Dr. Aparna Govil Bhasker The other day I saw a tweet from United Nations about the gap in gender pay parity. “Worldover……women across professions, earn 20 to 30% less than men.” It has been quite sometime and I just cannot get the figures out of […]
By Dr. Aparna Govil Bhasker Bariatric and Laparoscopic Surgeon There are only two types of surgeons. Those who have had surgical complications and those who are going to have. The law of averages catches up with us eventually. As the old adge goes, if you […]
Dr Aparna Govil Bhasker
There are good days and then there are the bad days. How much ever we wish for life to follow a logical course, every day the sun rises with new challenges. Some that can be tackled, some that are pushed under the carpet and some that may really bring us down.
This morning was one such morning when I woke up not feeling at ease. Believe me, when we are not at ease, nothing around us is at ease. Small issues appear far bigger than they are and everything is just more challenging and convoluted than it usually is. While on usual days multi-tasking is a breeze, on days like this, there cannot be a bigger burden. Handling home, hospital, surgeries, patients and kids at the same time can drive one to the verge of insanity. However, like most of us, today I also did not have much choice but to just grit my teeth and somehow get through the day.
Lost in my own thoughts, as I entered home this evening, there it was…. A beautiful red flower kept on the table. I was greeted with a big hug by my five years old son. He gifted the flower to me, said “I love you mumma” and ran off to play. This has been our secret ritual for as long as I can remember. Every evening, he brings a flower for me and tells me that he loves me the most.
I guess, today this was just what I needed. It helped me to bring back the much needed perspective in my life. It reminded me that love is of utmost importance in our lives. Love makes us stronger to deal with everything else that life has in store for us. Life is not easy and all of us are struggling in some way or the other. What we need to remember is that while each of us is served with our share of problems, we are also given blessings in the form of people who love us. They are the ones who make life worth living for. They are the ones who make it worth fighting for. They are also the ones who make us realize that there is more positive in this world than negative can ever be.
On some days, we just have to look a bit harder.
Dr. Aparna Govil Bhasker
Bariatric and Laparoscopic GI Surgeon,
Global Hospital, Parel; Apollo group of hospitals, Currae hospital, Thane; Namaha and Suchak Hospitals, Kandivali and Malad
It is widely believed that the cohort of children born in the year 2000 in the USA, may live sicker or may not outlive their parents. With 19.3% of Indian children being either overweight or obese, we too are staring into an epidemic of childhood obesity.
In the Indian context a “chubby” child not only signifies good health but also good parenting. While it is true that genetics load the gun, it is the environment that pulls the trigger. In the vast majority of obese children, the cause for weight gain is polygenic and environmental. Monogenic obesity such as that caused by leptin deficiency is extremely rare and is seen in less than 1% of obese children.
Obese children tend to suffer from various health consequences like type 2 diabetes, obstructive sleep apnea, hypertension, dyslipidemia, fatty liver and so on. Till 30 years ago it was rare to see type 2 diabetes in children, but today children as young as 8 years are turning diabetic. Unfortunately, the changes these chronic diseases bring are irreversible and even if these children go ahead and lose weight as adults it leads to permanent damage to their blood vessels and other organs like kidneys, liver and heart. Apart from the physical changes, they also have serious self-esteem issues and tend to get isolated from their peers.
Treatment options for childhood obesity largely include diet and lifestyle modification and pharmacotherapy in some instances. Success of bariatric surgery for treatment of adult obesity has led to a gradual surge in bariatric surgery cases being performed on obese children over the last few years. Bariatric surgery includes a variety of surgical procedures like gastric banding, sleeve gastrectomy, Roux-en y gastric bypass and duodenal switch. These are performed laparoscopic or by open method.
A couple of years back the International Journal of Surgery published a case report about a two years old toddler becoming one of the youngest patients to undergo weight loss surgery at a hospital in Riyadh, Saudi Arabia. This toddler underwent a laparoscopic sleeve gastrectomy surgery, wherein two thirds of the stomach was surgically removed. The report was published 2 years after the surgery was conducted and the child had lost about 10 kg in 24 months (an average of 0.4 kg per month).
This report was widely publicized in tabloids across the world and had generated a lot of media frenzy. Although most cases of bariatric surgery on children and toddlers are presumably performed as life-saving procedures; the overzealous media hype around them is worrisome. This overenthusiastic excitement borders on unreasonably coercing bariatric surgery as being a standard of care for obese toddlers and children, even in the absence of any hard evidence. These cases raise a lot of pertinent questions, not only about the future medical and psychosocial outcomes in these children, but also about medical ethics and moral accountability.
Most bariatric surgery procedures lead to a significant reduction in the levels of “Ghrelin” hormone. It has been proven that ‘Ghrelin’ plays a significant role in secretion of the growth hormone and is an important link connecting growth and body composition with metabolism. This reduction in Ghrelin levels can have unknown repercussions on the growth.
Bariatric surgery is also known to cause bone loss and osteoporosis in children. Nutritional deficiencies are known to occur after surgery, and to expect lifelong commitment in terms of nutritional supplementation from a toddler may be too much to ask for. The implications on future reproductive health and pregnancy outcomes are also unknown.
Direct extrapolation of adult results to pediatric population has not worked in the past and may not work in these case too. Moreover, an average weight loss of half a kg per month, can possibly be also achieved by implementation of a strict medically supervised lifestyle modification. These children are too immature to understand the gravity of the surgery being performed on them. For many years to come, they will not be able to apprehend the demands and exigencies of a bariatric procedure. It may be overzealous to perform this on children, who may be at risk of experiencing unanticipated negative consequences several years into the future. It is also not justifiable to surgically modify healthy organs of an innocent toddler in absence of any clear evidence regarding safety and future outcomes.
Another question that arises here is, ‘Who exactly are we treating?’
We would expect that parents would act in the best interest of their children, and usually, they are the ones who would take the decision and give consent for surgery. Poor parental food choices are a significant contributing factor leading to a rise in childhood obesity. More often than not, in such cases, we are probably actually treating the parental guilt rather than the health of the children in question. Surgery may be just a convenient solution to what may be perceived as parental failure.
As parents and doctors, we have a huge responsibility when it comes to the future of our children. Extreme caution is warranted while treating such cases. Prevention is certainly better than cure. Childhood obesity must be taken very seriously. We need to cultivate healthy eating habits in children and there must be regular health campaigns focused at prevention of obesity. Some of these severely obese children may be suffering from a genetic cause for obesity and must be evaluated and treated accordingly.
Cutting into a child’s healthy organ as a quick-fix must be avoided at all cost; and doctors and hospitals must refrain from generating unwarranted media hype around these cases. It is high time that the right perspective is brought to the forefront. Bariatric surgery must not be confused as being a standard of care for treatment of severely obese children. Even in cases where there is no other choice, a multidisciplinary team must look into all aspects before reaching to a decision and surgery must be performed with extreme caution. Bariatric surgery in children must be reserved only as a last resort when all other options have been exhausted and the choice is between life and death.
©Dr. Aparna Govil Bhasker Come December and its the season of weddings. Be it DeepVeer, Nickyanka or the Ambani extravaganza, this year it seems to be unending. Social media has gone into a frantic frenzy with hundreds of shared images of exquisite wedding locales, star […]
©Dr. Aparna Govil Bhasker As the year comes to an end, we finally wrapped up writing, editing, rediting and re-re- editing our book on doctor- patient relationships. Oh no…dont get me wrong! This is not a promotional post! Those will come later :), closer to […]
Author- Mariam Lakdawala (Registered Dietician)
Common questions I generally get from my patients suffering from obesity,
“I don’t eat much, still why am I gaining weight?”
“I eat less than one of my friend, but why is she so thin and I am not?”
My answer to such questions is simple, “Don’t only see how much is on your plate, but also see ‘what’ is on your plate”.
The basic rule of weight loss is to restrict the overall quantity of food and increase the calorie burning capacity of the body. However, this rule has been outdated as only quantity restriction in the absence of food quality management, will not result in positive weight loss outcomes. Also a good quality diet which consists of good quantities of proteins and fiber keeps you full for longer and delays the intake of subsequent meal.
Though factors like genetics and heredity play a major role in adding those kilograms, ‘food’ can also be a major factor for tipping the scales towards obesity. If the quality of the diet is poor, food becomes the major cause of obesity. Your food plate determines the quality of your meals. An ideal food plate must have all the major (macro) nutrients i.e. carbohydrates (also includes fiber), proteins and fats in correct proportions.
In India, our diet is rich in carbohydrates with very less quantities of vegetables and proteins. This has an adverse impact on our metabolism and exposes us to various metabolic diseases, including obesity. In metropolitan cities the dependence on ready to eat processed foods like biscuits, breads, noodles, sausages/ nuggets etc is much higher in order to save time. These processed foods are generally high in sugars, salt and fat which makes them less nutritious and dense with empty calories. Poor quality diet coupled with lack of physical activity just makes it worse and has played a big role in increasing obesity levels.
The quality and quantity of food are two sides of the same coin. Both the aspects are equally important not only for weight loss but also for maintaining good health and must not be ignored.
Author- Mariam Lakdawala, Registered Dietician The most common observation made among diabetic patients is that they generally grab on sugar or sugary beverages when they get hypoglycaemic (a drop in the blood sugar levels). But are these sugar shots really helpful? Temporarily – yes, but […]