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 Table of Contents  
Year : 2022  |  Volume : 1  |  Issue : 2  |  Page : 59-60

Time to Trust

Center of Bariatric Surgery, Wockhardt Hospitals, Mumbai, Maharashtra, India

Date of Submission27-Sep-2022
Date of Acceptance28-Sep-2022
Date of Web Publication11-Oct-2022

Correspondence Address:
Dr. Ramen Goel
C10, Wockhardt Hospital, Agripada, Mumbai - 400 011, Maharashtra
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jbs.jbs_17_22

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How to cite this article:
Goel R. Time to Trust. J Bariatr Surg 2022;1:59-60

How to cite this URL:
Goel R. Time to Trust. J Bariatr Surg [serial online] 2022 [cited 2023 Sep 29];1:59-60. Available from: http://www.jbsonline.org/text.asp?2022/1/2/59/358297

A leading businessman usually referred to as “Warren Buffett of India” with assets of over $5.8 billion breathed his last barely a week after launching a new airline. Living in a metropolitan city with quality health-care facilities, he passed away peacefully in sleep. Eulogizing obituaries mentioned his extraordinary entrepreneurial skills and business leadership, but little was discussed about an avoidable death at the age of just 62 years.

Neither education, disease awareness, and affordability nor intention to receive treatment differentiated him from over 350 million (~30% of the population).[1] Indians suffer from metabolic syndrome (MS), a cascade of diseases, leading to poor health and physical limitation. MS is known to increase the risk of diabetes, hypertension, cardiovascular events, brain stroke, renal failure, and even early death.

With MS prevalence affecting 50%[1] of the 50–59 years age group population in India, urgent attention is required to contain spiralling rates[2] of abdominal obesity (31.4%), hypertriglyceridemia (45.6%), low–high density lipoprotein (HDL) (65.5%), hypertension (55.4%), and raised fasting blood sugar (26.7%). These are higher for Indians than Caucasians[3] and even other South Asian ethnic groups like Malays and Chinese.[4]

The precipitating factors of this runaway India-specific epidemic include poor dietary habits (increasing consumption of carbohydrates,[5] fats [dairy and hydrogenated fats],[6] and low[7] vegetable and fruit intake), increased sedentary behavior,[8] higher stress levels,[9] migration-related uncertainties,[10] maternal malnutrition,[11] and improving socioeconomic status.[12]

Health awareness and community-based interventions remain the mainstay of prevention and have shown significant improvement.[13],[14] However, diagnosed individuals (~330 million Indians) are likely to require lifelong treatment of not only individual components (diabetes, raised triglycerides, weight gain, hypertension, and dyslipidemia) but also related complications such as coronary heart disease, brain stroke, and renal failure.

Bariatric procedures in suitable candidates remain the most effective treatment modality for MS[15] with a 96% reduction in triglyceride levels and an 83% increase in HDL cholesterol.[16] Postsurgical adiponectin increase is associated with a reduced risk of atherosclerosis.[17] While the reduction in insulin resistance and Insulin like Growth Factor - 1 (IGF-1) lowers the risk of common carotid intima-media thickness in young, morbidly obese patients.[18] Heat shock protein 60, a likely molecular link between adiposity-related inflammation and heightened risk of cardiovascular disease too decreases after bariatric surgery.[19]

A recent meta-analysis has shown significant reduction in major adverse cardiovascular events in the bariatric surgery group as compared to the nonsurgery group (odds ratio = 0.49; 95% confidence interval 0.40–0.60; P < 0.00001; I2 = 93%).[20] Long-term nationwide comparative follow-up studies have shown 49% reduced cardiovascular infarction risk and 59% lower cardiovascular deaths in the bariatric surgery group than that in the control group.[21]

Even though bariatric surgery has been accepted by the International Diabetes Federation[22] and the American Diabetes Association[23] as part of the standard of care, only 1% of the eligible persons undergo surgery in the USA,[24] as many eligible individuals believe that they are not heavy enough or are not suitable for surgery.[25]

In a study to analyze the referring patterns, eligible patients stated that 71.1% of physicians did not discuss or offer bariatric options. Only after the patient (s) initiated a discussion, 80.6% of physicians supported bariatric procedures and 18.4% agreed to refer to a bariatric surgeon.[26] The various reasons for hesitancy include questioning attitude toward long-term results, ignorance of inclusion of surgery in the treatment algorithm, and considering it as a measure of last resort.[27]

It is time that patients suffering from MS are offered bariatric surgery as an option early enough for better glycemic control, comorbidities prevention, quality of life improvement, and reduced related deaths. It is time to reinforce trust in science, research, and data among patients, physicians, and subspecialists to improve patient outcomes.

  References Top

Krishnamoorthy Y, Rajaa S, Murali S, Rehman T, Sahoo J, Kar SS. Prevalence of metabolic syndrome among adult population in India: A systematic review and meta-analysis. PLoS One 2020;15:e0240971.  Back to cited text no. 1
Ramachandran A, Snehalatha C, Satyavani K, Sivasankari S, Vijay V. Metabolic syndrome in urban Asian Indian adults – A population study using modified ATP III criteria. Diabetes Res Clin Pract 2003;60:199-204.  Back to cited text no. 2
McKeigue PM, Marmot MG, Adelstein AM, Hunt SP, Shipley MJ, Butler SM, et al. Diet and risk factors for coronary heart disease in Asians in northwest London. Lancet 1985;2:1086-90.  Back to cited text no. 3
Tan CE, Ma S, Wai D, Chew SK, Tai ES. Can we apply the National Cholesterol Education Program Adult Treatment Panel definition of the metabolic syndrome to Asians? Diabetes Care 2004;27:1182-6.  Back to cited text no. 4
Burden ML, Samanta A, Spalding D, Burden AC. A comparison of the glycaemic and insulinaemic effects of an Asian and a European meal. Pract Diabetes Int 1994;11:208-11.  Back to cited text no. 5
Misra A, Khurana L, Isharwal S, Bhardwaj S. South Asian diets and insulin resistance. Br J Nutr 2009;101:465-73.  Back to cited text no. 6
Misra A, Sharma R, Pandey RM, Khanna N. Adverse profile of dietary nutrients, anthropometry and lipids in urban slum dwellers of northern India. Eur J Clin Nutr 2001;55:727-34.  Back to cited text no. 7
Khunti K, Stone MA, Bankart J, Sinfield PK, Talbot D, Farooqi A, et al. Physical activity and sedentary behaviours of South Asian and white European children in inner city secondary schools in the UK. Fam Pract 2007;24:237-44.  Back to cited text no. 8
Suchday S, Kapur S, Ewart CK, Friedberg JP. Urban stress and health in developing countries: Development and validation of a neighborhood stress index for India. Behav Med 2006;32:77-86.  Back to cited text no. 9
Patel JV, Vyas A, Cruickshank JK, Prabhakaran D, Hughes E, Reddy KS, et al. Impact of migration on coronary heart disease risk factors: Comparison of Gujaratis in Britain and their contemporaries in villages of origin in India. Atherosclerosis 2006;185:297-306.  Back to cited text no. 10
Bavdekar A, Yajnik CS, Fall CH, Bapat S, Pandit AN, Deshpande V, et al. Insulin resistance syndrome in 8-year-old Indian children: Small at birth, big at 8 years, or both? Diabetes 1999;48:2422-9.  Back to cited text no. 11
Suchday S, Chhabra R, Wylie-Rosett J, Almeida M. Subjective and objective measures of socioeconomic status: Predictors of cardiovascular risk in college students in Mumbai, India. Ethn Dis 2008;18:S2-7.  Back to cited text no. 12
Ramachandran A, Snehalatha C, Mary S, Mukesh B, Bhaskar AD, Vijay V, et al. The Indian Diabetes Prevention Programme shows that lifestyle modification and metformin prevent type 2 diabetes in Asian Indian subjects with impaired glucose tolerance (IDPP-1). Diabetologia 2006;49:289-97.  Back to cited text no. 13
Rush EC, Chandu V, Plank LD. Reduction of abdominal fat and chronic disease factors by lifestyle change in migrant Asian Indians older than 50 years. Asia Pac J Clin Nutr 2007;16:671-6.  Back to cited text no. 14
Gloy VL, Briel M, Bhatt DL, Kashyap SR, Schauer PR, Mingrone G, et al. Bariatric surgery versus non-surgical treatment for obesity: A systematic review and meta-analysis of randomised controlled trials. BMJ 2013;347:f5934.  Back to cited text no. 15
Nguyen NT, Varela E, Sabio A, Tran CL, Stamos M, Wilson SE. Resolution of hyperlipidemia after laparoscopic Roux-en-Y gastric bypass. J Am Coll Surg 2006;203:24-9.  Back to cited text no. 16
Umeda LM, Pereira AZ, Carneiro G, Arasaki CH, Zanella MT. Postprandial adiponectin levels are associated with improvements in postprandial triglycerides after Roux-en-Y gastric bypass in type 2 diabetic patients. Metab Syndr Relat Disord 2013;11:343-8.  Back to cited text no. 17
Powell-Wiley TM, Poirier P, Burke LE, Després JP, Gordon-Larsen P, Lavie CJ, et al. Obesity and cardiovascular disease: A scientific statement from the American Heart Association. Circulation 2021;143:e984-1010.  Back to cited text no. 18
Sell H, Poitou C, Habich C, Bouillot JL, Eckel J, Clément K. Heat shock protein 60 in obesity: Effect of bariatric surgery and its relation to inflammation and cardiovascular risk. Obesity (Silver Spring) 2017;25:2108-14.  Back to cited text no. 19
Sutanto A, Wungu CD, Susilo H, Sutanto H. Reduction of major adverse cardiovascular events (MACE) after bariatric surgery in patients with obesity and cardiovascular diseases: A systematic review and meta-analysis. Nutrients 2021;13:3568.  Back to cited text no. 20
Eliasson B, Liakopoulos V, Franzén S, Näslund I, Svensson AM, Ottosson J, et al. Cardiovascular disease and mortality in patients with type 2 diabetes after bariatric surgery in Sweden: A nationwide, matched, observational cohort study. Lancet Diabetes Endocrinol 2015;3:847-54.  Back to cited text no. 21
Dixon JB, Zimmet P, Alberti KG, Rubino F, International Diabetes Federation Taskforce on Epidemiology and Prevention. Bariatric surgery: An IDF statement for obese Type 2 diabetes. Diabet Med 2011;28:628-42.  Back to cited text no. 22
American Diabetes Association. Introduction: Standards of medical care in diabetes-2022. Diabetes Care 2022;45:S1-2.  Back to cited text no. 23
American Society for Metabolic and Bariatric Surgery. Estimate of Bariatric Surgery Numbers, 2011–2017. Gainesville, FL; 2018. Available from: https://asmbs.org/resources/estimate-of-bariatric-surgery- numbers. [Last accessed on 2022 Sep 22].  Back to cited text no. 24
Sarwer DB, Ritter S, Wadden TA, Spitzer JC, Vetter ML, Moore RH. Attitudes about the safety and efficacy of bariatric surgery among patients with type 2 diabetes and a body mass index of 30-40 kg/m2. Surg Obes Relat Dis 2013;9:630-5.  Back to cited text no. 25
Primomo JA, Kajese T, Davis G, Davis R, Shah S, Orsak M, et al. Decreased access to bariatric care: An analysis of referral practices to bariatric specialists. Surg Obes Relat Dis 2016;12:1725-30.  Back to cited text no. 26
Tork S, Meister KM, Uebele AL, Hussain LR, Kelley SR, Kerlakian GM, Tymitz KM. Factors Influencing Primary Care Physicians' Referral for Bariatric Surgery. JSLS 2015;19:e2015.00046. doi: 10.4293/JSLS.2015.00046. PMID: 26390524; PMCID: PMC4539491.  Back to cited text no. 27


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