Metabolic and bariatric surgery

Q: Am I eligible for weight-loss surgery?

For Indian adults, usually at a BMI of 35 or more, or 32.5 or more with weight-related illness. From 27.5 if type 2 diabetes is poorly controlled. A full assessment decides.

Q: Sleeve or bypass: which is better?

It depends on your reflux, diabetes, eating pattern and nutrition. We will recommend the one that suits you best.

Q: Should I try weight-loss injections first?

Medicines like semaglutide or tirzepatide can help some patients, before or after surgery. They need medical monitoring. Your assessment decides the best option.

Q: Will I need vitamins for life?

Yes. Lifelong supplements and regular blood tests prevent deficiencies.

Q: Can a woman become pregnant after surgery?

Yes, fertility and menstrual regularity often improve significantly. However, guidelines recommend waiting 12 to 18 months until weight has fully stabilised before planning pregnancy.

Q: How does surgery help diabetes?

It changes gut hormones that control blood sugar. In some patients, blood sugar control improves soon after surgery, and diabetes medicines are then adjusted by your doctor.

Q: What is the diet plan after surgery?

Stage 1: Clear liquids (Days 1–7); Stage 2: High-protein liquids (Weeks 2–3); Stage 3: Pureed and soft foods (Weeks 4–5); Stage 4: Balanced solid nutrition (Month 2 onwards).

Metabolic surgery may help selected adults when obesity is affecting health and the expected benefit is greater than the operative risk. Assessment determines whether surgery is appropriate and which procedure may fit best.

Understanding the condition

Obesity is a chronic, relapsing health condition influenced by genetics, hormones, metabolism, sleep, medicines, environment and life circumstances. Its importance lies in how excess body fat affects health, rather than appearance alone.

It can contribute to type 2 diabetes, high blood pressure, sleep apnoea, fatty liver disease, reflux, joint problems, infertility and cardiovascular disease. Metabolic surgery changes stomach capacity and gut signals involved in hunger, fullness and blood-glucose control.

How it is assessed

A comprehensive surgical assessment reviews weight history, eating pattern, previous treatment, waist circumference and obesity-related disease. It also considers nutritional status, mental health, current medicines, previous abdominal surgery, anaesthetic risk and readiness for lifelong follow-up.

Structured nutrition, activity support and prescription medicines may be used before surgery, after surgery or when an operation is unsuitable. These treatments require medical screening and monitoring; weight-loss medicines are not used during pregnancy.

Asian-Indian BMI screening calculator

Adult BMI screening

Enter your height and weight for a preliminary BMI screening result. A clinician will interpret it alongside waist circumference, health conditions and previous treatment.

Height (cm)

Weight (kg)

When to Seek Evaluation

BMI ≥ 35, or ≥ 32.5 with health conditions
Uncontrolled diabetes (at BMI ≥ 27.5) or sleep apnoea
Repeated weight regain despite diet
Weight-related joint mobility limits
Fatty liver (NAFLD) found on a scan or in blood tests
High blood pressure or cholesterol that is hard to control
PCOS or difficulty conceiving linked to weight
Acid reflux or heartburn that worsens with weight gain
Weight loss medicines tried without lasting results
Weight affecting daily life, breathing or activity

Asian-Indian metabolic health & surgical eligibility matrix

Evidence-based clinical intervention thresholds and management pathways tailored to the Asian-Indian phenotype.

Health & BMI Category	Asian-Indian Thresholds	Clinical Action & Multidisciplinary Management Pathway
Healthy & Overweight	BMI 18.5 – 24.9 kg/m²Waist ≥ 80 cm (F) / ≥ 90 cm (M) warrants review	Preventive wellness, balanced nutrition, active lifestyle, and cardiometabolic risk screening for central adiposity.
Obesity Grade I	BMI 25.0 – 29.9 kg/m²Lifestyle + medical therapy	Structured lifestyle programme. Anti-obesity medicines (such as semaglutide or tirzepatide) may be added under specialist supervision.
Metabolic Surgery	BMI ≥ 27.5 kg/m²with type 2 diabetes, severe sleep apnoea or heart muscle diseaseBMI ≥ 30 kg/m²with poorly controlled type 2 diabetes or metabolic syndrome	Metabolic surgery may be recommended when these conditions are not well controlled despite the best medical treatment.
Surgical Candidate	BMI ≥ 32.5 (with a related illness) BMI ≥ 35 (with or without illness)Grade II / Grade III obesity	Bariatric & metabolic surgery recommended at BMI ≥ 32.5 with a weight-related illness, highly recommended at BMI ≥ 35 and strongly recommended at BMI ≥ 37.5. The procedure is chosen after a full assessment.

Clinical References:

• OSSI Guidelines for Bariatric and Metabolic Surgery, Version 3 (2026)

• ESI–OSSI Joint Consensus: Treatment Algorithm for Patients with Obesity in India (2026, Obesity Surgery)

• OSSI–ESI Joint Position Statement on Obesity Management Protocols (2026, Obesity Surgery)

• ESI Clinical Practice Guidelines for Obesity in India, 2025 Update (IJEM)

Central Adiposity

Waist ≥ 80 cm (women) or ≥ 90 cm (men) points to harmful belly fat. With weight-related illness, it can support an earlier decision for treatment, including surgery.

Medical Therapies (Anti-Obesity Medicines)

Semaglutide and tirzepatide can be used as medical treatment, and before surgery to shrink the liver and improve sugar control. They are stopped at least 1–2 weeks before surgery.

When Surgery Takes Precedence

Highly recommended at BMI ≥ 35. Also considered from BMI 27.5 when type 2 diabetes or another serious condition is poorly controlled, or when weight loss is needed before a major hernia repair.

When is surgery considered?

Metabolic or bariatric surgery may be considered when obesity is affecting health and the likely benefit is greater than the operative risk. It can support substantial weight loss and improve conditions such as type 2 diabetes, sleep apnoea, high blood pressure and fatty liver disease.

Body mass index is a screening measure, not the only criterion. People of Asian origin can develop metabolic complications at a lower BMI, so eligibility is decided through individual assessment rather than weight alone.

Surgery and important risks

Dr Prasad Bhukebag has clinical fellowship training in bariatric surgery in Belgium and Taiwan. The operation is selected after reviewing eating pattern, reflux, diabetes, nutritional status, previous surgery and the ability to continue long-term follow-up.

Diagram comparing the stomach before and after sleeve gastrectomy — Sleeve Gastrectomy
Most of the stomach is removed, leaving a narrow sleeve. Existing reflux and the possibility of new or worse reflux need careful discussion.

Diagram showing a small gastric pouch and rerouted bowel after Roux-en-Y gastric bypass — Roux-en-Y Gastric Bypass
A small stomach pouch is joined to the small bowel. Nutritional deficiency and internal hernia are among its specific long-term risks.

Important risks include bleeding, infection, blood clots, leak, narrowing, ulcer, reflux or dumping symptoms, gallstones, nutritional deficiency, weight regain and the need for another procedure. Your personal risk depends on the operation and your health.

Recovery and lifelong follow-up

Walking, breathing exercises and careful hydration begin soon after surgery. Hospital stay, return to work and lifting restrictions depend on the operation and individual recovery. Food progresses through planned stages under guidance from the bariatric team.

Lifelong vitamin and mineral supplements, scheduled blood tests and nutritional review are essential. Weight, metabolic health and any late symptoms are reviewed over time. Pregnancy is usually delayed until weight and nutrition have stabilised, following advice from the bariatric and obstetric teams.

Phase 01

Pre-Op Planning

Comprehensive health review, metabolic screening, blood tests, nutritional counselling, and tailored procedure selection.

Phase 02

Surgical Care

Minimally invasive laparoscopic or robotic operation, proactive pain control, early mobilisation, and staged liquid recovery.

Phase 03

Lifelong Follow-Up

Routine vitamin and micronutrient surveillance, long-term weight stability monitoring, and continuous endocrine care.

When to Seek Urgent Care

Seek urgent medical care for severe or persistent abdominal pain, repeated vomiting or inability to drink, chest pain, breathlessness, confusion or sudden deterioration. These symptoms need prompt assessment, particularly after starting a weight-loss medicine or following bariatric surgery.

Am I eligible for weight-loss surgery?

Sleeve or bypass: which is better?

Should I try weight-loss injections first?

Will I need vitamins for life?

Can a woman become pregnant after surgery?

How does surgery help diabetes?

What is the diet plan after surgery?

Discuss metabolic and bariatric surgery

Review your health, previous treatment and goals to decide whether surgery is suitable and which procedure may fit best.

Please bring: recent blood tests; a list of medicines; previous weight-treatment records; and sleep-study or endoscopy reports if relevant.

Why we see you in person: scans and reports can miss what an examination finds. That is why opinions are given in clinic, not on WhatsApp. Bring all your reports and they will be gone through with you.

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