Obesity surgery procedures like gastric bypass and sleeve gastrectomy can help treat obesity and related health conditions by restricting food intake or reducing nutrient absorption. The document discusses various bariatric surgery options, how to prepare for surgery, expected benefits and risks, and the significantly lower costs of these procedures in India compared to other countries. It also shares testimonials from patients who successfully underwent obesity surgery through an Indian healthcare provider and were able to extend their quality of life.

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2. Obesity Surgery in India
Obesity Surgery:
Obesity today ranks as a significant health challenge and studies show obesity to be a
major cause of preventable mortality. Obesity, perhaps in the next 25 years will become
the biggest financial drain on one’s family and country along with other associated life
style disorders like Diabetes and Hypertension to name a few. Obesity refers to a
spectrum of problems of excess weight ranging from being mildly overweight to being
morbidly obese. Patients with morbid obesity do not tend to respond to medical means
of weight loss.
What is Obesity?
Obesity is a condition in which the natural energy reserve, stored in the fatty tissue of humans and other mammals, is
increased to a point where it is associated with certain health conditions or increased mortality.
What Causes Obesity?
The etiology of obesity is multifactorial. Over eating is the primary cause, but – psychological problems, hormonal imbalance,
eating disorders, lack of proper directions in diet could all play a part. Likewise, the treatment options for obesity are varied –
including diet and exercise, body contouring surgery, bariatric surgery, psychological counseling, endocrine management, etc.
The most common causes for obesity include
• Lack of activity
• Overeating/ Unhealthy eating habits
• Hormonal problems like Cushing’s syndrome and PCOS
• Genetic reasons/ Familial obesity
• Poor lifestyle.
What is Obesity Surgery?
Obesity surgery includes a variety of procedures performed on people who are obese. Weight loss is achieved by reducing the
size of the stomach with an implanted medical device (gastric banding) or through removal of a portion of the stomach (sleeve
gastrectomy or biliopancreatic diversion with duodenal switch) or by resecting and re-routing the small intestines to a small
stomach pouch (gastric bypass surgery). Long-term studies show the procedures cause significant long-term loss of weight,
recovery from diabetes, improvement in cardiovascular risk factors, and a reduction in mortality of 23% from 40%.

3. Types of Obesity Surgery
There are several types of obesity surgery which fall into one of the following three categories:
• Restrictive
• Malabsorptive
• Combination (restrictive/malabsorptive)
Restrictive: This is the term given to a set of procedures which cause a physical reduction of the stomach volume. At present
there are three procedures although one of them – Vertical Banded Gastroplasty is no longer recommended due to a high rate
of side effects. Food intake is reduced as result of smaller stomach capacity: and less food means a reduced calorie intake
which will result in weight being lost.
These include the following procedures:
• Gastric bypass
• Sleeve gastrectomy (single technique)
• Gastric band
• Gastric Balloon
Malabsorptive: A malabsorptive procedure is one in which the absorption of food is greatly affected. When food is ingested it
passes down the gullet (windpipe) into your stomach. It is then broken down by stomach acids. As it leaves the stomach and
enters the top part of the small intestine or duodenum, it comes into contact with digestive juices from the pancreas and bile
from the gall bladder. These two cause a further breakdown of the food which means that vital nutrients such as vitamins and
minerals are absorbed. However, with a malabsorptive procedure this ability is vastly reduced. Food is not properly absorbed
which means that important nutrients are lost. This can result in vitamin/mineral deficiencies. You will be given daily
supplements to replace these. Malabsorptive procedures, such as the jejuno-ileal bypass are no longer performed.
Combination (restrictive/malabsorptive): These are ‘double whammy’ procedures: by this we mean that they are comprised of
both a restrictive and malabsorptive element. The restrictive element is the physical reduction of the stomach: which means
that smaller meals will have to be eaten (reduced food intake). Combination procedures or ‘restrictive/malabsorptive’
procedures are the preferred option. The malabsorptive element refers to the rerouting of the small intestine (see gastric
bypass for a more detailed description) which affects food absorption.
There are four procedures which fall into this category:
• Roux-en-Y gastric bypass
• Mini gastric bypass
• Biliopancreatic diversion (with or without duodenal switch)
• Sleeve gastrectomy with duodenal switch
These are all technically demanding procedures but when performed by an experienced surgeon can result in dramatic weight
loss.

4. Preparing for the Surgery:
The best preparation is to understand the risks and potential benefits and to closely follow your doctor's instructions.
To mentally prepare yourself:
• Understand the surgical process and what to expect afterwards.
• Talk to people who have had weight loss surgery.
• Write a letter to yourself and your surgeon explaining your reasons for having the surgery and outlining your
plans to maintain your weight loss after surgery.
• Start a journal about your experience. Record how you feel now, the obstacles you encounter, the things you
hope to be able to do after surgery.
• Get a letter of support from your family. It helps to know you have people behind you, waiting to help.
To physically prepare yourself, strictly follow your doctor's guidelines. These usually include, but are not limited to:
Restricting yourself to a clear liquid diet 12-24 hours before surgery.
• Stop smoking for at least a month before surgery.
• Be certain to follow your surgeon's instructions regarding any medications you may be taking to control other
health conditions.
• Arrive on time, with supplies from home for a three- to four-day hospital stay. If you use special equipment for
sleep apnea, you should bring your machine to the hospital.
Common Obesity procedures:
Gastric Bypass: Gastric bypass is a complicated surgery that can last up to four hours. The most common type of
gastric bypass is Roux-en-Y-gastric bypass, which is performed with one long incision. Using staples or a plastic
band, a surgeon makes a small pouch at the top of the stomach. This smaller stomach is connected to the section of
the small intestine called the jejunum. With this rearrangement, food bypasses the rest of the stomach. The patient
feels full more quickly, so fewer calories are consumed and absorbed by the body.
Gastric Banding: Made of inflatable silicone, gastric bands restrict the stomach. Using one of the two types of gastric
bands available in the United States (the Lap-Band System or the Realize Band), a surgeon wraps a band around the
top section of a patient's stomach by means of laparoscopic surgery. The band is injected with saline, causing the
patient to feel full sooner and eat less. Gastric banding is a less invasive surgery and can often be performed on an
outpatient basis. The bands can also be tightened or loosened as needed.
Duodenal Switch: The duodenal switch combines two surgical approaches. First, a surgeon removes about 85 percent
of the stomach. What is left is shaped like a banana, about 6 ounces in size. Next, a large section of the small
intestine, the section where most digestion occurs, is cut out and bypassed. With a smaller remaining section of the
intestines involved in digestion, not as many nutrients and calories can be absorbed, so patients lose weight.

5. Gastric Sleeve Surgery: Gastric sleeve surgery is a newer type of weight-loss surgery. The laparoscopic procedure is
typically used to kick-start weight loss for the extremely obese---people who are too overweight to withstand more invasive
surgeries. During a gastric sleeve operation, a surgeon removes more than half of the patient's stomach. What's left takes
a sleeve- or tube-like shape, and it is sealed with staples. When the patient has lost enough weight, he or she may then
undergo gastric bypass or another type of weight-loss surgery.
Gastroplasty: It is also known as "stomach stapling," was once a popular type of weight-loss surgery. The original
gastroplasty debuted in the 1970s. It involved stapling the stomach into a smaller section, so only a small opening was left
for food. Surgeons eventually began performing Vertical Banded Gastroplasty (VBG). In this type of surgery, both staples
and a band are used to reshape the patient's stomach into a small pouch. Like regular gastroplasty, only a small hole is
left for food to travel into the rest of the stomach. Today, gastroplasty is not performed as often, as studies indicate many
patients regain weight.
Sleeve Gastrectomy: This procedure reduces the stomach by 15% of its original size, by surgical removal of a large
portion of the stomach, following the major curve. The open edges are then attached together (often with surgical staples)
to form a sleeve or tube with a banana shape. The procedure permanently reduces the size of the stomach. The
procedure is performed laparoscopically and is not reversible. It is usually performed on extremely obese patients, with a
body mass index of 40 or more, where the risk of performing a gastric bypass or duodenal switch procedure may be too
large.
Roux-en-Y Gastric Bypass: is currently the most commonly performed bariatric operation with roughly 7 out of 10 bariatric
surgeons use it as their primary weight loss procedure. An easier gastric bypass operation than either Biliopancreatic
Diversion Stomach Bypass, or Duodenal Switch Stomach Bypass, Roux-en-Y has been practiced for more than 30 years,
during which it has demonstrated a high long-term success rate with relatively low rates of mortality (less than one
percent) and post-operative health complications. Roux-en-Y patients typically lose 50-75 percent of their initial excess
weight, which is a sufficient weight reduction to cure or significantly reduce most of the life threatening medical conditions
associated with severe clinical obesity.
Gastric Balloon: is becoming a popular alternative to ‘going under the knife’. It is a non-invasive procedure which means
no general anaesthetic or overnight stay and can be done quickly and painlessly. It can take as little as 10 minutes and
you can return home after an hour. You are looking at just a day spent at home recovering although you will experience
some nausea in the first week following this procedure. Your suitability for this procedure will be discussed with your
surgeon. This is exactly the same as for any other obesity procedure. He/she may recommend this if you do not want
surgery; if you do not fulfill the criteria for obesity surgery or as a means of achieving weight loss before undergoing a
surgical procedure.
Advance Obesity Surgeries
ROSE Procedure: ROSE, stands for Restorative Obesity Surgery, Endolumenal, is a new, safer, incision less, gastric
bypass revision. It is not a primary method of weight loss surgery, but a follow-up procedure that is specifically designed
for gastric bypass patients with weight regain. The ROSE procedure is indicated for gastric bypass patients who were
initially successful in losing the excess weight but are now regaining some of the lost weight because the stomach and
stoma have stretched out and no longer effectively control hunger and food intake.

6. Life after Obesity Surgery:
Obesity surgery is not a quick fix. It's an ongoing journey toward weight loss
through lifestyle changes. After surgery, the difference in your body makes it
physically easier to adjust your eating and lifestyle habits. Fortunately, you will
not have to go through the process alone. A team of professionals will be there
to support your efforts. Positive changes in your body, your weight, and your
health will occur, but you will need to be patient through the recovery process.
The following are some of the generally accepted dietary guidelines for a
healthy diet after bariatric surgery:
• When you start eating solid food, it is important to chew your food thoroughly and eat very slowly. It is important to
wait two to three minutes after swallowing before putting the next bite of food in your mouth.
• Don't drink fluids while eating. They will make you feel full before you have eaten enough food. Fluids consumed
with meals can cause vomiting and dumping syndrome, and can lead to feeling hungry sooner after a meal.
• Don't eat desserts and other items with sugar if they have more than 3 to 5 grams per serving size.
• Avoid carbonated drinks, high-calorie nutritional supplements, milk shakes, foods high in fat, and foods that have
no nutritional value.
• Avoid alcohol.
• Limit snacking between meals. Eating after bariatric surgery will be much different than before!
Benefits of Obesity Surgery
Obesity surgeries and procedures are designed to reduce illness and complications caused by obesity. For many, weight
loss improves multiple conditions including high blood cholesterol, high blood pressure, diabetes, and coronary artery
disease. In addition, other body systems, including digestive, endocrine, and immune system benefit. However, such
procedures require dedication and determination for those who undergo them to maintain permanent lifestyle changes.
After surgery, patients who follow instructions may enjoy as much as a 60% weight loss, improving health problems as an
added benefit.
Risks of Obesity Surgery
All surgeries come with the possibility of complications, but fortunately their incidence is quite small. These include,
Slippage of the band due to food intolerances or even perforation of the stomach, vomiting after the surgery may develop
which can lead to a small stomach pouch stretch. While in 10-20% of the cases, abdominal hernia may occur. It can be
caused by vomiting or straining after surgery, usually before the incision heals.

7. Obesity Surgery in India
India has become a Mecca for various obesity surgeries for the international patients coming all across the world. The
world has realized the fact that the healthcare technologies in India are at par with that provided by the healthcare facilities
in any advanced country, using exactly the same advanced technologies, machines and equipments as used in USA or
Europe thereby delivering similar or even better results. Adherence to the highest quality standards of healthcare by
competent weight loss surgery specialists with priority treatment.
Most of the obesity surgeons and doctors in India performing minimally invasive Lap Gastric Banding, vertical sleeve
Gastrectomy and Roux-en-Y Gastric bypass have graduated from top medical school universities of North America-USA,
Canada, UK, Europe, Australia and have vast overseas healthcare surgery experience and training from best hospitals.
The foreign patients can therefore avail the finest board certified medical professionals- board certified surgeons, board
certified doctors, physician and JCI – JCAHO accredited, government registered and approved private medical Healthcare
facilities in India for their respective surgery.
Thus a world-class low price facilitation services for the visiting overseas patients for their cheaper surgery treatment trip
at the top rated private specialty hospital and clinical facilities in the following Indian cities:
Some of the common countries from which patients travel to India for surgery are:
USA UK Canada
Australia New Zealand Nigeria
Kenya Ethiopia Uganda
Tanzania Zambia Congo
Sri Lanka Bangladesh Pakistan
Afghanistan Nepal Uzbekhistan
Besides, having a world class medical treatment, the foreign patients also have the opportunity to explore the country’s
heritage places like the Taj and Red Fort, along with the natural scenic places of Goa and Kerala encompassing all the
beauty which Mother Nature’s empowers these areas.
Cost of Obesity Surgery in India
The greatest benefit the foreign medical tourist can avail in India is the cost factor. They get personalized attention at
incredible costs which are the root cause of driving the patients worldwide to India for different procedures of obesity
surgery. One can assess the significant differences at cost purse from the following table:
Procedure USA ($) Singapore($) UK($) India ($)
Laparoscopic Adjustable Gastric Banding AGB 18,500 10,000 15,000 5,490
Laparoscopic Gastric Bypass Roux-en-Y RGB 28,000 15,000 22,000 8,970
Laparoscopic Vertical Sleeve Gastrectomy VSG 23,000 12,000 17,000 6,580

8. Obesity Surgery Patients Testimonial:
Elizabeth, Dallas
Obesity Surgery (Gastric Sleeve)
My name is Elizabeth I am from Dallas USA .I came to India for my obesity surgery through Forerunners Healthcare
Consultants. I had put on lot of weight in these recent years. When my friend saw me she suggested me to undergo
obesity surgery. And she told me about Forerunners Healthcare Consultants. Then I sent my details to the company
.The associates of the company were so prompt and helpful. My obesity surgery in India at Mumbai was arranged
within a day’s time. On the third day I was in India for my obesity surgery.
Mrs. Carol, UK
Bariatric Surgery
I am Carol from the UK. I came in to India with my husband for my bariatric surgery to remove excess of fats from my
body. It was my husband who supported me to undergo this surgery because I am at my age of 62 and it is not that
easy to undergo surgery at such an old age. I was also ready to undergo this surgery at bariatric surgery Hospitals in
India because it was my dream to spend time with my coming grandchildren to play with them. I am very thankful to
Forerunners Healthcare to give all their support and also their staff to fulfill each and every demand of mine. Bariatric
surgery Hospitals in India helped me to extend my life.
Ms. Jelly, Tanzania
Sleeve Gastectomy Surgery
The doctors provided to me by the team of Forerunners Healthcare were really caring and professional and they
gave me the perfect surgical solution in the form of sleeve gastrectomy at Mumbai in India. I really appreciate the
caring attitude of Indian doctors and medical staff so they took all the required precautions during the post surgery
care after completion of my Sleeve gastrectomy at Mumbai in India. I pay my warm regards to Indian doctors.

9. Knee Replacement Surgery in India
Knee replacement surgery also known as knee arthroplasty is procedure to replace the
weight-bearing surfaces of the knee joint to relieve the pain and disability of
osteoarthritis. It may be performed for other knee diseases such as rheumatoid arthritis
and psoriatic arthritis. The procedure has been proven to help individuals return back to
moderately challenging activities such as golf, bicycling, and swimming. Total knees
are not designed for jogging, or sports like tennis and skiing (although there certainly
are people with total knee replacements that participate in such sports). Knee
replacement is a routine surgery performed on over 600,000 people worldwide each
year. Over 90% of people who have had Total Knee Replacement experience an
improvement in knee pain and function.
Knee Replacement Surgery Candidates
A person would be considered a candidate for knee replacement if there is:
• Daily pain
• The pain is severe enough to restrict work, recreation and ordinary activities of daily living
• Significant stiffness in the knee
• Significant instability (constant giving way) of the knee
• Significant deformity (knock-knees or bow-legs) that hinders normal function of the knee
• Damage from arthritic conditions, such as osteoarthritis, rheumatoid arthritis or post-traumatic arthritis
Success Rate of Knee Replacement Surgery:
Knee replacement surgery is recognized as a miracle of modern surgery. Most orthopedic experts consider replacement to be
the best method of handling arthritis in the knee. Knee replacements have literally put hundreds of thousands of Americans
back on their feet and allowed them to enjoy their golden years.
Knee Replacement Surgery Preparations:
• If you smoke, cut down or quit. Smoking changes blood flow patterns, delays healing and slows recovery.
• If you drink, don't have any alcohol for at least 48 hours before surgery.
• Ask your doctor for pre-surgical exercises. If you are having hip or knee replacement surgery, doing exercises to
strengthen your upper body will help you cope with crutches or a walker after surgery.
• Your primary care physician or an internist will conduct a general medical evaluation several weeks before surgery.
This examination will assess your health and your risk for anesthesia. The results of this examination should be
forwarded to your orthopaedic surgeon, along with a surgical clearance.
• Shortly before your scheduled surgery, you will probably have an orthopedic examination to review the procedure and
answer any last-minute questions.
• You may need to take several types of tests, including blood tests, a cardiogram, a urine sample and a chest X-ray.
• Advice your surgeon of any medical conditions you have and of all the medications you are taking. You may need to
stop taking certain medications or your surgeon may recommend substitute medications until your surgery.
Medications such as corticosteroids, insulin or anti-coagulants will need to be managed before and after surgery.