Obesity and overweight: what is the difference?

Obesity and being overweight are often misunderstood as synonyms for each other. A better understanding of these will help us to understand the optimum resolutions for each Obesity is defined as having a body mass index (BMI) of greater than 25. BMI is a measure of your weight relative to your height.  India has more than 30 million obese people, and the number is increasing alarmingly. The problem is more acute among women than men.

Obesity is looming threat of the 21st century and is a major causative factor for many other metabolic disorders and comorbidities. 

If one is to look at the causes, there is no single cause of obesity or excess weight. Though both are primarily a result of energy imbalance, excess calorie intake, and insufficient physical activity or a combination of both, there are various genetic, behavioural, and environmental factors that also contribute to the causes of overweight and obesity. The modern lifestyle is often blamed for increasing obesity. Our typically urban lives allow us access  to comforts and luxuries alike use of mechanized transport, increasing the availability of processed and fast foods, increased television viewing, adoption of less physically active lifestyles and consumption of more “energy dense, nutrient-poor” diets. It is this very modern lifestyle that brings with it an unwanted epidemic of obesity and various health conditions that eventually become a threat to healthy living.

The risk of many diseases including cardiovascular diseases (CVDs), hypertension, hyperlipidemia, diabetes mellitus, and certain cancers increases many folds in association with obesity. There are no quick-fire solutions to the looming threat of the obesity epidemic. When an individual fails to lose enough weight to improve his health using other methods such as diet and exercise regimes and yet faces serious obesity-related health problems, then weight loss surgery or bariatric surgery are suggested for such individuals.

Various procedures of bariatric surgery leverage innovative technologies and enable severely obese individuals to live longer and more fulfilling lives. When used for a right candidate, irrespective of the procedure used, it has been clinically proven that weight loss surgery results in greater improvement in weight loss outcomes and obesity-related health conditions. Bariatric surgery holds the potential to improve many obesity-related health problems, such as type 2 diabetes, high blood pressure, unhealthy cholesterol levels. Bariatric surgery also positively impacts a person’s quality of life by improving physical function and mood.

Having said that, it is important to understand that bariatric surgery is no replacement for healthy habits It can only help if the candidate undergoing the surgery is willing to abide by a healthy lifestyle post-surgery.




My Experiences With Truth


The feedback from our facebook page ‘Centre for Metabolic Surgery, Mumbai’ & emails received have shown that expectations & concerns vary between patients. Apparent annonymity provides an outlet for expression which may not happen during consultations esp in presence of family or friends.

Just last week a gentleman, operated almost 3 years back, messaged me that he has gained few kgs in last 1 year. He is one of those who is regular in follow up & extremely bullish about bariatric outcomes. However, alcohol had been his achilles heel, as is with so many others.

A common adage is that if one cannot eat, drink & make merry than what use is life? Personally, I am also a supporter of the view that quality of life is eqully important. Majority of those opting for weight loss surgeries have phenomenal will power – eating small portions, exercising regularly & have given up smoking/alcohol years back.

On the other hand, most of our obese or diabetic patients have never experienced a situation where they can consider themselves free of these diseases. Post bariatrics, patients start believing that, alcohol or sweet consumption is an expression of new found freedom or normalcy which had eluded them for decades, failing to realise that, unlike their slim friends, they continue to have tendency to gain weight if they go overboard.

Is alcohol consumption a complete no-no after bariatric surgery? Consumption of alcohol per se is not a major concern after adequate weight loss but regular & significant intake with consumption of high calorie snacks can indeed cause weight regain & maybe other health problems.

How much is too much? Well, for the first year after surgery or till weight stabilises alcohol should be completely stopped for excellent results. After that, if absolutely necessary, 1-2 drinks a week should not be a problem, but anything more & ……. It is important to remember that these lifetime problems have lifestyle origins.

For most, losing weight or getting rid of diabetes had been a major problem for years. The effort to lose weight is usually stupendous before surgery & now that you are living a dream after losing 30, 50 or over 100 kgs and with normal blood sugars, without daily insulin jabs, the party has just begun.

Why let a drink spoil the party!

Dr Ramen Goel












My Experience With Truth

ArticlesMy-Experiences-with-Truth-960x3721.jpgInter human variation always intrigues me. How come the same surgery works well for most while not for few? They believe  ncreased hunger & ability to eat frequent meals is the culprit.

This explanation is based on poor understanding of post bariatric dietary education. Hunger is a physiological process & there is nothing wrong if the person is hungry before a meal. Hunger indeed reduces after surgery for few months due to decrease in hunger hormones. But body compensates by producing hormones from other organs & hunger is back.

The key message is that surgery is done to enhance satiety or feeling of fullness after a meal & not to curb hunger.  Surgery is also expected to increase interval between meals. This is possible to achieve & maintain lifelong if the principles of surgical follow ups are adhered to, which include –

Consumption of liquids with meal – Post surgery stomach capacity is usually 30-50 ccs, which can increase to ~200 ccs after 1-2 years. Even this capacity is 1/3rd of normal stomach size so meal portion remains small permanently. Few patients realise that by gulping liquids with a meal, they are able to flush the food down from their stomach & consume larger meal. This also results in feeling of emptiness within 1-2 hours of surgery. This is completely avoidable by learning to eat without liquids for at least 1/2 -1 hour after a meal. 

Protein intake – Many patients believe that they they eat more sweets & fried items, when stressed. The fact is that once high GI(glycemic index) food like sweets, refined flour etc are consumed, the blood sugar precipitously rise & fall. This makes person hungry again & craving of food manifests within 1-2 hours.On the contrary, high protein meal results in slow & sustained provision of nutrients to body. Thus a protein meal is known to result in satiety which keeps hunger away for hours. Thus food choices play an important role in altering hunger mechanism.


Food choices & technique of eating plays an important role in feeling full & keeping hunger at bay. Hunger is normal & should not be considered as personal failing.

Surgery has worked well for millions across the world & do not let few episodes of indiscretion envelope you in feeling of guilt, personal failing or hopelessness. Important thing is to always remember years of lost hope & control over your body. The secret of success lies within you through education, compliance and positive approach. Yes…..you can.

Myths And Facts On Bariatric Surgery Victims And NOT Culprits

Did you know that crash dieting is the most effective way of weight-loss or there are some magical foods that cause weight-loss? The beauty about myth is that, although everyone knows it is untrue, one wants to believe it.

For instance, when it comes to losing weight, most people make uncountable efforts and yet are not able to sustain the weight-loss results for longer durations. For such cases,Bariatric surgery has proven to help a lot. Despite its success, many suitable candidates still hesitate to choose Bariatric surgery because of the misconceptions around it. Here is a list of seven most common myths on Bariatric surgery and facts that will burst the bubble around them.


    • Myth – Bariatric Surgery is only for grossly obese


  • Fact – Anybody with 20-25 kgs excess weight or a BMI of over 32.5 kg/sq m can undergo the surgery



    • Myth – Bariatric Surgery is risky


  • Fact – Bariatric surgery has become as safe as a hernia surgery with mortality risk of 0.05% & re-operation rate of 0.01%



    • Myth – Bariatric surgeries should be considered as the last option for weight loss.


  • Fact – Weight loss surgery is good option for people who are finding it difficult to maintain weight with diet and exercises.



    • Myth – Weight may be regained after few years


  • Fact – Possibility of weight regain is only 10%* compared to 98% after other weight loss measures like diet, medicines etc in suitable persons. * for banded gastric bypass



    • Myth – Diet has to be continued even after surgery.


  • Fact – Patient is allowed to eat food of his choice till he is full. This can include fish, chicken, eggs, dal, rotis, bread, rice etc & there is no need to eat salads or remain hungry to lose weight anymore.



    • Myth – Drastic weight loss will result in poor energy levels.


  • Fact – Energy levels go up significantly within a short span after surgery due to reduced breathlessness, less joint pains & better nutrition.



    • Myth – Surgery is a short cut to weight loss.


  • Fact – Almost all patients opting for surgery have exhibited exemplary will power by multiple dietary & exercise efforts. Most have given up alcohol and smoking for many years. They are victims and not culprits. Victims of a disease over which they have minimum control.


Like other spheres of life, even in health, reliable information can build understanding and trust. Hearsay or myths should never be determining factor in taking any decisions esp if it concerns your health and life.

Bariatric surgery is an effective and natural way to lose weight. The unrelenting ambition to be fit and healthy always wins the battle against obesity. May the force be with you always!


My Experiences With Truth


Hats off to all you digital users……I had been attempting to write a blog for almost 6 months & could not, while most of you tweet, write & express your thoughts ‘in few words’ on hourly or daily basis.

I saw ‘Haider’ last night & I realised that everyone should try to see other person’s view point as well, because there are no absolutes in life. I hope to keep that balance as I begin this new journey of communication with all of you – friends & family….

Bariatric surgery had been an enlightning journey for me for so many reasons. Prolonged interactions, understanding changing inter-personal relationships in family & guiding them with a firm but caring hand while maintaing dispassionate stance, had been a challenge.

Just yesterday, a patient (herself a doctor) operated 3 years back came for a follow up with her doctor husband. She has lost over 40 kgs & is maintainingherslf at 56 kgs. She looked gorgeous & fit. The major problem was that her husband has still not reconciled to the fact that she should be so slim, because her weight at marriage was 68 kgs. For the smallest health or other issue in their family, he would criticise her decision to undergobariatric surgery. Instead of being a happy person with control on her life, she is fighting a different battle everyday.

We have seen this happening with many of our patients. Friends or family, who were supportive of your effort to lose weight through surgery, are not so accepting anymore.

Please believe me – it is neither jealously nor their unhappiness to see you healthy. Try to understand their concern & reasons for change in their approach. Most of them, in their life, have never seen you so slim or bony.

  • also most of our patients are psychologically & physically dependent on their

near ones but post surgery mobility & fitness gives them new found confidence. This new found lack of dependence may not be accepted by the person resulting in unhappy companions.

Who is responsible for this? You, your companion or the surgery……no one actually, all that we need is time, understanding & communication between us, you & your companion & life will be fun once again.

Please, please do not snap & do not let it snap… remember, these were the people who stood with you, when no one else.

I am sure some of you had similar experiences. Feel free to write to us to enlighten us so we can help more of you…

Dr Ramen Goel


Can You Gain Weight After Bariatric Surgery?


Are you sure, the weight will not come back? This is one of the 3 mandatory questions every bariatric patient asks me. The others(which I shall cover in next blogs) being the safety & cost.

dad-daughter obese 1What does everyone want to hear? The failings of past haunt obese like nothing else. I still get emotional when I recollect helplessness of a father whose beloved single child, a 21 yrs daughter, failed to maintain weight despite diet & working out in gym for, hold your breath, 4 hours a day. He provided best gym membership & diet counseling but inevitable rebound led her to avoid social gatherings, & outings with family & friends(as a young adult is expected). Of course she lost weight after surgery & her outlook changed completely.

We are aware that obese have tendency(inherited or otherwise) to gain weight even with moderate calorie intake. We have operated on many members of many families, confirming tendency related weight gain belief.


 Bariatric Family

Most start believing that surgery will automatically result in continued weight loss, changes in lifestyle & disappearance of weight gain tendency. This is neither the target of bariatric surgery, nor feasible expectation from surgery. Surgery does not change genes, environment or psychological approach to food.

Does that mean that weight regain is inevitable? Definitely NOT. Please remember that surgery is an excellent ‘tool’ to help lose weight & all patients have indeed reported good weight loss.



Dr J could lose the weight regained after surgery

However, we continue to consult patients with weight regain of 2kgs, 5 kgs or 10-12 kgs usually few years after surgery. All of them are indeed aware of reasons for their weight gain & most are able to take corrective actions as well.

What can cause weight regain after surgery? Even few years after surgery, the meal size remains small i.e. 1-2 chapatis/equivalent food. This is usually the meal that is prescribed by a dietitian for weight loss to a non-bariatric obese. Then how come abariatric patient eating even less gain weight?





IMG_0987 2

This can only be explained by

  • Consumption of calorie dense food on regular basis. These include alcohol, fried snacks, sweets & increased fat consumption in meals.
  • Poor metabolic rate – With weight loss, most will lose fats & muscles both. Low muscle mass results in less calorie burnt by patients at rest, reducing the energy expenditure.
  • Non-compliance of bariatric lifestyle – This primarily means inadequate chewing of food (resulting in stretching of pouch/stoma), drinking liquids with a meal & inadequate protein intake. These may result in excessive calorie intake.

These defeat the purpose of surgery since calorie intake exceeds expenditure & weight gain may happen in few.

Preventing Weight Regain

Can you prevent weight regain despite all the mentioned reasons – the answer is YES. 5 simple steps for weight maintenance are –

  • Acknowledge that you have weight gain tendency, which does not change by surgery. Realise that surgery has NO magic but is an excellent TOOL to help you lose & maintain weight. Paste large ‘before’ pictures – surely you do not want to be like that again.
  • Lifestyle cannot change automatically after surgery. It will change only if you work towards it by
  • avoiding alcohol & calorie dense food(fried, sweets, snacks etc).

Read my blog on ‘Alcohol & Weight loss Surgery can be a bad Combination’

  • b) avoiding liquids with meals
  • c) chewing, chewing & chewing your food.
  • Similarly protein, protein & proteins in each meal is essential to prevent muscle breakdown, provide fullness for longer duration & prevent sudden blood sugar spikes in diabetics.
  • Exercise – Strength training helps maintain muscle mass with increased metabolic rate. This helps burn more calories even when one sleeps. Regular exercises not only make you look smart but also takes care of occasional indiscretion(s) without weight regain.
  • Follow up – Few patients, after surgery, start believing that they have broken the ? code & do not require professional support. Weight maintenance is best in patients who are regular in their follow-up, attends support group meetings & interacts with bariatric team.

I do agree that law of diminishing returns apply when you re-visit but even small changes in technique or diet may avoid weight regain or a second surgery.

Am I sure, the weight will not come back? Yes, I am certain that with these 5 reasonably simple steps coupled with your will, each one can maintain their weight for a long time.

For more information watch Dr Ramen Goel’s Presidential address on Weight Regain at National Conference of Obesity & MetabolicSurgery Society of India at JW Marriott, Mumbai in January 2015