of gaining abnormal weight in a small span of time.

Few years back, bariatric surgery was a standard exclusion across the industry. However, with the changing needs of the world and the technical advancements, bariatric surgery is considered by many insurance companies now. If you are hospitalized for a Bariatric Surgery which is medically necessary, on the advice of a Medical Practitioner, we cover the related medical expenses. However, it is to be kept in mind that Bariatric Surgery Insurance benefit can be availed only when it is medically necessary and not for cosmetic purposes.

To cover the expenses of your bariatric surgery in health insurance, these are the conditions that needs to be kept in mind:

• The insured person undergoing the surgery is at least 18 years old.
• BMI more than >=40 or Conditions like morbid obesity (BMI 35-39.9) with heart disease or diabetes or stroke or disease involving heart and lungs are mostly covered under bariatric surgery.

Some of the common procedures that are covered under Bariatric Surgery:

• The Roux-en-Y Gastric Bypass
• Biliopancreatic Diversion with or without Duodenal Switch (BPD/DS) Gastric Bypass
• Sleeve Gastrectomy
• Laparoscopic Gastric Banding

Yes, bariatric surgery in health insurance has a waiting period of usually 2 to 4 years. Which means, if you want to cover your expenses for bariatric surgery you will have to wait for 2 years from the start of your policy. So, it is always advisable to opt for such a benefit with your first health insurance policy itself.

If you are porting an existing policy from some other General or Health Insurance Company or if you are adding this cover while renewing your health policy, a fresh waiting period will be applied for bariatric surgery benefit.

Bariatric surgery for the following reasons is not covered:

• For cosmetic/aesthetic reasons.
• For treating drug-induced obesity, for severe untreated hormonal imbalance, psychiatric and eating disorders-induced obesity.

What is required is a documented detailed history of your obesity-related health problems, difficulties, and treatment attempts demonstrating that a multidisciplinary approach with dietary, other lifestyle modifications (such as exercise and behavioral modification), and pharmacological therapy, if appropriate, have been unsuccessful, at least for past 6 months.

Bariatric Surgery is usually not covered with most insurers in the base policy. However, health insurers nowadays provide an option where you add this benefit to your health insurance policy by paying a little extra premium. So, before buying a health insurance policy, do your bit of the research. Bariatric Surgery Insurance is a fresh take at how health insurance is gradually becoming completely customer friendly, with plans that can be personalized according to relevant needs!

Carbohydrates, or carbs can be both good and bad. It is important to identify good carbs from bad carbs. Good carbs come from grains, vegetables, legumes, fruits etc. whereas bad carbs come from white bread, sugary drinks, refined foods etc. You must learn to cut out bad carbs and focus on healthy, unprocessed and fresh forms of carbohydrates. “Carbohydrate-rich foods, such as vegetables (including beans and peas), fruits and whole grains, are the foundation of each of these healthy eating patterns,” notes Andrea Dunn, RD, LD, CDE.

It is always important to pay attention to what you put into your body. Counting calories and food restriction is never a healthy way to lose weight as your body becomes deprived of many vitamins and minerals that it needs to function and this can even cause adverse effects to your weight loss attempts. You need to fill yourself up with healthy foods that suit your body, not restrict yourself from these foods and replace them with artificial supplements.

You also must remember to never skip meals and go hungry! All this will do is weaken you as well as your metabolism over time. It can lead you to feel irritable and frustrated and in the end when you decide to stop dieting all your progress will be lost as your body resets itself. A healthy way to cut down your portions is to smaller meals throughout the day more frequently.

Similar to carbohydrates, there are healthy fats and unhealthy fats, too much unhealthy fat will obviously have adverse effects on you but your body and your cells require fat to replenish themselves so you must educate yourself about the different kinds of healthy fats you can incorporate into your diet. Some sources of healthy fats are beans, eggs, seeds, walnuts, fish etc.

Many believe think it’s okay to eat whatever they want as long as they work out because they will be burning it off, but there is a saying that everyone should remember and it’s “abs are made in the gym but shown in the kitchen” this means that regardless of how much you work out, you will only see true results prompted by a healthy change in your dietary habits. Although working out is effective your body needs nutritious food to help it heal and regenerate itself otherwise your workout will become obsolete if your body can not recover and rebuild from it. Weight loss requires you to change your life in all aspects not simply just the gym. If you have unhealthy eating habits it will show on your body, if not when you are young when you are older and it becomes hard for your body to burn off unhealthy foods. This is why it is important to incorporate a healthy diet which has all the right amount of fats, carbs, fibre etc. that you need in order to maintain a healthy weight.

Reality: It’s not just about your weight. Your health conditions are also a big factor. Numerous recent studies have shown that even moderately obese individuals who have significant health issues can show marked health improvements after undergoing weight loss surgery. There are guidelines for weight-loss surgery, set by the ACMOMS (2009)for Indian population. However, it's not just based on weight alone but on what other medical conditions you also have, such as diabetes.

• BMI > 35 kg/m2 with or without comorbities
• BMI > 32 kg/m2 with comorbities
• BMI > 30 kg/m2 with central obesity WS > 80cm (females) WS > 90 cm (males) with at least two criteria of metabolic syndrome
• Raised TG (>150 mg/dL )
• Reduced HDL (< 40 mg/dL )
• Increased LDL
• Hypertension (>130/>85 )
• Raised FBS (> 100mg/dL )
• BMI >27.5 kg/m2 with inadequately controlled DM (HbA1c >7)

Reality: Every candidate for weight loss surgery must be assessed based on his or her specific health conditions and Body Mass Index. It is widely agreed that anyone with a BMI over 40 qualifies, even if they do not have significant health problems. Individuals with a BMI over 35, plus one or more obesity-related health conditions are considered candidates for surgery.

Reality: Most people recover from weight loss surgery within one to two weeks. Some patients are able to return to work and their normal activities within just a few days.

Reality: Most people can eat a wide variety of all kinds of foods. Some patients who’ve had Gastric Bypass Surgery experience an unpleasant sensation when they eat very sweet foods. However, most people can eat just about any kind of food in small quantities. Our ultimate aim is to educate patient to choose right and healthy food.

Reality: While most surgical weight loss centers include age as a criterion, the ages of the patients they treat often cover a wide range, from 18 to over 65.

Reality: Weight loss surgery is becoming a primary treatment for diabetes, especially for patients with Type II Diabetes, because of the high rate of cure after surgery.

Reality: This is not true. However, it is true that you will be on a liquid diet for a short period of time. Before you have weight loss surgery your doctor will put you on a liquid diet for approximately two weeks. This allows your liver to shrink and makes the surgery easier to undertake. You will then be on a liquid diet for approximately 1-2 weeks post-surgery and then transitioned onto a regular solid food diet.

Reality: A few decades ago this may have been true, due to the type of surgery that was performed. However, the majority of weight loss surgeries are now carried out laparoscopically, meaning you will be left with a very small mark. "Lap Band, gastric bypass and sleeve gastrectomy are performed via a laparoscopic technique," says Dr. Abhishek Katakwar, Asian institute of gastroenterology’s bariatric surgeon. "The laparoscopic technique is a minimally invasive way that a surgeon can perform complex procedures that used to require the conventional large incisions."

Reality: It is possible to have children after weight loss surgery. However, most doctors will advise you to wait atleast one year before trying to get pregnant. This is because you need to wait until you have lost a large proportion of what you wanted to lose and your weight loss has stabilized. After weight loss surgery your hormones will be changing and your body will be nutritionally depleted until you stabilize your daily vitamin intake. This is because the operation inhibits the absorption of vitamins and minerals. All of these things can affect getting pregnant and are the main reasons why your doctor will advise you to wait. Infact weight loss can resolve problems related to polycystic ovaries improving fertility. Patients are much less at risk during pregnancy because their other health problems have lessened or disappeared. After your weight is back to normal, and assuming you don’t have any other health problems, you can expect to have a normal delivery.

Reality: Dumping syndrome, although common after weight loss surgery, is not experienced by everyone. Some people don't "dump" at all, some occasionally and some extensively. "Dumping syndrome is commonly caused by the rapid entry of undigested food products from the stomach into the small bowel where your body is not prepared for the concentration and rushes to dilute it by "dumping" fluid and electrolytes rapidly into the contents of the intestines," says Dr D.N. Reddy, Gastroenterologist from Asian institute of gastroenterology. "Avoiding excessively fatty foods, or high sugar simple carbohydrate meals in small portions, may help to ease the symptoms."

Reality: Insurance companies use the guidelines when considering whether or not to support weight loss surgery. However, it is not all based on weight alone. If you have other risk factors that your obesity is causing, adding to or affecting, it may be possible to use this as supporting evidence for your insurance claim. Every insurance company works to different guidelines, so you should always check with your insurance company first.

Reality: Many people don’t realise that gastric banding, sleeve gastrectomy and gastric bypass are not cosmetic procedures to be taken as lightly or performed as frequently as Botox or a nose job. Weight loss surgery is a definitive and final step for people weighing at least 40Kgs over their ideal body weight. These people have a BMI of 32.5 to 37 or higher, and have unsuccessfully tried many a fad diets, taken so called “weight reducing pills” and attempted other means of weight loss. There is consideration, conversation and qualification before a procedure. After the operation, patients must keep to a rigorous follow-up schedule. People who are 10-15 kilos overweight have a host of tools and approaches available to them that can assist them in regaining health, managing their appetite and keeping weight off.

Reality: On a personal level, this misperception annoys me the most. By the time these people come to my outpatient clinic, they have tried every diet available. They have suffered immense social, emotional and psychological stress, and they want nothing more than to rid themselves of the excess body weight they carry. Due to an individualized interplay among genetics, environment and behavior, these patients have realised that their best chance of living a normal life is to resort to a band, sleeve or bypass.

Reality: As part of my job, I literally get inside of people and either reroute their digestive tracts or slip a lap band over the top of their stomachs. Sounds dangerous, right? As with any surgery, weight loss surgery carries risks. But modern technology has made bariatric procedures relatively safer. In a study of 66,000 obese people over five years, those who chose to have a bariatric surgery lived longer than those who did nothing. It has been shown repeatedly that it’s far more dangerous to live life morbidly obese than to undergo a bariatric procedure. I’ll put it in perspective: In most programmes, the risk of a bariatric surgery is in line with the risk of having one’s gallbladder removed.

Reality: Patients who undergo bariatric surgery can, in fact, celebrate their birthday with a little cake, they just can’t eat the whole thing anymore! People learn new, reasonable, healthy eating behaviors. Trying to eat too much at one time would make it hard to keep the food down. With those caveats, a person can live an unrestricted life following surgery. They can go out to restaurants, take a cooking class and host a family dinner!

Reality: Bariatric surgery has a significant impact on the patient’s personal life. Men and women who are morbidly obese deal every single day with deep, core issues of self-esteem and pride. For example, there are physical repercussions of being so overweight (like, inability to control the bladder) that can be embarrassing, if not humiliating. Bariatric surgery can help restore dignity. About sixty percent of my patients are women. Many obese women have suffered not only emotional abuse because of their weight, but actual physical abuse as well, perpetrated by our society that didn’t respect them and convinced them that they were unworthy of love and affection. Dramatic weight loss over time often brings these women a new self-confidence and a new beginning to a more fruitful life.

Reality: Though, there is a large amount of overlapping between Bariatric and Metabolic surgery, however, all Bariatric procedures can also be called Metabolic procedures because the word metabolic says that it changes your metabolism. So, what happens in a Bariatric surgery? It can be divided primarily into three limbs— One, Surgery done for morbidly obese patients who do not have any associated co-morbidities such as diabetes, hypertension, etc. The second limb would consist of patients who have obesity which is related with diabetes, and other co-morbidities like hypertension, heart problems, kidney problems, etc. And the third limb would consist of patients who have diabetes only, without any associated obesity. So Bariatric surgery is primarily done for patients who are obese or have related diseases like diabetes and hypertension. Whereas, metabolic surgery for diabetics would encompass purely surgery done for patients with diabetes without associated obesity.

Reality: Absolutely NOT! There have been strict guidelines and criteria to choose a patient who would benefit from this surgery. So, based on individual cases, we decide which patient will benefit from it. However, broadly speaking, patients who have Diabetes for less than a duration of 10 years, have good C-peptide levels, good pancreatic function, or those who have not been Insulin dependent for a long time or those who do not have involvement of more than 2 organs have a much better chance of getting a resolution in terms of Diabetes. But an individual study of cases can speak best.