I'm a bariatric surgeon, one patient taught me weight loss isn't the same as health

Editor’s Note: In this fortnightly column, top doctors share how they deal with their own health challenges, offering readers expert insight grounded in experience. In my more than 25 years of practice, I have learnt through patients like Ankita and Rohit why blood reports and muscle strength often tell me more about a person’s health than kilos alone.Ankita sat across from me with her reports in her lap and would not look up.

Six months earlier, she had come to my clinic because her knees hurt too much to sit on the floor for the morning puja, and now she was in tears because she had lost only a few kilos. At a family wedding the week before, a relative had said she looked the same.In more than 25 years and over 10,000 bariatric operations, I have treated patients who are visibly obese and patients who look slim.

In both groups, I have often found that medical reports reveal what the body may not show. I have changed Ankita’s details, but hers is a story many of my patients share.

JUST A 5–10% WEIGHT LOSS IMPROVES HEALTH, EVEN WHEN NOBODY CAN SEE ITAnkita was disappointed every time she looked at the scale, but her reports had improved. Her blood sugar had come down, her blood pressure tablets had been reduced, and the acid reflux that used to wake her at night had eased.

She had also climbed the temple stairs without stopping for the first time in years.I explain to my patients that a modest loss of 5–10% of body weight can significantly improve health. Keeping off even 3–5% of body weight can improve blood pressure, triglycerides, good cholesterol and HbA1c while lowering the risk of type 2 diabetes.

Weight loss can also ease joint pain, acid reflux, liver problems, infertility and depression.AT A NORMAL BMI, INDIANS CAN STILL CARRY DANGEROUS FAT Ankita’s husband, Rohit, came to every appointment. He was slim, had never dieted, and in his family, he had always been considered the healthy one.

When he mentioned that his belt had moved two notches in five years, nobody was concerned. When I tested him, his blood sugar was in the diabetic range.This is what doctors often describe as the thin-fat Indian.

Many South Asians have a low body mass index but carry fat around their internal organs, along with insulin resistance. This pattern can lead to metabolic disease earlier and more severely.

Thin arms and legs with a belly are a common sign.I often remind my patients that standard BMI cut-offs can miss these risks because they were developed using data from Caucasian populations. For Asian Indians, overweight begins at a BMI of 23 and obesity above 25.

This means a person like Rohit can appear normal by international standards and still be at risk by Indian standards. His blood report confirmed it.THE DIFFERENCE BETWEEN WEIGHT LOSS AND HEALTHI tell my patients that weight loss is a number on the scale.

It counts fat, muscle and water together, and it cannot tell them which of these they have lost.When I assess health, I look at how well the body functions, from blood sugar, blood pressure and cholesterol to joints and digestion. I also consider everyday activities: whether a person can climb stairs, sit on the floor and get through a working day comfortably.The World Health Organization defines obesity in terms of excess body fat that presents a risk to health, rather than size alone.

In Ankita and Rohit’s case, appearances were misleading. By size, she appeared unwell and he appeared healthy.

But when I assessed their health and medical reports, both needed treatment.GLP-1 INJECTIONS MUST BE SUPPORTED BY MUSCLE-BUILDING AND LIFESTYLE CHANGESThe question I hear most often now is, “Doctor, which injection should I start?” Newer treatments based on GLP-1 and GIP hormones have an important role in supporting weight loss, especially when diabetes and obesity occur together. However, losing muscle along with fat can lower the number on the scale without delivering the full health benefits patients are seeking.

This is why I emphasise that medical treatment must be accompanied by lifestyle changes.Diet: I advise patients to reduce calories gradually and steadily, choosing high-protein, high-fibre meals that keep them full and meet their nutritional needs.Exercise: I encourage at least 200 minutes of activity a week, combining strength training to protect muscle with aerobic activity to help maintain weight loss.Habits: I ask patients to set realistic goals, track what they eat and how much they move, and see their doctor regularly so their treatment plan can be adjusted.Without these changes, many people fall into a cycle of losing, regaining and dieting again, known as weight cycling or the yo-yo effect. I also encourage patients to set goals they can sustain.

Drastic changes in body shape may not always be achievable, and the body does not need them to become healthier.WHAT TO KEEP CHECKING FORIndia has more than 135 million people living with obesity, and Gujarat ranks third in the country. This Anti-Obesity Day, I urge people to look beyond the scale and pay attention to how their bodies are functioning.I advise my patients to check their HbA1c, blood pressure and cholesterol levels rather than focusing only on their weight.

I also ask them to notice whether climbing stairs, sitting on the floor and getting through the working day are becoming easier or harder. If they are slim but have a growing belly, I recommend getting their blood sugar and cholesterol tested anyway.Ankita can now sit on the floor for puja again, and Rohit checks his HbA1c every year.

These are the changes I want my patients to focus on: building muscle, keeping track of their medical reports and not judging their health by their size or anyone else’s.Ankita’s weight was what everyone could see. Rohit’s health risk was what nobody thought to look for.Dr Mahendra Narwaria is a bariatric, gastrointestinal and robotic surgeon at AB Plus Hospital, Ahmedabad.- Ends