Positive Outcomes Of Arthritis Post Bariatric Surgery

From health to work, obesity has a wide-ranging effect on an individual’s life and contributes to a bunch of health problems such as heart disease, type 2 diabetes, sleep apnea etc. But those extra Kgs can also increase the stress on knees and set you up in a world of pain. Knee pain is one of the common complications of being overweight. If you are among the millions who suffer from degenerative joint diseases including rheumatoid arthritis, osteoarthritis, crystalline arthritis, in that case bariatric surgery rewards you in countless ways. Research shows weight loss following surgery is associated with improved rheumatoid arthritis and a significant decrease in the need for medication and inflammatory markers. At six months post-surgery, patients lose an average of 72 lbs and six years after surgery, 78 lbs.1,2,3

The most notable benefits of bariatric surgery are –


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Diet and exercise, the two pillars for Losing weight

How diet and exercise play a role in weight loss?

Obesity has become an Achilles heel for many. Most obese people realise, often late, that it is extremely difficult to lose and maintain weight. However, medical or surgical intervention cannot be the only answer for the millions of overweight individuals in the world.


The most established long-term strategy for weight loss is by restricting calorie intake popularly known as ‘dieting’. Unfortunately, ‘diet’ is used as a fad most of the times, defeating the real purpose of a well-balanced diet for optimal health.

To understand the relevance of a balanced diet, one needs to understand the principles behind weight changes. It was widely believed, that if calories consumed equals calories spent, then weight can be maintained and in order to lose 2 kg/month, a person generally needs to reduce his/her calorie intake by 500 calories.

In reality, calories are so delicately balanced in the body, that to maintain weight, a person needs to eat exactly the same amount of calories that is spent on a daily basis.

For instance, having 2 potato chips (22 calories) daily, results in 8000 surplus calories over one year. Even this is likely to result in 1 kg of weight gain annually.

This recent understanding has a few major implications on weight loss:

  • Restricting 500 calories/day from current intake may be insufficient for weight loss since many people consume 1000-3000 calories extra daily.  The correct approach is to calculate one’s daily calories expenditure and then consume at least 500 calories less than the calories spent.  This may result in restriction of 500-3,000 calories/ day depending on pre diet food intake and exercise levels.
  • One’s diet should not be manipulated for only a few weeks or months with the purpose of weight loss. It should be improved for life. A person’s tendency to gain weight is unchanged over time.
  •  Once calories through food are restricted, the body starts using internal stores for energy. Initially glycogen (stored in muscles and liver) and then fat depots are used as energy sources. Usually it is advisable that despite dieting, calories intake should always be more than 1000/day to avoid a starvation response by the body.

 How the human body resists weight loss?

Reduced food intake results in two major physiological responses

  •  Increased in ghrelin hormone secretion by the stomach, which makes people feel hungry.
  • Reduced food intake over time means that as food digestion decreases, the rate of metabolism will also fall. This means that, with time, people will experience lower levels of weight loss.


Scientifically speaking, exercise on its own does not result in significant weight loss. However, exercises are extremely important to

  • enhance diet induced weight loss
  •  maintain weight in the long-term
  • improve fitness and overall health

Enhancing diet induced weight loss

People can increase their daily calorie expenditure by 200-1000 calories through aerobic exercises. If the calorie intake is fixed, calories spent can be increased through exercises and weight loss will thus speed up.

Role in long-term weight maintenance

Regular strength exercises result in increased muscle mass. Muscle cells consume more calories than fat cells. People with more muscle mass burn more calories even at rest. Thus exercise helps people maintain weight long-term.

Improving fitness and overall health

Besides its role in weight loss/maintenance, regular exercises play an extremely important role in one’s fitness through improved cardiac contractility. Aerobic exercises also help improve breathing capacity of a person. They also result in increased glucose utilisation by muscles, thus reducing insulin resistance and improving blood sugar control amongst diabetics.

In conclusion, diet and exercises remains the cornerstone of an attempt to lose weight. The successful outcome is largely based on long-term compliance with the same.

India: A Hub For Medical Tourism In Bariatric Surgery

Millions of men and women are grappling with obesity, which is a global epidemic now. Even after following strict diets and doing regular exercises, most people complain of not losing excess pounds.

For these reasons, many prefer to undergo bariatric or weight loss surgery for long term weight loss. Despite knowing the benefits, most avoid a bariatric surgery due to prohibitive cost in UK, USA, Canada, and several other European nations1. The long waiting period of 6 months to 2 years, for a bariatric surgery, in most of these countries is also a major deterrent.

In India, the cost of bariatric surgery is a fraction of what it costs to get the surgery done in western world. It’s the third most obese country with one in every fifth Indian diagnosed with obesity. India is carrying out more than 100 weight loss surgeries a day with Mumbai, being one of the preferred locations for patients seeking such treatment. Thanks to the medical tourism, India has become a popular destination for weight loss surgery. The availability of experienced surgeons, advanced equipment, competitive prices and world-class hospital facilities gives India an edge over other countries. However, the cost of weight loss surgery in India differs with the surgery type, surgeon experience, quality of hospital, as well as the city chosen to get the surgery done.

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Understand Bariatric Surgery with Dr.Ramen Goel,Bariatric Surgeon,Mumbai

Understand Bariatric Surgery with Dr.Ramen Goel

Bariatric surgery is connected to a lot of industries- there is the entire health and wellness food industry worth about 33000 crore. Some major hospitals like Apollo, fortis and Workhardt are talking more about bariatric and investing heavily, since it’s now insurable and has multiple benefits. Swati Khandelwal Jain spoke to Dr. Ramen Goel, Director, Bariatric and Metabolic Surgery at Workhardt Hospitals to know the pros and cons of it.

How to Choose a Bariatric Surgeon?

Here are tips on how to choose a bariatric surgeon for yourself – http://bit.ly/1M4WhN7



To do or not to do, that is the question that everybody asks themselves when thinking about going under the knife. Once you have decided to opt for Bariatric Surgery, choosing a Bariatric surgeon can be a crucial factor for  successful weight loss in your journey towards good health.

Weight loss surgery is not a new technique since it is practiced worldwide for over 60 years. The winds of time have favorably changed directions for the surgery. Many of us already know someone who has had Bariatric surgery.

It is definitely not a cosmetic procedure. To start, bariatric surgery isn’t performed by plastic/cosmetic surgeons. Today there is a slew of bariatric surgeons, options for procedures to choose from and other additional services assisting the weightloss surgery.

There are a plenty of factors to keep in mind before you finalize a surgeon, Here is a list of things you should ask your surgeon before making final decision.

Doctor’s Credentials

Is your surgeon qualified? Ask for your doctor’s credentials. One should know if your bariatric surgeon is well trained and accredited by international / national rating agencies. The most well known rating agency worldwide is ‘Surgical Review Corporation, USA.’

It is also important to know if the surgeon will be operating himself or a team member or associate surgeon will be operating you.

Numbers Matter

A doctor’s credibility lies in his/her experience. When it comes to a bariatric surgeon’s expertise, it’s important to see whether surgeon is doing atleast 100 bariatric surgeries/year.

Is he a complete bariatric surgeon?

Within Bariatric surgery, there are a number of procedures that one can undergo. It is also important to know how many types of procedures the surgeon can perform. A surgeon performing various types of bariatric surgery can objectively suggest the best possible procedure & individual bias can be avoided.

Support Team

After the surgery, different patients have different needs. The actual weight loss surgery is just the first part of your journey. Post op care is an important part of the overall journey. It is important that the facility that you have chosen is equipped with ample amenities for patients. Knowing the support staff team in advance helps smoothen post op recovery.


Ultimately, it all boils down to the fact whether or not you can trust your doctor. Bariatric surgery may be a simple procedure but it still requires experienced surgeons to perform it. After having met all the criteria, you need to listen to your instincts and go by your gut feeling before choosing your doctor.

Choosing the right bariatric surgeon may seem unnerving, but it doesn’t have to be. It is crucial to select a surgeon who understands your concerns, is able to answer your queries and can put you at complete ease. Asking the right questions and knowing what to look for in a bariatric program can help you cruise ahead in weight loss journey.


Insurance in Bariatrics

Dr Ramen Goel, Director, Center of Bariatric & Metabolic Surgery, Wockhardt Hospitals bats for the inclusion of bariatric surgery under insurance coverage. He explains that contrary to popular belief it is more than just a cosmetic procedure and often is a life-saving surgery

Dr Ramen Goel

Insurance for bariatric surgeries has been a controversial subject in our country for almost 20 years. Routinely almost all insurance companies (private or public) had been declining claims and pleas for payments (cashless or reimbursement) citing various reasons.

These refusals arise from a perception that obesity is a self inflicted problem and these self indulging individuals have no right to insurance largesse. Mostly reasons cited for rejection includes exclusion of obesity and related treatment in policy document and/ or bariatric surgery is a cosmetic procedure. None of these arbitrary pronouncements can withstand evidence-based scientific and legal scrutiny.


The Complete Guide to Diet after Bariatric Surgery

Bariatric surgery is a life-saving procedure. One is able to lose the stubborn weight along with associated diseases and most importantly feel and look healthy. However, for the surgery to be effective, one has to be vigilant about his/her diet intake. This is required for 2 reasons –

  1. For adequate healing of recently operated stomach/intestine
  2. For adequate weight loss and long term weight maintenance

For adequate healing post surgery, there are three stages to a Bariatric diet. Here is a quick guide to the do’s and don’ts when it comes to following a healthy diet post-Bariatric surgery

Liquid Diet (2 weeks after weightloss surgery)

The first three days after the surgery mainly involves clear liquid diet. This is to be followed in order to maintain adequate hydration levels in the body. During this period, a patient is guided to limit consumption to plain water, coconut water (if sugars are normal), clear soups, green tea, lime water etc. From the fourth day onwards, a patient can consume protein shakes, thin dal, buttermilk, tea/coffee, and soups.

Soft Diet (2-4 weeks after surgery)

The duration of this stage may vary depending on the type of surgery. A patient who has undergone a Gastric Bypass surgery needs to follow it for two weeks, while sleeve Gastrectomy patient needs it for 4 weeks. The diet mainly involves the consumption of egg whites, fish, porridge, dal, khichdi, low-fat paneer, curd, idli, dhokla, beans etc. It is important to ensure that foods should be soft and slightly overcooked. Things like bread, salads etc are not allowed.

Full Diet

4-6 weeks after surgery, person can start consuming even bread, dry fruits etc as staple lines have adequately healed.

Adequate Weight loss & Maintenance

Everyone loves to eat, who doesn’t? Nothing gives more satisfaction than a plate of food that you love. An obese person has to remember that bariatric surgery does not change the tendency to gain weight. So, in order to live a healthy life, optimal care of diet is necessary. Being healthy is a lifelong commitment for everyone irrespective of bariatric surgery. In our experience, most patients opting for bariatric surgery have immense will power as they have given up smoking /alcohol for years and have been exercising regularly for years.


After weight loss surgery, person is allowed to eat the food of his choice till he is full. Emphasis has to be on adequate protein intake (50-60 Gms per day) & liquids (1.5-2 litres per day). This can include fish, chicken, eggs, dal, roti, rice etc & there is no need to eat salads etc. Healthy food choices and a dose of exercises can help achieve lifelong healthy weight in all bariatric patients.

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