Intended for healthcare professionals

Feature Non-communicable disease

The advent of bariatric surgery for diabetes in India

BMJ 2013; 347 doi: (Published 26 July 2013) Cite this as: BMJ 2013;347:f3391
  1. Ron Thomas Varghese, fellow, department of endocrinology, diabetes and metabolism, Christian Medical College, Vellore, India
  1. ronthomasv{at}

Obesity and diabetes are some of India’s growing problems. Is surgery the answer? And is the market best left to decide? Ron Thomas Varghese reports

Economic development in India has led to a shift in disease burden, with a huge increase in non-communicable disease. The prevalence of obesity, for example, has risen even in rural areas. Some 42% of the population in rural Kerala have been reported to be either overweight or obese.1 A study of an urban slum in northern India reported 40% of the women to be obese,2 and the prevalence of obesity among 350 patients attending a clinic for diabetes mellitus in Gujarat was 70%.3

Bariatric surgery is seen as a tool for tackling obesity. Some studies suggest that bariatric surgery could even help to prevent diabetes mellitus, especially in patients who are obese.4

Patients with diabetes often find it difficult to cope with multiple insulin injections. They can feel frustrated when their glycaemic control remains poor despite their best efforts. Their quality of life can decline,5 and a vicious cycle of non-adherence to treatment and poor glycaemic control can set in. The quality of life of obese patients undergoing bariatric surgery is thought to improve as a result of weight loss,6 and many patients perceive bariatric surgery to be a panacea.

The number of patients in India undergoing bariatric surgery is rising. The Obesity Surgery Society of India has stated that the number of people having such surgery rose from 2200 in 2010 to more than 5000 in 2011.7

Motivation and effort

Patients undergoing bariatric surgery should understand, though, that maintaining weight loss after surgery takes considerable motivation and effort. They should also be aware that the initial decline in weight loss might not continue in the years after.

Muffazal Lakdawala, a …

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