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… 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

How To Choose A Bariatric Surgeon?


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 ofbariatric surgeons, options for procedures to choose from and other additional services assisting the 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 abariatric program can help you cruise ahead in weight loss journey.

Challenging Obesity With Support Groups


At 267 Kg, Mr Virani was the heaviest person in the country to undergo Bariatric surgery. He had not ventured out of his house for over five years. After undergoing Sleeve Gastrectomy and 122 Kg lighter 15 months later, he now does not hesitate to attend support group meetings.

It is an established fact that human beings are social animals. We are dependent on each other. Our connections to others are key to not only our survival but also to our happiness and the overall success of our lives. While families  form a preselected social group; there are groups outside the circle of immediate families too.

Mostly, people are satisfied with the support offered by their families and friends, however, this may not hold true for everyone. Thus, enter ‘Support Groups’. Support Groups are a gathering of people who share a common health concern or interest. They help people facing similar health issues cope better  and feel less isolated.

When it comes to Obesity, the biggest challenge is the pressure to lose weight. The factors leading to a person’s inability to lose  weight could be many, ranging from health problems to  difficult lifestyle. An  effective solution to become healthy is opting for Bariatric Surgery. Post which, a person is likely to experience significant weight loss and thereby gain a whole new identity.

Ms. Prabhavati is physically active after losing 70 Kg post undergoing Gastric bypass and getting rid of her excruciating joint pains. Her husband, a security supervisor had to mobilize resources to get the surgery done. Prabhavati is motivating her daughter (31 years) to undergo the same & had brought her along to meet other younger beneficiaries of surgery.

A Bariatric Support group typically consists of patients who have had surgery at different time intervals. The Support group meetings regularly brings together the operated patients and encourages them to share their experiences. Most of these people have fought hard to fight a disease which not only makes them miserable but also attracts unnecessary negative social prejudices against them. Facing such attention can be a daunting affair for anybody but in case of an obese who already has a negative view about himself or herself; this attention can be catastrophic. It is even more excruciating since biases exist within their own family, physicians and close friends as well.

Thus, when these patients come together in an environment that is positive and with individuals who have faced similar situations, it is but natural for them to encourage & motivate each other. It has been proven that regular attendance at support groups has a direct impact on patient’s well-being & results.

Dr Ramen Goel, Founder, The Centre for Metabolic Surgery, holds regular support groups. A large gathering of patients attend these meets. They look forward to participate as a lot of recent scientific information, various dietary topics- like Eating out, Proteins, Mindful eating, Role of family in a Bariatric patient’s journey are covered in these meets.  He says, “It is a wonderful feeling to walk together on the same path, facing identical issues and having similar goals.”

Is Surgery The Final Cure For Obesity?


From trying to wake up early in the morning to keeping a close watch on eating habits, obese people do everything they can in order to lose weight. While some succeed, most find it difficult to continue the journey.

Bariatric surgery has proven to be an effective weight loss option for people who have fought and lost battle with their weight. It is a blessing for those who suffer from related diseases. Lifestyle changes remain an important tool even after surgery.

Gastric Bypass is the oldest bariatric procedure being carried out for over 50 years. This surgery involves creation of a small stomach pouch & re-routing the small intestines. The rest of the stomach remains functional & is connected to intestine. The other procedures include Sleeve Gastrectomy, Mini Gastric Bypass, Ileal Transposition, Gastric Band etc.

The various procedures lead to weight-loss depending on the following factors:

  • Reduction in the size of the stomach through placement of a gastric band
  • Removal of a portion of the stomach
  • Re-routing of the small intestines to a small stomach pouch

Patients typically lose over 50% of their excess weight after bariatric surgery. Obesity-related diseases markedly improve after bariatric surgery, reducing cardiovascular risk and improving life expectancy.

The combination of bariatric surgery and lifestyle changes makes an effective roadmap towards long term weight-loss and improved quality of life.