Posts tagged bariatric surgery

WHEN A CHILD IS PUNISHED FOR HER WEIGHT

Blog

She is just 13 years old.
Six months ago, she weighed 153 kilos. Today, after 6 months of bariatric surgery, she weighs 112 kg.

She has lost 25% of her total body weight—a remarkable achievement by any medical standard. Physically, she’s doing better than ever. Emotionally, she’s struggling.

Because no school wants to take her in.

She hasn’t been to school since Grade 3. Her weight—and the judgement that came with it—forced her into homeschooling. Now, even after making such incredible progress, she finds herself rejected again. Every admission form, every interview, every polite refusal chips away at her self-worth.

She is a bright, curious, and articulate girl. But instead of celebrating her courage and recovery, the system is punishing her for a disease she never chose to have.

Obesity is not a failure of willpower. It’s a complex medical condition—one that affects the body, mind, and social identity. Yet, even when a child fights back with everything she has, stigma continues to stand in her way.

Schools need to do better.
Education is not just about marks—it’s about inclusion, empathy, and growth. A young girl’s potential must not be limited solely by her weight.

It breaks my heart that even after winning the battle against her body, she still has to fight one against society.

THE SILENT STRUGGLES

Blog

Yesterday, a 44-year-old man living with a weight of 182 kg broke down in tears during the consultation.

He did not cry because he was in any kind of physical pain. He cried because he felt utterly helpless—and scared. He cried because he could no longer breathe easily or walk without difficulty. Breathing and walking are basic, right? He cried because he felt he was failing as a father and as a husband, unable to support his wife and children the way he wanted to.

Every attempt to lose weight had ended in defeat. He felt like he was a burden on everyone. He felt that his life was over.

This is the hidden weight of obesity. It’s the part no one sees.

People living with obesity carry years of silent suffering. They are constantly mocked, judged, and dismissed. They are labelled as lazy, irresponsible, or lacking willpower. They live an entire lifetime with smirks, unsolicited advice, or silent disdain.

And yet what we see in our clinic is that most of them have tried—tried harder than we can imagine.

Here lies the paradox: society expects them to “do something” about their weight but offers little understanding of the disease or support. Instead, it adds layers of #shame, making an already difficult journey even more difficult.

It expects them to fight a complex battle alone and also pins the blame on them at every step of the way.

Obesity is more than a physical condition—it’s a complex and deeply emotional experience. What people with obesity often need is not more advice, but more #empathy.

Sometimes, just being treated with kindness and understanding can lift more weight than any scale ever could.

©️Dr. Aparna Govil Bhasker

PS- Image is AI generated

A PAGE FROM A DOCTOR’S DIARY

Blog

Together through every step

Seven years ago, Anaya walked into our clinic as a young, bubbly girl. She had struggled with obesity since puberty. She chose to undergo a bariatric surgery in the form of a laparoscopic sleeve gastrectomy and stepped into a new phase of life.

Yesterday, she came in for a follow-up consultation—a graceful woman, now married, a mother of two, and running her own business. Over the years, life has changed beautifully for her. But one thing hasn’t changed: her struggle with weight. Unlike many other health conditions, obesity is rarely understood. The frustration, the social pressure, the silent judgment—it can eat you up from inside.

Over the last 7 years, we have walked this journey together as a team—helping her through phases of weight regain after both pregnancies. This time, too, we helped her achieve her weight loss target. Our patients slowly become part of a larger family, and their victories, big or small, mean everything to us.

She told us about the joy and hope she regains with even a little progress, made possible through our support. And as she left, she said, “I really love you for all the support that you have given to me through the years.” Hearing that touched me deeply. It’s moments like these that make all the effort worthwhile.

This journey is not about numbers on a scale. It is about being understood, supported, and never left alone.

Obesity is a chronic and relapsing disease. And that is why it needs long-term care—care that continues well beyond the treatment itself.

©️Dr. Aparna Govil Bhasker

PS- The image is AI generated

The Unseen Struggles

Blog

©Dr. Aparna Govil Bhasker

“I am continuously trying, but I feel like I’m constantly failing.”

This was the first thing she said when we started talking about her weight issues. She was a 32-year-old working mother of a 16 months old baby girl, struggling with obesity, exhaustion written all over her face. Every day was a battle between juggling work, home, baby and her own well-being.

Her day started early, rushing through chores before heading to work. She worked long hours, returning home only by 9:30 p.m. By then, her little girl—who had been waiting for her all day—wanted all her mother’s time and attention. And how could a mother say no? She played with her, fed her, and held her until she fell asleep. Then came the household tasks—cleaning up, preparing for the next day, squeezing in a few moments of personal time before finally collapsing into bed, usually around 1 a.m. And the cycle repeated, day after day, month after month.

The weight kept piling on. She desperately wanted to prioritize her health. She knew she needed to exercise, eat better, and get proper sleep. But by the end of the day, there would be no time and energy left. She had tried waking up earlier to fit in a workout, but sheer exhaustion made it impossible. She tried to meal prep, but something always got in the way. Life was like an express train without brakes.

As doctors, we often advice our patients to aim for balance—to have a structured schedule, to eat clean, to work out, to prioritize sleep hygiene, to make time for themselves. But in real life, especially for women who are juggling work, home, and motherhood, is balance truly possible? Advice alone is not enough. What women really need is, tangible support—partners who share responsibilities, workplaces that accommodate their realities, families that step in when needed.

She looked at me, eyes filled with frustration and exhaustion. “I know I need to do better. I want to. But I just don’t know how.”

And I had no perfect answer for her. Because the truth is, she wasn’t failing—she was surviving. Every single day, she showed up, doing her best for her child, her work, and her home. In the process she could not do justice to herself. As doctors, we often find ourselves helpless in bridging the gap between the ideal and the reality of lived experiences.

She didn’t need more advice. She needed reassurance. She needed to hear that she was already doing enough and things will eventually get easier and better. That she wasn’t alone. That her worth was not tied to a number on the scale or the hours spent exercising. Because balance isn’t about perfect schedules—it’s about grace. It’s about finding kindness for yourself in the midst of chaos.

As doctors, we must remember that medicine is not only about prescriptions and protocols—it’s about people. We need more compassion, more acceptance, and a deeper understanding of the lives our patients lead. Because sometimes, healing is not just about more advice—it’s simply letting them know they are seen and heard.

She sighed, stood up, and adjusted the bag on her shoulder. “I’ll try again,” she said softly.

And I hoped that, someday, the world would make it easier for women like her.

#WorkingMoms #StrugglesOfMotherhood #ObesityAwareness #MoreThanWillpower #SupportMatters #BalanceIsHard #HealthBeyondAdvice

Beyond the prescription

Bariatric Surgery Blog

Beyond the prescription

©Dr. Aparna Govil Bhasker

I’ve always enjoyed talking to my patients, and as much as I love surgery, I truly cherish my time in the OPD. However, the time available in the OPD is limited, and we need to cover a lot in those precious few minutes with each patient. As healthcare professionals, we often become laser-focused on providing well-meaning advice and delivering a neat looking prescription (a challenge in itself for any doctor! Thank God for the digital softwares!). By the end, we feel we’ve fulfilled our duty.

As our practice grows and the number of patients increases, the time spent with each patient tends to become shorter, or the waiting list grows longer. Both scenarios lead to decreased patient satisfaction. But it’s not just patient satisfaction that takes a hit—our own job satisfaction suffers too. Over time, frustration starts building on both sides, and we all know where that leads to.

In recent months, I’ve felt that tension growing within me. I began to question: if I wasn’t feeling satisfied with the consultations, what were my patients walking away with? As obesity care specialists, were we truly making a meaningful impact when it came to lifestyle changes and behavioural modifications? Despite spending nearly 40 minutes with each patient, it felt like something was missing, like we weren’t reaching the level of progress we aimed for. We were not getting through the way we wanted to.

Fortunately, I’m lucky to have friends who share a similar mindset. When I discussed my concerns with my friend Dr. Tejal Lathia a renowned endocrinologist, she highly recommended the Motivational Interviewing course by Prof. Miller and encouraged me to explore it. Although I’ve been in medicine for nearly 30 years and can confidently say I’m a skilled doctor and surgeon, I must admit I’ve never been formally trained in the art and science of communication.

As a bariatric surgeon and specialist in obesity care, I’ve come to realize that communication is the real game changer. We can perform the most advanced surgeries, but it’s only through consistent and effective communication that we can truly help our patients make lasting lifestyle changes. Without it, both doctor and patient can fall into a cycle of judgment, bias, and blame, which benefits no one.

Yesterday in the clinic, we tried the “person-centered” approach for the first time. “We went beyond seeing the deficits on the patient’s side (3 months post a bariatric operation) such as- staying up late in the night, skipping breakfast, feeling low on energy, avoiding exercise, and neglecting her prescribed supplements.” On a normal day, our usual approach would have been to tell what she was doing wrong, offer well-meaning advice, explain the associated health risks of future complications, give her a prescription and send her off, hoping she’d correct course and be on a better trajectory by her next visit.

However, the person-centered approach encourages curiosity. It teaches us to move beyond assumptions about what we think we already know and what we believe is needed. It invites us to engage in deeper conversations with our patients. “With some gentle prompting, this particular patient revealed that for the past six months, she had been burdened by intense guilt. A close relative’s health had deteriorated after being admitted to a hospital that she had recommended. The financial burden from the medical bills was overwhelming, and the relative’s daughter had to give up her full-time job to care for her mother. This guilt weighed heavily on my patient, robbing her of sleep and triggering a cascade of problems—waking up late, missing meals, low energy, and neglecting self-care. It was also preventing her from feeling or accepting any joy in her own life”

She broke down in tears during our conversation, and we discussed the possibility of seeking help from a counselor. While she wasn’t entirely open to the idea, a seed had been planted. She seemed more receptive to make changes to her lifestyle and came up with some solutions on her own. More importantly, she felt understood, and we, as her healthcare team, felt like we had moved beyond simply judging her for not meeting our expectations.

This experience reminded us that as healthcare professionals working with chronic conditions like obesity, we can’t “fix” patients overnight. We can’t just hand out prescriptions and expect perfect adherence. We aren’t in a position to command or take charge of their lives. Our role is to guide them, safely and hopefully enjoyably, towards a destination we both desire. We must acknowledge that life happens to everyone—our patients are no exception.

For those living with obesity, these challenges are often compounded. In addition to everyday struggles, they also face the stigma and bias that come with societal expectations. Patients who have undergone bariatric surgery often feel the weight of taking what is perceived as a “shortcut,” along with the pressure of not meeting expectations, even after the surgery.

As healthcare providers, it’s crucial to make the most of the limited time we have with our patients. Sometimes, the connections we form matter more than the prescriptions we give. Kindness, empathy, and compassion are universally effective tools, often more powerful than any advice alone.

Incorporating motivational interviewing into our practice has the potential to transform not only the patient’s journey but also our own. By fostering deeper connections and helping patients uncover their own motivations, we empower them to make meaningful and lasting changes. As healthcare professionals, we should be open to learning and refining the art of communication at every stage of our careers. It’s not just about enhancing patient satisfaction—this approach brings greater fulfillment and satisfaction to us as doctors too. A well-communicated, empathetic consultation can be the difference between frustration and fulfillment for both parties, ensuring that the care we provide is as effective as the surgeries we perform.

I’m just beginning this journey, but I hope that by sharing my experiences, I can enrich my own path and perhaps make a small difference along the way.

PS: The image is AI generated.

EMPATHY AND OBJECTIVITY- A DELICATE BALANCE

Blog
EMPATHY AND OBJECTIVITY- A DELICATE BALANCE

©️Dr. Aparna Govil Bhasker

As doctors, we love evidence-based medicine! Most of us believe in the old adage- “In God we trust. All others must bring data.” We are deeply impacted by impact factors and the graph of our pride rises in direct proportion to the number of times our research papers are cited in the literature. Today, we have journals sprouting by the dozens and thousands of research papers being published every year. We go around the world, brainstorming with colleagues and trying to make sense of these infinite numbers in an attempt to solve the mystery of human health and disease. Though we are always trying to apply the evidence to generate best practices, many times during heated discussions in conferences it all boils down to- “What would you do (WWYD) if this was your wife? WWYD if this was your mother? And saving the best for the last…… drumroll please!!….. WWYD if this was your (you guessed it right!) ….. mother-in-law?”

The biggest irony faced by medical practitioners is that while data guides clinical practice, statistics get severely skewed when viewed from the perspective of the patient and their family. The universally acceptable 0.1% adverse event rate is a one hundred percent catastrophe when the life of a loved one is on the line. Randomized controlled trials (RCT) fall terribly short when we have to break bad news to a patient’s family. Unfortunately, RCTs can’t feel the pain or the disappointment. In real life, numbers are just numbers and they have no feelings. At such times, emotions overrule evidence leading us back to the timeless question- “Doctor, what would you have done if this was your own family member?”

Medicine is probably the only profession with a direct impact on a person’s life and death. An average person would probably make life and death decisions once or twice in their entire life. Some may never have to do it at all. Doctors are professionals who have to make these difficult choices on a daily basis. We have to remain objective while everyone is panicking and remain calm in the midst of chaos. We have to keep our head on our shoulders and our heart tucked a little away. We are bound by oath to take risks on behalf of others. Well, we all know that taking a risk is a risky affair and things can go either way. We have the impolite job of being realistic and setting the expectations right. Sometimes we have to say things that people may not wish to hear. And sometimes when we say things, people may choose not to hear. At the end of the day, we have the challenging task of keeping hope alive too, for hope can be a stronger potion than any medicine in the world.

Striking a balance between objectivity and empathy is like navigating a ship through turbulent seas. If either side is lost or if there’s an excess of one, it could tip the balance and sink the ship. Published literature, studies, trials, data and numbers can at best guide clinical practice to some extent. However, rattling off numbers can never provide solace to a suffering family. The practice of medicine is beyond that and the healing potion must contain the right dose of empathy to be effective.

Some of us can overdose on empathy too. Excessive emotional involvement in every patient’s case can lead to burnout and compassion fatigue. Overwhelming empathy can be quite exhausting and we need some degree of professional detachment and objectivity to navigate the medical maze effectively. This brings me back to the WWYD question. Throughout my career, I’ve been taught to treat patients as I would my own family. While we hold our loved ones dear, treating every patient as kin would lead to an emotional roller coaster. Trust me, it’s not good for any of the stake holders.

The journey of a doctor is a delicate balance between objectivity and empathy. We begin our careers armed with a solid foundation in evidence-based medicine and data-driven practices. With experience, we come to appreciate the necessity of complimenting these with empathy and a profound understanding of the humane aspect of healthcare.

When science marries compassion, the journey of healing begins. Those who find this equilibrium our blessed and experience immense gratification and fulfilment in their professional lives. For others, it remains a work in progress. It’s challenging, yet attainable. It’s not easy, yet possible. It is a continuous journey of growth and learning, shaping us into better healers every day.

Using bariatric surgery to fight obesity

Bariatric Surgery Blog Obesity Surgery Weight loss surgery
Using bariatric surgery to fight obesity

Dr. Aparna Govil Bhasker
Bariatric and Laparoscopic Surgeon

In the last week amongst the other patients I saw, there was one with a history of a stroke a few days back, one with a history of stroke, 2 years ago and a young lady with a condition called intracranial hypertension.

The one common factor between all three patients was, that all of them suffered from morbid obesity or clinically severe obesity, as it is called now.

The thing about obesity is that it is wrongly perceived as a sign of good health and a well to do economic status, atleast in India. However once people crossover from the overweight to the obese category, which is somewhere around a BMI of 29 to 30 or so, they tend to put on weight faster.

As the BMI continues to increase, obesity gradually starts affecting each and every part of the human body. Diabetes, high blood pressure and dyslipidemia are the big three that alongwith obesity form the metabolic syndrome. Eventually these together increase the risk of having cardiovascular events. Stroke is one of them.

Coming to the treatment part. Bariatric surgery is recommended for patients suffering from clinically severe obesity if their BMI is greater than 35. It can also be considered as a treatment option for patients with a BMI more than 32.5 with two or more associated diseases. As of now it is the only valid treatment option that leads to sustained weight loss in this patient population.

As a bariatric surgeon, I see many such patients on a daily basis. I also usually see that these patients and their families are very scared of getting the surgery done. There are many myths and many detractors who prevent these patients from getting treated on time.

Now here is the thing about treatment of any disease. Firstly, one needs to recognize that he or she is suffering from a disease. Secondly, get one or may be two expert opinions from qualified professionals and specialists about the best way forward. Thirdly, plan the entire process, prepare well and get it done. Last but not the least, dont delay the treatment. Every treatment works best in the early stages of a disease. Every single day that you delay, you are allowing the disease, time to grow and decreasing the chances of curing it.

Problems like stroke, heart related issues, embolism etc are life threatening complications of obesity. Dont let it grow to this extent.

Getting timely treatment can save your life and also improve your quality of life. Consult the right doctor at the earliest. Please dont miss the bus.

Dr. Aparna Govil Bhasker
Bariatric and Laparoscopic Surgeon

BARIATRIC SURGERY – Should Children Have It

Bariatric Surgery Blog
BARIATRIC SURGERY – Should Children Have It

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.

Quality versus Quantity Nutrition

Bariatric Surgery Blog Diet Obesity Surgery Weight loss surgery
weightloss diet in mumbai, india

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.

weight loss diet in mumbai, india

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.

How to manage Reactive Hypoglycemia?

Bariatric Surgery Blog Gastric Bypass Gastric Sleeve Obesity Surgery Weight loss surgery
Hypoglycemia

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 after 2-3 hours there are higher chances of experiencing another episode of Hypoglycemia. This kind of meal or rather simple sugar induced Hypoglycemia is known as Reactive Hypoglycemia. After the ingestion of sugar/ sugary beverages there is a rapid increase in the insulin secretion. Insulin causes a rapid digestion and absorption of sugars and still remains in the blood eventually causing low blood sugar levels.

The symptoms include dizziness, fatigue, light headedness, sweating, irritability, confusion, blurred vision, heart palpitations, etc.

Here are some dietary tips to prevent and manage reactive hypoglycaemia,

  1. Avoid consumption of sugar, honey, jaggery, processed foods, bakery products (bread/ biscuits/ cookies/ toast/ khaari/ butter, etc).
  2. Add fiber rich foods like vegetables, pulses, sprouts, fruits to every meal in order to improve the quality of carbohydrates.
  3. Do not keep long gap between the meals. Eat a small snack in between the main meals.
  4. Ensure every meal is balanced with good quality proteins from milk, curds, paneer, soy and its products, egg, fish, poultry, meat, etc.

Reactive hypoglycaemia could be because of multiple other reasons (Eg. Post gastric bypass surgery) and can be managed with the same dietary modifications. In case it doesn’t resolve with the diet, you can check with your doctor for further medical management.

Bariatric Surgery – How to maintain weight when the “Honeymoon” Wears off

Bariatric Surgery Blog Obesity Surgery Weight loss surgery

Mariam Lakdawala, Bariatric nutritionist; Dr. Aparna Govil Bhasker, Bariatric Surgeon

Honeymoon period is basically the golden period in the first year post bariatric surgery wherein the patient experiences drastic weight loss. Obesity surgery leads to weight loss through a combination of various mechanisms such as restriction of food intake, a decrease in hunger sensation, mal-absorption of calories, action of gut microbes and hormonal activity in the gut.

An interesting fact about the “post-bariatric surgery honeymoon phase” is that it is relatively longer than the “post-marriage honeymoon phase”. However, like the other one, this too is a temporary phase which sadly comes to an end after 6-9 months of surgery. After about 6 months or so, weight loss starts slowing down, but continues to happen until 1 year-18 months. Most patients reach the nadir of weight loss between 18 to 24 months.

By the end of 12 to 18 months, there is a considerable increase in food intake and hunger. Bariatric surgery is a tool that must be used for pushing one into a lifestyle change. Patients who embrace a healthy diet and an exercise regime, tend to do better in the long term. Varying degrees of weight regain is seen after obesity surgery in the long term. Regular follow up is the key to maintenance of weight loss in the long term.

In the first 6 to 9 months after the surgery, the main focus must be on conditioning the mind to, adopt a low calorie well balanced diet:

  • Your diet is important not only during the honeymoon phase but is even more important after 12 to 18 months to prevent weight from coming back
  • Restricting outside eating & intake of fried food, ice-cream, chocolates, processed foods, sugary foods etc.
  • Fat gives double the amount of energy as compared to carbohydrates and proteins, hence it should be restricted in the diet.
  • The body spends more energy to digest protein; thus, a high protein diet is very important for weight loss and maintenance. It is wise to distribute protein rich foods in all the meals in order to ensure better absorption.
  • Avoid keeping long gaps between meals, eat every 3-4 hours to prevent overeating in the subsequent meal
  • Maintaining a food diary is the best method to be aware of the food choices you make.
  • Grazing which is a repetitive eating behaviour, in an unplanned manner not associated with hunger or satiety sensations, could develop post the surgery. It might lead to poor weight loss if not corrected. A simple way to deal with it is to eat the entire meal at a go and keep a decided gap consciously between the meals.

Mindful eating

The story doesn’t end on what to eat, how to eat? how much to eat? When to eat? Is equally important. Given below is the cycle of mindful eating created to make you more mindful about your eating habits.

Mindful eating basically involves the practise of eating food slowly, in a relaxed environment by limiting other distractions so that you can focus well on your meals. As a result, you will be more conscious of portions and food intake.

Make exercise a way of life – Engage in any form of physical activity daily for at least 40-45 minutes. Make exercising fun by engaging in the activities you like so that you don’t leave it in between.

In addition to a focused exercise, increase the nonspecific exercise activities like usinga stairs instead of taking elevators or escalators, park your vehicle a little away from the intended destination, avoid using vehicle for short distances, etc

Stay away from lifestyle stressors like alcohol, smoking, erratic sleeping, sedentary lifestyle, work stress, etc.

Engage in meditation/ yoga/ breathing techniques or spend 30-40 minutes of your time daily in any activity that keeps you away from negative thoughts.

Dr. Aparna Govil Bhasker is one of the best bariatric surgeons in India and is associated as a consultant bariatric surgeon in Mumbai with many renowned hospitals.