UNLOCK TRANSFORMATION - DR. MOHIT BHANDARI - Mohak Bariatrics and Robotics
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THE AUTHOR Dr. Mohit Bhandari MS, DMAS (France) Minimal Access, Obesity & Diabetes Surgeon Founder Director, Mohak Bariatrics and Robotics, Indore Director, Bhandari Hospital and Research Centre, Indore Dr. Mohit Bhandari is a known name in Bariatric, Metabolic, Robotic, and Endoscopic Surgery world. He is the youngest and most experienced bariatric surgeon in the Asia Pacific who has performed 15000+ bariatric surgeries. 2019 is the year marked with a lot of personal and professional achievements. By performing 53 surgeries in just 13 hours and 20 minutes, he has registered his name in Guinness Book of World Records and World Book of Records. For his exceptional contribution to the field of bariatric and metabolic surgeries in the Asia Pacific region, he is honored with IFSO Ambassador Award 2019. Not just this, with his dedication and indomitable will, he has set himself as a fitness inspiration for all his patients, colleagues, and team members. In 2017, Dr. Mohit Bhandari has introduced Endoscopic Sleeve Gastroplasty (ESG), a non- surgical weight loss procedure in India. It is now the most commonly performed endoscopic procedure at Mohak Bariatrics & Robotics to treat obese patients without incisions and scars. He is one of the first surgeons to perform robotic bariatric surgery in India and also the first Indian doctor to perform a single anastomosis duodenal-ileal switch. Dr. Bhandari has performed notable surgeries that have gained national and international attention. In 2012, Dr. Mohit Bhandari performed the first documented obesity surgery in Asia, operating on an Asian woman weighing 350 kg. He also performed bariatric surgery on a 6-year-old boy in 2013, the youngest person on record to receive such surgery in India. Bhandari entered the Limca Book of Records in 2015 by performing 25 bariatric surgeries in an 11-hour period, performing the feat with the help of a 40-person team. Dr. Mohit Bhandari successfully operated a Mauritian "Dharamveer" weighing 410 kg at Mohak Bariatrics and Robotics, Indore. In 2018, Bhandari performed revision bariatric surgery on the youngest documented patient who was eight years old at the time of the surgery.
INDEX 01. What is obesity? 04 02. What is BMI? 05 03. How common is Obesity in India? 06 04. Top secret of transformation 07 05. Calorie deficit 08 06. Ways to transform 10 07. Diet 13 08. Workout 15 09. Obesity Surgery 17 10. Patient stories 19 11. Mohak Bariatrics & Robotics 20
WHAT IS OBESITY? When I asked this question to my patients of different age groups and backgrounds, I got some heartfelt responses. Here are some - A 12-year boy defined obesity as a Disability is the name, a dancer condition that stopped him from assigned to obesity. playing outside with his friends. An IT industry professional defined A 15-year girl said obesity is a obesity as the punishment of his shameful disease that made her negligence. face the bullies all her life. Mother of the 6-year old obese child A parent of an obese child said it said that obesity is the love turned is a curse that he gave to his son in into a curse. heredity unwillingly. A 27-year old girl defined it as the A 22-year girl described obesity as reason for her getting rejections from a hindrance between the dresses boys and their families for marriage. she wishes to wear. A 35-year businessman feels A 60-year man said it is nothing constrained because of obesity and but a disease that has ceased him said it is the reason for his failure. in the 4 walls of his home. A 55-year old doctor defined obesity A 25-year man labelled it as as the black spot on his white coat. helplessness that he sees in his mother's eyes. A 28-year man said obesity is a compromise with dreams, health, A poor man named it as a rich emotions, confidence, and life. man's disease. There is 'n' number of such definitions, and each of them defines the situation in which people feel locked. They feel helpless. As an obesity surgeon, I meet a lot of obese patients daily, and on average, I treat 10-15 patients daily who come to my center from various parts of the country and world. This anguish I can feel and see in everyone's eyes and stories. But as a doctor, I need to see it as a medical condition. Obesity is defined as a condition in which Body Mass Index (BMI) is greater than 30. 04
After hearing a lot of my patients, Less I found that negligence at an Physical Work early stage is the major cause of Less Physical Stress obesity in most people. Fewer Today’s manner of living is less Calories Burned More physically active as compared to Mental Work our ancestors who used to travel More either by bicycle or on foot. Mental Stress People now travel by cars, buses and their vehicle rather than More Hormonal Disturbances walking. They travel to work, where they are sitting for 8-10 Decreased hours in front of a screen, in other Metabolism Increased words, they are living a sedentary Fat Gain lifestyle. Calorie intake is higher and the calories burnt rate is lower in 80% of the population living in Urban India. A sedentary lifestyle is like slavery that we give to ourselves. But unfortunately, there is no alternative to it. So let's together work on the solutions to reduce weight and get back a healthy lifestyle. WHAT IS BMI? To work on solutions, let's first understand Weight (in Kg) the term Body Mass Index or BMI which is BMI = commonly used as a factor to decide if the Height person is obese or not. (in metre square) BMI is the measurement of a person’s weight with respect to his/her height. If the A normal BMI score is between 18.5 BMI score is more, you have more fat stored and 24.9. If you have a BMI that falls in in the body. You can calculate your BMI by this range, your weight is normal for yourself, with the help of a formula given. your height. A BMI chart can be used to You can also calculate it on categorize any person for underweight, www.indiaobesity.in/bmi-calculator overweight, obese, and normal. 05
HOW COMMON IS OBESITY IN INDIA? Obesity has reached a condition in which it can be called as an epidemic affecting millions of people. India has an alarmingly high number of overweight and obese people, around 9.8 million Indian men are overweight and 20 million Indian women are obese. If such a trend continues, then by 2025 global obesity prevalence will be 18% in men and 21% in women. A higher prevalence of obesity can be seen in urban areas as a result of a sedentary lifestyle and a decrease in the levels of physical activity. People spend more of their time sitting in front of screens and eating junk. As a result, they are moving towards obesity which is not only a cosmetic disorder but also a disease. 06
TOP-SECRET BEHIND THE TRANSFORMATION FROM FAT TO FIT 'Secret' this word itself increases curiosity. Isn't it? There are a lot of transformation stories that we see on social media and in real life. But how do they achieve the result remains a mystery. Unlocking transformation is not an easy job for anyone. Weight is gained over the years when you were busy with something else and neglected the gains. So losing weight can also not be a miracle that happens in a moment or a day. It is a gradual process. Most of the transformation stories you see revolve around different types of diets, workouts, and surgical procedures. And you keep wondering what is best for you. Am I right? Just answer one question to yourself before we move further - ? How many diets, workouts, or other pieces of advice you have tried till now for weight loss? Now, are you curious to know the secret behind every transformation? Do you want to know what went wrong with you while making efforts? I know your answer is 'YES'. Here is the secret - Calorie Deficit A caloric deficit is any shortage in the number of calories consumed relative to the number of calories required for maintenance of current body weight (energy homeostasis). A deficit can be created by reducing input/calories consumed or by burning more calories in a day. Ultimate body transformation from Fat to Fit is based on this simple theory, but it has multiple factors or hurdles. Let's first understand the calorie deficit in detail. 07
WHAT IS CALORIE DEFICIT? Calories are basic units of energy that are obtained from foods and beverages you intake, and when you burn more calories than you intake- you achieve a calorie deficit. The calorie you burn each day while doing tasks is referred to as calorie expenditure. It includes the following components- 1 Energy expenditure while resting- This refers to those calories your body uses while you are resting or sleeping. Calories at this time are used for functions like breathing, healing, and blood circulation- necessities to keep you alive. 2 Thermic effect of food- This includes the calories your body spends while and after eating- digesting, absorbing, and metabolizing the food. 3 Energy expenditure while doing any activity- This includes the energy that you spend while doing any kind of physical activity- sports, walking, exercising, or just doing household chores. If you are consuming fewer calories than your body spends to support each of these components, you put your body into a calorie deficit condition. Doing this consistently for a long time results in weight loss. In contrast to this, if you consume more calories than you spend, you put your body in a calorie surplus condition. “What I know for sure is this: The big secret in life is that there is no big secret. Whatever your goal for this year is, you can get there - as long as you're willing to be honest with yourself about the preparation and work involved. There are no back doors, no free rides. There's just you, this moment, and a choice.” - Oprah Winfrey (American Host) So I completely agree with what Oprah has said. The secret is that there is no big secret. If you are preparing your mind for making the choice to bring a difference then read the next chapter. 08
Don’t store junk in the refrigerator Have more of vegetables Try to avoid storing junk in your refrigerator Another Japanese secret of living a longer as it is easy to reach. Replace the junk with and healthier life- eat more vegetables. Try to healthier options like nuts, fruits, or include a bowl full of green vegetable in your vegetables. Having junk at your disposal every meal, proteins are also a good option if can be problematic if you are the person you can include it in at least one of your meals who tends to eat junk when in stress. in a day. Eat-in smaller plates Have protein in every meal This is a Japanese secret that they eat in Protein helps in improving metabolism and smaller plates to live longer and stay burning fat stored in the body. It also helps in healthy in the long run. Incorporate their the healing of the body. secret in your lives as having your meal on a smaller plate makes you eat less automatically. It gives you a sense of fullness and ultimately your calorie intake becomes less. 09
Ways to achieve a Calorie Deficit You can achieve a calorie deficit either by consuming fewer calories or by spending more calories. Both the ways take your body in a calorie deficit condition and help in weight-loss. However, it is easy to take care of your diet than to exercise regularly. It is sustainable to achieve a calorie deficit condition by diet, rather than exercise alone. You might not have time, energy, or enough motivation to exercise consistently. Exercise doesn’t let you burn as many calories as you eat. A person tends to eat more in a day, it is easier to consume 600 calories in a day than to spend in an hour of physical activity. Nonetheless, it is advised to engage in any kind of physical activity and do vigorous exercise daily for overall health. Some useful tips to consume fewer calories - Say no to highly processed foods Drink water before your meals There is a surplus of sugar, salt, and fat in Drinking water before your meals can help processed foods like wafers, breakfast you eat less, as a person feels more satisfied cereals, sugary beverages, or any kind of and full after drinking a glass of water. It has packed food. also been said that drinking water aids in If your diet includes highly processed weight loss. foods, try to minimize consuming that as it leads you towards obesity. Swap wafers Eat your meals slowly and chips with fruits and home-cooked Take your time and eat slowly, don’t rush. food. Eating slowly can make you feel full in a less amount of time, thereby causing you to intake Prefer home-cooked meals fewer calories. Also, properly chewed food Home-cooked meals are not only fresh, but helps digestion. it allows you to keep a check on size and proportion of ingredients you are using to Read food labels prepare a meal- ultimately your calorie If you see the ingredients written on the intake. packet, you will find fat and sugar content too. Try to make it a habit of reading food labels so Having your meals cooked at home not that you can easily spot healthier foods and only helps in consuming lesser calories but avoid those which contain a high percentage also it kind of engages you in a task. Home- of fat and sugar. Also check the number of cooked meals give you a better quality diet, calories per serving, to know the exact lower fat level, and lesser risk of diabetes number of calories you are going to consume. and heart diseases. 10
WAYS TO TRANSFORM Are you ready for the transformation? Most people would say 'yes'. But here I would like to bring into your notice that this would not just be a physical transformation from Fat to Fit. In a weight loss journey, you have to go through mental, psychological, emotional, habitual, social, and physical transformation. This demands a complete lifestyle change. You can't embrace transformation by continuing the same habits of - Socializing with a glass of alcohol every day Keeping yourself awake all night and stressing the body Thinking the same depressing thoughts and releasing the stress hormone - 'cortisol’ Eating mindlessly and not taking care of the required nutrients Not treating your own body with love and care Sitting on a chair all day in the office without taking breaks in every 1-2 hours As Robin Sharma says, “Yes, your transformation will be hard. Yes, you will feel frightened, messed up, and knocked down. Yes, you’ll want to stop. Yes, it’s the best work you’ll ever do.” So unlocking transformation would not be that easy if you don't prepare your mind. The three ultimate ways to transform your body from fat to fit are - Diet, Workout, and Obesity Surgery. DIET Nutrition plays a prominent role in transforming your body, whether you are looking to shed some fat or build muscles. A proper healthy diet aids in weight loss and leads you towards a healthier lifestyle. According to statistics, diet plays a major role- more than intense physical activity too. If your diet and nutrition are not proper, exercise and other things won’t work for you. Make sure you are taking regular healthy meals and in a defined amount. Optimize your diet for maximum results in minimum time. 11
WORKOUT Working out not only helps to transform your body but also helps in keeping the other diseases away- Diabetes, Cardiovascular diseases, Cancer, and Hypertension. Any kind of physical exercise can have benefits in the long run. Exercise is another secret of Japanese people for a healthier and longer life. They don’t even get retired, there is no such concept in their lives. Instead, they keep on doing physical exercise and any kind of activity that keeps their body working. OBESITY SURGERY Nutrition plays a prominent role in transforming your body, whether you are looking to shed some fat or build muscles. A proper healthy diet aids in weight loss and leads you towards a healthier lifestyle. According to statistics, diet plays a major role- more than intense physical activity too. If your diet and nutrition are not proper, exercise and other things won’t work for you. Make sure you are taking regular healthy meals and in a defined amount. Optimize your diet for maximum results in minimum time. Obesity surgery, often referred to as Bariatric surgery makes the size of your stomach small by making incisions in it. A person tends to feel full in a lesser amount of food after the Surgery. If diet and exercise are followed consistently after the surgery, the weight loss achieved stays for a lifetime. 12
DIET DIET Diet plays an important role in achieving weight-loss. Workout and Obesity Surgery will also need a healthy and proper diet to sustain weight loss and achieve desired results. It is the key element and a lifestyle choice that you have to make if you want to achieve body transformation from FAT to FIT. BENEFITS OF DIET Aids in weight-loss Diabetes management Keeping in mind the calories you intake Eating a healthy diet can help a diabetic helps in weight-loss and ultimately person in- transforming your body. A person looking to lose weight, in the long run, should keep a • Losing weight check on how much calories they are • Manage blood sugar levels consuming every single day. You should • Keep the blood pressure within the limits reduce the calorie consumption to no more • Prevent complications of diabetes than what is required each day. Reduced risk of cancer Healthy heart An unhealthy diet can lead you towards Nearly 8 in 10 people have one or more Obesity, which in turn causes cancer. cardiovascular diseases, which involve the Obesity increases a person’s risk of heart and its blood vessels. According to a developing cancer and other chronic survey, 80% of heart diseases can be illnesses. Diet rich in proteins, vegetables, prevented by making lifestyle changes- and fruits can help in achieving weight loss taking a healthy diet and exercising and keeping you away from cancer. Some regularly. researchers have found that a healthy diet reduces the risk of any sort of cancer. Obesity is the root cause of every problem and if a person gets successful in achieving weight loss, he can reduce the risk of any type of cancer and heart disease. 13
Constraints of Dieting As an obesity surgeon, I meet a lot of Diets are not helpful in weight loss when patients who have already tried different people have BMI greater than 27 along types of diets and all have failed in giving with co-morbidity like type 2 diabetes or results. This happens mostly because hypothyroid or sleep apnea. Hormonal or usually people don't consult the dietitians Metabolic issues restrain the weight loss. and try diets on their own. Internet is the They are to be analyzed and treated biggest education source for them, and of timely to see the effective results. course suggestions from friends. But they Also, diet fails to help mostly for the mostly forget that each individual is people who have a BMI greater than 30 different and no same diet can suit all. because their stomach size is already You must have heard of Keto - diet , increased to the extent that they feel Intermittent Fasting, Low Carbs Diet, hungry and can't stay on strict calorie Atkins Diet, Vegan Diet, Liquid Diet, Detox deficit diets. Diet, Crash Diet, Dukan Diet...the list goes on. The diet that suits your friend is not necessarily meant for you. Also, there can be some other physical condition that you might already have and these diets can trigger them. On the path of transformation through diet - You may have to fight a battle more than once to win it. —Margaret Thatcher 14
WORK WORKOUT Workout helps in unlocking the transformation by increasing the calories burnt in a day. But this works mostly along with diet. Its a slow process and works usually for young people. Workout increases metabolism and keeps your body active and lets the blood flowing in your body. Including any kind of physical activity in your daily routine not only helps in weight loss but also in keeping the heart and lungs healthy and working efficiently. It’s been wisely said that you should never quit working out, even if you are retired. BENEFITS OF WORKOUT Reduce the risk of heart attack Manage your weight Exercising regularly improves blood Exercise helps in managing weight loss, it circulation in the body, which ultimately helps to increase your body’s metabolism helps in reducing the risk of developing any and therefore reduces the number of blood clots and blockages. Doing any kind of calories you consume in a day. However workout helps the heart in keeping healthy exercising alone won’t help you, diet plays a and strong. central role here as well. If you are taking a healthy diet along with a daily workout, you Reduced risk of type-2 Diabetes are on the right path. When you have Type-2 Diabetes, physical exercises become an integral part of your A healthier state of mind treatment process. Of course, you can’t A good number of studies have found that avoid the medications, but exercising exercise helps in reducing stress and regularly can help to maintain blood sugar depression. It distracts you from daily levels and prevent any complications worries and negative thoughts fade away further. from your mind. The increased heartbeat may lift your mood and helps in sleep Controlled blood pressure patterns to a great extent. Regular physical activity helps in keeping the heart healthy and strong. A strong heart can pump the blood efficiently with minimum efforts. If your heart is working less, it exerts low pressure on the arteries and therefore, keeps the blood pressure under control. 15
Constraints of Workout Sticking to an exercise routine is not easy, it requires a lot of dedication, time, patience, and efforts. Exercise comes with its pros and cons- it can feel like boredom and cause injuries if not done in the right way. Some of the most common constraints (or excuses) of exercising - You are short of time You think exercise is a boring activity You feel tired to exercise after work Lack of motivation You are not an athletic You are afraid of injuries that come along with it Elderly people can't do many exercises with a heavyweight body You are self-conscious of how you look while working out Overweight people have weak bones and thus, doing too much cardio can cause them permanent joint injuries People with overweight and co-morbidities can't workout as their body doesn't allow them and they get tired easily Insanity: Doing the same thing over and over again and expecting different results. —Albert Einstein Exactly, when choosing the path of exercising for transformation, you need to be consistent but only at progression. You can't do the same exercise with the same intensity over and over to expect results out of it. So, choose wisely. 16
OBESIT OBESITY SURGERY When we talk about unlocking transformation then, obesity surgery is the top and the most reliable method. As I mentioned earlier, transformation is not just about shape and size, it is about the overall health, and as far as results speak, obesity surgery improves the entire functioning of the body. Obesity Surgery or Bariatric Surgery is a metabolic procedure that helps you to lose weight drastically and improves the metabolic functions of the body. There are two types of bariatric procedures - Restrictive & Malabsorptive. Restrictive bariatric surgery reduces the size of the stomach. This limits the amount of food that can be consumed and creates a feeling of fullness. Malabsorptive bariatric surgery limits the amount of nutrients the body absorbs by bypassing a portion of the small intestine. Bariatric Surgery is the ultimate secret towards your body transformation if your BMI is 30 and above. People having BMI 27 and above along with co-morbidities like type 2 diabetes, sleep apnea, osteoarthritis, knee pain, asthma, hypertension have no other choice of reducing weight and getting back to normal life. Their transformation through diet and workout is way more difficult and risky. Most of the patients who come to me have already tried diet and exercise and they are quite confident that it doesn't work for them. Also, most of them have lost hope. They think they will never be able to have a fit body again. I am happy to offer them hope and transformation that medical science has made possible and easily accessible. Bariatric surgery is no more a risky surgery to go through. It is a common procedure, and in a country like India which is the third most obese country in the world, it has become a way more reliable. I have treated 15000+ obese patients and offered them 50- 80% reduction in their current weight (at the time of surgery). If you want sure-shot safe transformation in just 90 days, go for bariatric surgery. 17
Bariatric Surgery Benefits Severely obese patients find themselves constantly struggling with weight and often feel like they are trapped in a weight gain cycle. You might have adopted various types of healthy diets for weight loss- only to see your weight continue to increase in the end. It has been reported by The National Institutes of Health that those individuals who are badly affected by Obesity are resistant to making any lifestyle changes like consuming fewer calories, weight loss programs, exercising regularly, and all the traditional ones. They feel nothing is going to benefit them. Bariatric Surgery is the only secret that can take your body towards transformation from FAT to FIT in just 90 days. Bariatric Surgery combined with a detailed treatment plan, acts as an effective tool in providing you with sustainable weight loss and increased quality of health. Bariatric Surgery has been shown to improve co-morbidities like High blood pressure, Type-2 Diabetes, Asthma, Sleep Apnea, Osteoarthritis, Knee Pain, Alzheimer's, and some cancers. Significant weight loss achieved by bariatric surgery paves the way for many other things like increased confidence, better personal relationships, improvement in social relations, and better self-esteem levels. Several studies have found that those individuals who had severe obesity and went for Bariatric Surgery, have a lower risk of death as compared to those obese people who did not go for the surgery. Life expectancy improves. Depression and anxiety levels seem to have drastically reduced after having Bariatric Surgery. At Mohak Bariatrics and Robotic Center, I have successfully transformed the lives of many people through Bariatric Surgery. Offering a healthier and peaceful life to obese patients is my mission. 18
OUR PATIENT STORIES One of our patients, Ms. Preetika Zaweri had diabetes, knee problem, and blood pressure along with obesity. All the problems are gone in just 90 days post- surgery. She lost 22 kgs in the first 3 months and the weight loss journey continued. She was a dance teacher but because of obesity, she could not dance. Bariatric surgery gave her another chance to start dancing in her 60s. Another patient, Mr. Praveen Kothari, undergone Bariatric surger y and has lost 60 kgs after the procedure. He was fond of horse riding but due to severe obesity, he faced a lot of difficulties in pursuing his hobby. After the procedure, he could continue horse riding and wear any clothing of his choice. Mr. Praveen is extremely happy with his after surgery life and continues to thank Mr. Ramesh Miglani, who lost 55 kgs, faced severe problems due to obesity. He had breathing issues and after opting for Bariatric Surgery, he could not only breathe easily but also took part in a marathon and completed it in time. 19
MOHAK BARIATRICS & ROBOTICS Mohak Bariatrics & Robotics is the best and most well equipped bariatric center in India. It has won No. 1 rank in Times Health All India Lifestyle Hospital & Clinic Ranking Survey for 5 times consecutively. Mohak Bariatrics & Robotics is a center par excellence that is dedicated to minimal access, obesity, and diabetes surgery. It has world-class infrastructure, highly equipped intelligent operation theatres OR1s, HD endovision, dedicated services for obesity surgery, and last but not least a team that cares for its patients. In a very short span of time, the center and team have done 15000+ minimal access bariatric surgeries through various procedures and are consistently doing 150+ surgeries every month. The center comprises of surgeons who specialize in various areas of surgery and are dedicated to performing surgical procedures with a special emphasis on the utilization of minimal access techniques (Laparoscopic Surgery) so that patients reap the benefits of faster recovery, lesser post-operative pain, and minimal post-surgical complications. Center has also benefited 5000+ type 2 diabetic patients with bariatric surgery by resolving it completely. Mohak Bariatrics & Robotics is one of the leading bariatric surgery hospitals in India and the Asia Pacific region, with a serious focus on managing morbid obesity. Bariatric surgery (or weight loss surgery) includes a variety of procedures performed on people who have excess body weight. Procedures are based on either restrictive, mal- absorptive, or a combination of both methods. Weight loss is achieved by reducing the size of the stomach with a gastric band or through the removal of a portion of the stomach or by resecting and re-routing the small intestine to a small stomach pouch. Sleeve Gastrectomy, Roux-en-Y Gastric Bypass, Mini Gastric Bypass, Single Incision Lap Sleeve, Banded Gastric Bypass, Duodenal Jejunal Bypass, and Endoscopic Sleeve Gastroplasty are the commonly performed procedures at Mohak Bariatrics & Robotics. 20
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