Obesity is one of India’s most significant public health crises. Nationwide thirty million Indians struggle with their weight. Shockingly, this figure includes 14.4 million children who are considered obese. One of these children embarked on a battle to save his life. This fight saw him become the world’s heaviest teen to undergo gastric bypass surgery.
Fourteen-year-old Mihir Jain could barely stand when he arrived at Max Hospital Saket for surgery last year. He was struggling to talk and even breathe properly.
A native of Uttam Nagar in West Delhi, Mihir weighed 237 kg and had a body mass index (BMI) of 92. He had a normal birth weight of 2.5 kg. In adults, a BMI exceeding fifty is considered class IV (high-risk) obesity.
Preeminent bariatric surgeon Dr Pradeep Chowbey, chairman of the Max Institute of Minimal Access, Metabolic and Bariatric Surgery in Saket, operated on Mihir.
“He had a 92 BMI when we first saw him,” Dr Chowbey told Health Issues India. “He could barely stand on the weighing scale.”
What is a gastric bypass?
Gastric bypass is a procedure which divides the stomach into a smaller and larger pouch. The small intestine is divided and one part is bypassed. The remaining part of the small intestine is connected back to the small stomach pouch created. The small stomach pouch restricts the amount of food intake and also bypassing one part of the small bowel causes less absorption of fat.
Before receiving gastric bypass surgery, Jain reduced his weight to 196 kg. He did this by following a supervised Very Low Calorie Diet (VLCD) of just 800 calories a day and rigorous physiotherapy sessions at home that encouraged him to walk. An average male in urban setting consumes 1800 calories a day. An average female consumes 1500 calories a day.
It rapidly became clear that Mihir’s case was one of life or death.
“When the BMI becomes more than 60,” says Dr Chowbey, “then it becomes very difficult to do a gastric bypass, which is a complex procedure in any case of obesity. When a BMI is 60, we call it super-super obesity. When we had a BMI of 92, it was very alarming. We asked ourselves: could he survive that excess weight more than a few days or weeks?
“If we had not operated, he would have succumbed to his obesity-associated problems. It would not have been possible for him to survive. The body would simply give way.”
“A success story” pointing towards a larger crisis?
The case of Mihir Jain is ultimately, as Dr Chowbey tells us, “a success story.” It enabled Jain to reduce his weight to 165 kg after three months of surgery. The hospital has said he hopes to reduce his weight further in the next three years, to 100 kg.
Mihir’s case may be viewed as an extreme example. However, as mentioned above, it points towards a much larger crisis involving rising rates of obesity among India’s children.
“In the last couple of years,” says Dr Chowbey, “we have seen a very significant and alarming rise in such cases of obesity. We are quite worried that we might get even more in the coming future.”
Childhood obesity is of particular concern to Dr Chowbey. “I think that there is a significant and alarming rise in childhood obesity in the country. After two decades, we have observed more and more patients coming with more cases of obesity to seek advice and operations and other types of management.”
Obesity: Bad news for India’s public health system
It is important to understand the cultural issues surrounding obesity in India. Genetics, poor diets, less physical exercise and the antiquated notion that being overweight equals being prosperous may all have a hand to play.
Growing rates of obesity are bad news for India’s public health system. Obesity is a significant risk factor for numerous noncommunicable diseases (NCDs). In particular, obesity presents as a massive risk factor for type-2 diabetes. More than 60 percent of type-2 diabetics are obese. Obesity is also a risk factor for heart disease – India’s biggest killer. Other conditions for which obesity is a risk factor include cancer, hypertension and kidney failure.
Public hospitals are already overburdened, understaffed and underfunded. The future influx of patients requiring treatment for chronic diseases that could result from the current obesity crisis is likely to add to the burden. As Dr Chowbey notes, “obesity is a very expensive and time-consuming disease, even for the developed and rich countries.” For India – a lower middle-income country – this risk is amplified.
“Parents must be cautious about rising BMI and consider it a disease”
The need is to raise awareness among parents about BMI and the importance of keeping track of it, Dr Chowbey tells us. “Parents must be cautious about rising BMI,” he says, “and consider it a disease. The national average BMI is 25. It is very desirable to keep it around that mark.
“A very young teenager is in a calamity or grave situation when they are obese. The parents must be bold enough to face it. Mihir Jain was bold enough to face the need to get to a lower weight before his operation. This makes it a success story.” Dr Chowbey expresses confidence that the case of Mihir Jain might encourage parents of young children, teenagers and adolescents to take preventative action in order to avoid obesity.
Indeed, surgery should be a last resort in saving someone’s life. That an ever-increasing number of Indians – including children and teens – may be needing that last resort should be a cause for alarm. It should lend a greater sense of urgency to campaigns aiming to improve Indians’ nutrition and spur renewed efforts to educate the populace about the steps they can take to make sure they do not need to face such a drastic option.
The case of the world’s heaviest teen undergoing gastric bypass surgery may be an extraordinary incident. However, what belies it is a public health and wellbeing crisis that is increasingly – and dangerously – common. After all, while the case of Mihir is a success story, the next one might not be.