Obesity is a complex disease involving genetics, metabolism, hormones and life style. Morbid obesity which is also termed as severe obesity is a disease and it is approved as a disease by all medical councils, insurance companies, Govt, etc.

Just like any other diseases, IRDAI, Insurance Regulatory and Development Authority of India have approved morbid obesity as a disease. Hence treatment for morbid obesity including metabolic and bariatric surgery is covered under insurance.

What is morbid obesity :

Asian and Indian guidelines state that anyone with a BMI of 32.5 with obesity associated conditions or anyone with a BMI of 37.5 or above is termed to have morbid obesity.
However, Indian insurance companies have limited the insurance cover for the following:

• Anyone with a BMI above 40kg/m2 with obesity induced symptoms
• Anyone with a BMI above 35 with either uncontrolled type 2 diabetes or severe sleep apnoea or coronary heart disease.

Note : There is no definition for ‘severe’ sleep apnoea and hence a document or report or a specialist certificate is necessary.

Uncontrolled diabetes is when the HbA1c, or three months average sugar is above 7, or multiple blood sugar levels are very high; in spite of medical treatment for diabetes.
It is important to preserve all earlier medical record including prescriptions, doctors consultation notes, reports, etc.

Ideally a unit with two bariatric surgeons is preferred so that two bariatric surgeons can certify for the patient.
Patients are expected to preserve all records of earlier weight loss attempts.

Even though severe osteoarthritis, PCOS, migraine, urine incontinence, high lipid levels, knee or spine diseases, etc are also few of the main indications for bariatric surgery, insurance companies in India do not accept these for bariatric surgery cover. It is still recommended to have the documents related to the above as supporting documents.

When can one get insurance cover for bariatric surgery after having the insurance?

Some insurance companies have a waiting period of two to four years after the date of inception, that means from the date on which insurance was first stared.

Corporate insurance does not have any waiting period.

If you are suffering from morbid obesity and associated problems, metabolic and bariatric surgery is the best long term solution for you. If you have a valid insurance cover, you deserve to get insurance cover for the same.

What is intragastric balloon :

Intragastric balloon placement has been started in India at Laparo Obeso Centre since 2006 and LOC is known to be one of the pioneer balloon clinics in India. Since then,LOC has trained and certified many endoscopists and nutritionists.
Intragastric balloon is a non-invasive modality for weight loss. However, since the balloon needs to be removed after a period of time, it is accepted as a temporary method of weight loss.It is popular as a nonsurgical weight loss method for those who do not wish to undergo bariatric surgery or do not need surgery.
A silicon or similar balloon is filled with saline and occupies the space in the stomach.
The material of the balloon prevents it from being digested and hence stays in the stomach.Balloon can be swallowed or endoscopically placed in the stomach under sedation.

Who should undergo intragastric balloon for weight loss?

• Those who can’t lose weight after diet and exercise
• Ideal for those with an excess weight up to 10 to 15 kg
• PCOS
• Those with infertility needing weight loss
• Failed IVF and with obesity
• Cosmetic reasons

Balloon therapy is not ideal for patients with morbid obesity who require bariatric surgery.

How does gastric balloon work?

The balloon occupies the space in the stomach limiting the food intake. However, a person needs to be careful with the caloric intake to get the maximum benefit of weight loss. The balloon in the stomach gives a feeling of fullness and reduces hunger and cravings. However, the effect of balloon starts wearing off slowly and the person needs advice from a qualified bariatric nutritionist to learn to keep the food intake and calories to the lowest.

Is balloon a day care procedure?

Intragastric balloon placement is known to be a day care procedure and one can be discharged in about 3 to 4 hours.
Balloon is placed under short sedation and filled with saline under vision through an endoscope or gastroscope. could be some discomfort or pain for the first few days since the stomach would contract and attempt to digest the balloon.Some patients may need intravenous medications to suppress nausea and discomfort or pain after the balloon insertion. The discomfort usually disappears after about two to four days.

How much weight can be lost after the balloon?

It is generally said that a person can lose about 5 to 10 percent of weight. The results are variable based on the excess weight, BMI, metabolism and dietary compliance.
The weight loss is maximum in the initial 6 weeks and may slow down over time. Maintenance of weight loss is necessary with a proper follow up.

What is a swallowable balloon or a balloon pill?

These balloons are available as large capsules and can be swallowed by a person, with some difficulty. It is then confirmed under X ray vision that the balloon is inside the stomach. The balloon is attached to a tube through which saline can be instilled inside the balloon and the tube can be pulled. Some balloons rupture and pass out in about two to three months. The weight loss effect lasts for a very short time and needs to be maintained. This method is expensive and weight regain could be very rapid after the balloon passes out.

Can a gastric balloon be kept inside the stomach for a year?

There are balloons which can be left inside the stomach for one year, so that the weight loss benefits can be sustained for longer period. ‘Spatz’ balloons are adjustable balloons which can be left inside for a year. The word adjustable means that the same balloon can be further inflated with more saline so the effect of fullness and satiety can be augmented if the weight loss slows down or stops during the period of one year.
There are different types of balloons which can be kept up to 3,6 or 12 months. The effect of the balloon lasts longer if the balloon can be kept inside for a longer period.

Balloon removal procedure:

It is an outpatient procedure. Patient reaches the clinic fasting and under short sedation the saline/ fluid inside the balloon is sucked out with a special needle passed through the endoscope. Patient d

Can balloon rupture or leak?

The incidence of balloon leak is very low. However, the balloon is filled with saline tinged with a water-soluble dye known as methylene blue. If a balloon leaks, the methylene blue leaks in the stomach, absorbed and excreted through the urine. Urine turns bluish green and the person can immediately know it. In case of a leaked balloon, it can be safely removed or replaced with a new one. Balloons are made with silicon and hence can not rupture.

What are the contraindications for a balloon?

People with acidity or reflux disease are not recommended to have gastric balloon placed.
Ideally, an endoscopy is recommended to ensure whether it can suit a person.
Those on aspirin, blood thinners, pain killers are generally requested to avoid balloon placement.

What are the side effects of gastric balloon?

Side effects of balloon are usually mild and well tolerated.
Nausea, vomiting, abdominal discomfort or pain are the most common side effects seen initially and can be controlled easily with medications. Acidity is sometimes a challenge especially after spicy food and should be treated with antacids. Vitamin and protein supplements are needed to keep the nutritional status healthy.

कोरोना हा सहव्याधी रुग्णांसाठी जसा जीवघेणा आहे, तसाच तो स्थूल लोकांसाठीसुद्धा धोकादायक आहे. लठ्ठपणा या आजाराचे शिकार असलेल्या लोकांना कोविडमुळे श्वसनात अनेक अडचणी येतात आणि त्यामुळे त्यांच्या जीवाला धोका निर्माण होतो. त्यामुळे आता स्थूलपणाला कात्री लावण्यासाठी लोकं बॅरिएट्रीक सर्जरीकडे वळत आहेत.

स्थूलव्यक्ती मरता-मरता बचावले

वाढत्या स्थूलतेकडे दुर्लक्ष करणार्‍या माणसांनी आता अंगावर वाढलेली अतिरिक्त चरबी घटवण्याकडे कटाक्षाने लक्ष देण्यास सुरुवात केलीय. कोव्हिडची बाधा झाल्यानंतर थोडक्यात बचावलेले रुग्ण आता कटाक्षाने वजन नियंत्रित राखण्यात तसेच बॅरिएट्रीक शस्त्रक्रिया करण्याकडे लक्ष देत आहेत. यापैकी बॅरिएट्रीक शस्त्रक्रिया करणा-या रुग्णांचे प्रमाण लक्षणीय असल्याचे मत लीलावती रुग्णालयाचे बॅरिएट्रीक सर्जन डॉक्टर शशांक शाह यांनी व्यक्त केले. या शस्त्रक्रियांना आता इन्शुअरन्सचाही आधार मिळू लागल्याने रुग्णांचा आर्थिक भारही हलका झाला आहे. त्यामुळे या शस्त्रक्रिया वाढू लागल्या आहेत. चुकीच्या जीवनशैलीमुळे आता सर्व वयोमानात स्थूलता दिसून येत आहे. मुळात स्थूलता हा आजार असल्याबाबत आजही जनसामान्यांमध्ये संमिश्र प्रतिक्रिया आहेत. ज्या रुग्णांनी औषधोपचार घेतले त्यांनाही कित्येकदा पुन्हा स्थूलतेचा सामना करावा लागला. परंतु कोव्हिडकाळात हे रुग्ण मरता -मरता बचावले, असेही डॉक्टर शाह म्हणाले.

डॉ. शहांनी सांगितला अनुभव

स्थूल रुग्णांना उपचारांना प्रतिसाद देताना असंख्य अडचणी निर्माण झाल्या. परिणामी, मृत्यू पावलेल्या रुग्णांमध्ये स्थूलतेचे प्रमाण जास्त असल्याचा निष्कर्ष डॉक्टरांनी मांडला. याबाबतचा अनुभव मांडताना बॅरीएट्रीक सर्जन डॉक्टर शशांक शाह यांनी सख्या दोन भावांचे उदाहरण देखील दिले.यापैकी ज्या भावाने वजन नियंत्रित न राहिल्याने बॅरिएट्रीक शस्रक्रियेकडे कानाडोळा केला,त्याला कोविड झाल्यानंतर कित्येक दिवस अतिदक्षता विभागात उपचार घ्यावे लागले. मरणातून वाचल्यानंतर त्याने दीड महिन्यानंतर त्वरित बॅरिएट्रीक शस्रक्रिया केली, अशी माहिती शाह यांनी दिली. मात्र ज्या भावाने कोविडची बाधा होण्याअगोदरच बॅरिएट्रीक शस्रक्रिया केलेली त्याच्या उपचारांत अडचणी आल्या नाहीत, तो या जीवघेण्या आजारातून सुखरुप बाहेर आला, असं शाह पुढे म्हणाले.

बॅरिएट्रिक शस्त्रक्रियेविषयी

• बॅरिएट्रिक शस्त्रक्रियांना चयापचय शस्त्रक्रिया म्हणून देखील ओळखले जाते, कारण ते मूळ कारणांवर कार्य करतात आणि चयापचय गतिमान करतात. हे बदललेल्या आतड्यांसंबंधी मार्गाद्वारे आणि आतड्यांच्या वेगवेगळ्या भागांना उत्तेजन देऊन होते. या उत्तेजनामुळे हार्मोन्सचा स्राव होतो ज्यामुळे भूक कमी होते, तृप्तता सुधारते आणि वजन कमी होते.
• या प्रक्रिया मधुमेह, रक्तदाब, सांधेदुखी, स्लीप एपनिया इत्यादी स्थूलपणाशी संबंधित सर्व आजारांना उलट करण्यासाठी ओळखल्या जातात आणि कॉमोरबिडीटी कमी करून आयुष्य वाढवण्यासाठी ओळखल्या जातात.

स्थूलतेच्या शस्त्रक्रियेसाठी कसा मिळतो इन्शुअरन्स

• हृदय विकार, मधुमेह आणि झोपेची समस्या असलेल्या रुग्णांना स्थूलतेचा आजार असल्यास इन्शुअरन्स कंपन्यांकडून बॅरिएट्रीक शस्त्रक्रियेसाठी आर्थिक उपाययोजना केल्या जातात.
• खासगी रुग्णालयात बॅरिएट्रीक शस्त्रक्रियांचा खर्च हा २ ते ५ लाखांपर्यंत जातो. तर सरकारी रुग्णालयांत या शस्त्रक्रियेसाठी मोठी किंमत मोजावी लागत नाही.