 So, venatic surgery is not just about losing polyfag or losing fat from any part of the body. Venatic surgery is actually a life-transforming decision. It is. Yes, everything changes. So, it is sort of a turning point in the person's life. You start eating healthy on your own, you feel more energetic, you lose weight, you get rid of a number of diseases, you live longer. These social effects are enormous. You have acceptability at work and in your social circles increases, your self-conscious increases, your job prospects increase, everything changes. Whether we like to accept this or not, but this is a fact. Is there any age limit doctor to undergo this? The prescribed age limit is from 18 to 65 years, but these are not rigid limits. If somebody needs or will benefit from the surgery, you can do this surgery even in younger patients or even in older patients. The only requirement is that the person should be fit enough to undergo surgery. And this is one question from Preksha Modi. Losing 8 to 10 pages in a month without any exercise or diet, does it indicate hazardous diseases? Absolutely. If you are losing weight without trying, it absolutely indicates that there may be something serious without. You should immediately consult a physician. Everyone would love to lose weight like this. 8 to 10 pages is not really needed. Absolutely. There is one more question from Preksha Modi itself. She has asked, what is the best way to reduce weight without compromising in diet? As I said, everyone knows the easier way. I know. But unfortunately there is no easy way to lose weight. And diet and exercise are definitely not easy. And on top of that, they are not very easy. So if you are aiming and losing, say maybe about 10% of your weight, diet and exercise are perfectly fine. It will give you a lot of benefit. I am not saying that it won't give you benefit. Even 10% weight loss gives you a lot of benefits in terms of improvement in overall fitness and improvement in diseases associated with obesity. But sometimes that may not be enough. So the diet definitely has to be changed. If you want to lose weight, you have to cut down on the carbohydrates and you have to increase proteins. Fats may be kept the same. You may not really cut down fats because they are now not thought to be that healthy. The total number of calories consumed in a day also has to be cut down. There is no shortcut to that. There is a question from summary. Does obesity lead to high BP? Yes, definitely. Obesity leads to high BP. So more people who are overweight suffer from hypertension or high blood pressure than people who are not overweight. And once the weight starts to come down after many addicts really or after other methods of weight loss, the blood pressure also starts to become better. Medicine requirement goes down. In a lot of people, you can actually stop medicines for blood pressure. So there is a question from Vishal Parmar. Should I consider myself having a weight loss surgery? What he means to say is... Does he need weight loss? Very good question. Very important question. The basic criteria for considering weight loss surgery is a BMI of more than 37.5 without any other medical problems. And a BMI of more than 32.5 with any of the problems which are related to obesity like diabetes, hypertension, obstructive sleep, acne or snoring at night, like knee joint pain, back pain, and any other mechanical problems that we know are related to obesity. So if you have any of these problems, and your BMI is more than 32.5, you will definitely, definitely benefit from surgery and you are a candidate for surgery. If you are more than 37.5, even if you don't have any of these diseases, it will be very, very helpful or very, very much beneficial to undergo this surgery because it will prevent a number of these diseases and it will improve the quality of life and ultimately it will increase your total lifespan by an estimated 5-10 years. Vishal has asked two more questions. One is, what are the pros and cons of various weight loss surgeries? What should my goal weight be? So your goal weight is again, the BMI has to fall between 18.5 to 22.5. 20 is a ground figure, ballpark figure that you can take. You have to calculate your BMI and there are a number of apps available on all mobile platforms. There are charts available online. Or you can just use a simple calculator and calculate your BMI. So if your BMI should fall between these two limits, that is your ideal or goal weight. Depending on how much overweight you are and depending on what your method of treatment is, your target weight for that particular treatment or method of weight loss will change. If you are going for diet and exercise, then your target weight loss should be around 5-10% over the next one year or so. Expecting more weight loss than this is usually unrealistic, is seldom achieved and it will give rise to a lot of disappointment. If you need to lose more weight than this, I would suggest that you consult a weight loss surgeon and he will be able to evaluate you more completely and advise a better method of weight loss. What are the other questions? What are the pros and cons of various types of dietary services? So basically broadly there are two types of dietary services. One is called sleep aspect, the other is called bypass. Both of them give rise to approximately equal amount of weight loss. Bypass gives a little more weight loss than sleep. If there are diseases associated with obesity present in the person, a bypass would be a more preferred operation. It gives better resolution of energy, better resolution of high blood pressure, better resolution of high cholesterol. Obstructive sleep apnea is probably one disease which is equally benefitted by both these services, either sleep aspect or bypass. So these are the pros and cons of these services from the patient's point of view. From the doctor's point of view, bypass results little more difficult to perform and require more time and expertise. So somebody who is experienced in both, for him both these services are basically equally easy to perform. On a family, how many kgs can we reduce by 101? Well, the number of kgs is something which is not fixed because it depends on the person's initial weight and the ideal weight. So we expect our patients to lose at least 60-70% of their excess weight. Say for example somebody is, the ideal weight is 100 kgs and he is 150 kgs and we lose so much weight. Then we should be expecting him to lose somewhere around 35-40 kgs. Some people lose more weight and some people lose a little less, but this is an average figure that I am stating. In minimum weight loss that we accept as a surgery being successful is a 50% loss of excess body weight. Here is a question from Ambarina, question number 46. What is more important, the number of calories you eat or the type of calories you eat? Well, both are important. The type of calories is also important, you have to eat more protein, less carbohydrates, fats are not that bad. But the total number of calories also have to be monitored and they have also to be kept in check. So both are equally important. I don't think that we can really substitute one for the other. Both have to go ahead and handle them. Upan has asked two more questions. I go to bed early, but I am always too exhausted to work out what should I do? First thing is that I know very little about your clinical condition. If you are extremely overweight, then you may have diabetes which may be causing all this lethargy and all these things. The other reason could be that if you are dieting heavily or if you are on a crash diet or something like that, it may be leading to the lack of energy or reduced metabolism. So very difficult to actually pinpoint the cause. Probably weight loss, surgeon or a physician may be able to guide you better once you see it. How do I always stop wanting a dessert after lunch and dinner? That exactly, that actually may be pointing towards craving for carbohydrates. Which means that your body is actually wanting you to consume more carbohydrates because the set point of your body's weight may be higher than what you are at. So really you have to be evaluated in thoroughness and then you can decide whether this is pathological or this is just... Doctor, what are the risks of weight loss surgery? Well, the biggest misconception is that weight loss surgery is a complicated complex surgery and it is associated with energy risky. But there is nothing farther from the truth. In good hands, in competent hands, weight loss surgery is very, very safe. In fact, it is almost as safe as say for example a gallbladder or a hernia surgery. The patient goes home in 2-3 days and they are back to work in 10 days. So it's a very, very safe surgery. So for 10 days they will live normal life? Absolutely. They will be walking on the day of surgery. They will be made to walk, they will be cut off from the bed and they will be made to walk on the day of surgery itself. And when they go home from the hospital in 2-3 days, they will be walking. They will be able to take care of themselves. In a week, 10 days, most of my patients are actually able to restart their full working schedule. What other problems can be relieved by weight loss surgery? All the problems which are associated with overweight and obesity are actually improved by weight loss surgery. Diabetes disappears in a good 70-80% people. And a lot of them, about 70-70% can actually stop all medicines for diabetes. And their person will remain normal. The rest of them will actually need less medicines. Blood pressure becomes easier to control. We need less medicines. And their blood pressure remains better controlled. Obstructively, backnia or snoring and choking actually begins to disappear very soon after surgery, even before significant weight loss has happened. Fatty liver improves. The long-term solution to fatty liver is, bariatric surgery is probably the only current long-term solution to fatty liver. No other method of treatment actually improves fatty liver so much. The risk of cancer goes down gradually. The knee problems, the back problems actually improve. Your fitness improves. Everything improves. So doctor, when did this actually start, this procedure, bariatric surgery? Well, bariatric surgery is not a new procedure. People have been doing this for the past 50-60 years. The only problem at that time was that we did not have laparoscopic equipment or expertise. So we had to do all these surgeries by cutting open the tunnel. There was a very high morbidity associated with this surgery. It was difficult to manage those people who are big and who have big cuts in their abdomen. Since the advent of laparoscopy, it has become much easier and much more comfortable for the patient. You have just three or four, five holes in your tummy which are about two of them or about one, one and a half centimetres and the rest of them are all about half a centimetre. And the pain is very much less. The wound problems are very much less. There is no wound infection. The return to activity is so much better. And all other problems associated with major surgery or major fatality are actually gone. So that's why it has become more popular and more widely available now. In the past, say 20-30 years. But it's not a new surgery at all. So we all had a misconception about what is Viratis surgery and mid-law surgery. Even I used to think it's a new procedure actually. I never knew it's a 50-60 year old procedure. Yes, absolutely. Another big misconception that people have is that weight loss surgery is just removal of fat from the body. There is always a confusion between liposuction and liposuction. So liposuction is actually removal of the fat from under the skin of a specific part of the body. So liposuction is not used for weight reduction. Liposuction is used for body stretching or body contouring. If you don't like the way part of your body is because of the excess fat under the skin, you can get that skin, get that fat removed by liposuction to give it a better or more pleasing shape. But for overall weight loss from the whole body in a healthier natural day, Viratis surgery is actually the only procedure that works. So we have come to the end of the show and done all the questions. So I would like you to tell something which we are not covered actually in this show. Well, I think we have left out questions or answers which you would like to address to our viewers. Well, I think most of what is required to be known and we have spoken about, I would just like to recap everything in brief. So the first and most important thing that we have to remember is that obesity or overweight is a disease. It is not a lifestyle problem. Therefore, it is not the fault on the person who is obese or overweight. It is not in his hands because his set point of the weight is high. That is why his weight will remain high whatever he may want to do. That also leads to the conclusion that diet and exercise are not effective in losing large amount of weight. They are effective in losing about 5-10% of weight. And for maintenance, the same diet and exercise has to continue indefinitely in the weight loss actually. Currently, only bariatric surgery is effective in producing large amount of weight loss and helpful in maintaining that weight loss over prolonged periods of time like 10, 15, 20 years. The weight loss after bariatric surgery is not immediate. You will not be even a ground lighter when you come out of the operation theater. You will actually start losing weight gradually over the next 1-1.5 to 2 years. The weight loss speed is higher in the first few months. It slows down and then it plateaus at 1.5 to 2 years. The other thing that you have to remember is that bariatric surgery is an extremely safe and extremely comfortable surgery to undergo in experts. The last thing that you need to remember is that all the diseases that are associated with and related to basically like diabetes, hypertension, high cholesterol, obstructive sleep, apnea, fatty liver, etc. are all benefited by bariatric surgery and weight loss. Some of them are benefited more, some of them are benefited less. But all patients do derive some amount of benefit in all the conditions. Thank you. So on behalf of all the viewers, I would like to thank you doctor for coming over here and letting us know some vital facts and letting us know how effective is weight loss surgery and you have answered all the questions related to obesity and weight loss. So I would like to thank you on behalf of all the viewers. Thank you very much. It was a pleasure being here. And all the viewers out there, I would like to tell you we will be coming soon in the next episode of Health Wives. That will be the fifth episode of Health Wives. So stay tuned, meanwhile like and share this post so that we can create awareness about today's topic and reach out to more crowd. So the next episode topic will be secret and I will be revealing it in the next episode itself. So stay tuned, till then stay fit, stay happy, stay healthy. Thank you.