What is Bariatric Surgery and Who Should Consider It?

November 19, 2025

What is Bariatric Surgery and Who Should Consider It?

For many individuals struggling with severe obesity, the journey can feel like a lonely and frustrating battle. You may have been told that the solution is simply to “eat less and move more.” However, medical science tells a different story.

For people with class III obesity, achieving and sustaining significant weight loss through diet and exercise alone is “nearly impossible”. This is not a failure of willpower, but a matter of biology. Once the body registers a higher weight as “normal,” it actively fights to return to that weight, creating a difficult biological set point.

If this sounds familiar, it is important to know that you are not alone and that there is a powerful, effective, and life-changing solution.

Bariatric surgery, also known as weight loss surgery, is recognized as the most successful and durable long-term treatment for severe obesity. It is not a “quick fix” or a cosmetic procedure; it is a “life-saving procedure” that treats the underlying biology of obesity. However, it is a tool, not a magic wand. Its success depends on a lifelong partnership between you, your surgeon, and your commitment to a new, healthier lifestyle.

This comprehensive guide is designed to give you an honest, medically-backed understanding of this transformative journey. This information is presented from the perspective of Dr. Ramesh Makam’s practice, a pioneer with over 35 years of experience who introduced Gastric Bypass Surgery to India and holds a world record in Banded Sleeve Gastrectomies. As a leading bariatric surgeon in Bangalore, Dr. Makam is dedicated to providing a compassionate, patient-focused, and holistic approach to metabolic wellness.

What is Bariatric Surgery? A Life-Changing Metabolic Solution

The Definition: Beyond a “Weight Loss Surgery”

At its simplest, bariatric surgery is a group of operations that help you lose weight by making changes to your digestive system, specifically your stomach and sometimes your small intestine.

However, in modern medicine, the term is now used interchangeably with “metabolic surgery”. This is a critical distinction. The true goal of these procedures is not just to reduce the number on a scale, but to treat and prevent the cluster of “metabolic diseases related to obesity”. Dr. Makam’s practice is founded on this “Bariatric and Metabolic” philosophy, focusing on your complete health transformation.

How Bariatric Surgery Works: The Three Mechanisms

Bariatric surgery is effective because it works in three powerful ways to reset your body’s biology:

Restriction: The surgery makes your stomach significantly smaller. For example, a gastric bypass creates a new stomach pouch about the size of an egg. This smaller stomach holds less food, making you feel full much sooner.
Malabsorption: Some procedures, like the gastric bypass, also reroute your small intestine. This causes your body to absorb fewer calories and nutrients from the food you eat.
Hormonal & Metabolic (The True Reset): This is the most profound and least understood mechanism. The surgery dramatically alters your gut hormones, which regulate hunger and satiety.

Decreases Hunger: It removes the part of the stomach that produces Ghrelin, often called the “hunger hormone”.
Increases Fullness: It increases the production of satiety hormones (like GLP-1 and PYY) that signal to your brain that you are full.

This hormonal reset is why, after surgery, many patients find they “lose many of their improper food cravings” and “rarely do people feel deprived”. Your body is no longer fighting you; it is finally working with you.

The Proven Health Benefits of Bariatric Surgery (Obesity Treatment)

The primary reason to consider this obesity treatment is the dramatic and life-saving improvement in your overall health. The goal is not just to lose weight, but to gain health. Dr. Makam’s holistic approach is focused on this “overall health enhancement”.

Powerful Remission of Metabolic Disease

The metabolic impact of bariatric surgery is its greatest benefit:

Type 2 Diabetes: Bariatric surgery is one of the most effective treatments for Type 2 Diabetes, leading to significant improvement or complete remission in a vast majority of patients. Studies show remission rates are 56% higher than with non-surgical methods. Remarkably, this improvement in blood sugar can begin “even before any weight loss occurs,” proving its direct metabolic effect.
Cardiovascular Health: The surgery significantly lowers your risk of heart disease, heart attacks, and stroke.
Hypertension & High Cholesterol: It often leads to the resolution or vast improvement of high blood pressure and high cholesterol levels, reducing or eliminating the need for medication.

Relief from Other Obesity-Related Conditions

The health benefits extend to nearly every system in the body:

Fatty Liver Disease (NAFLD/MASLD): Bariatric surgery is one of the only effective treatments to reverse fatty liver disease and prevent its progression to cirrhosis.
Obstructive Sleep Apnea (OSA): This condition is often completely resolved, allowing patients to sleep better and stop using a CPAP machine.
Joint Pain & Mobility: The significant weight loss provides immense relief from debilitating pain in the joints, knees, and back, dramatically improving mobility.
Other Conditions: It also improves fertility, Polycystic Ovary Syndrome (PCOS), and can decrease the risk of developing certain types of cancer.

Enhanced Quality of Life & Longevity

The combined result of these benefits is a “marked improvement in quality of life”. Patients report boosted self-esteem, improved mental health, and more energy. Most importantly, studies show that bariatric surgery can increase your life expectancy, reducing the risk of premature death by 30-50%.

Who Should Consider Bariatric Surgery? Understanding Eligibility

Determining if you are a candidate for bariatric surgery involves a comprehensive medical evaluation. While general guidelines exist, the criteria in India are specific.

General International Guidelines (ASMBS/IFSO 2022)

In 2022, the leading international bariatric societies (ASMBS and IFSO) updated their 30-year-old guidelines, making them more inclusive. The current recommendations state that surgery should be an option for:

Individuals with a Body Mass Index (BMI) of 35 or higher, regardless of any associated health problems.
Individuals with a BMI between 30 and 34.9 who also have a metabolic disease, such as Type 2 Diabetes.

Important: Bariatric Surgery Eligibility in India (OSSI Guidelines)

This is the most critical information for patients in India. Medical experts have recognized that Asian and Indian populations have a different body composition (more visceral fat) and “need a more aggressive approach” to treatment. In this population, serious metabolic diseases like diabetes begin at a “relatively lower BMI”.

For example, in India, a “healthy” BMI is considered 18.5-22.9, and “obesity” begins at a BMI of 25.

Because of this, the Obesity and Metabolic Surgery Society of India (OSSI) and other Asian consensus groups have established different guidelines:

BMI of 37.5 or higher: You may be eligible for surgery even without any comorbidities.
BMI of 32.5 or higher: You may be eligible if you have one or more significant comorbidities, such as Type 2 Diabetes, hypertension, sleep apnea, or high cholesterol.
BMI of 27.5 or higher: In the latest consensus, bariatric surgery may be considered for patients with a BMI of 27.5 or higher who have uncontrolled Type 2 Diabetes or other serious metabolic issues.

This last point is crucial. A patient in Bangalore with a BMI of 28 and uncontrolled diabetes may be a prime candidate for life-saving metabolic surgery, even though most international websites would tell them they do not qualify.

Table 1: Bariatric Surgery Eligibility (General vs. Indian Guidelines)

Patient Profile	General (US/EU) Guideline (BMI)	Indian (OSSI) Guideline (BMI)
Obesity with No Comorbidities	35 or higher	37.5 or higher
Obesity with Comorbidities (e.g., T2D)	30 or higher	32.5 or higher
Uncontrolled T2D with Lower BMI	Not typically covered	27.5 or higher may be considered

More Than Numbers: Are You a Good Candidate?

A BMI number only opens the door. A truly good candidate for surgery is someone who:

Has made serious attempts to lose weight through non-surgical methods but has not found long-term success.
Is psychologically prepared and demonstrates a deep “commitment to long-term lifestyle changes” in diet and exercise. This is a partnership.
Understands the risks and benefits and is willing to commit to lifelong medical follow-up and vitamin supplementation.

Surgery may be contraindicated for individuals with certain unmanaged psychiatric conditions, active drug or alcohol dependency, or those who are not able to commit to the required follow-up.

What Are the Different Types of Bariatric Surgery?

There are several types of bariatric surgery. The choice is a complex medical decision based on your unique health profile (e.g., your weight, your existing conditions like diabetes or acid reflux, and your goals). This is where consultation with an experienced surgeon is vital. Dr. Makam’s practice in Bangalore offers unparalleled expertise across a range of procedures, ensuring you receive the operation that is right for you.

Laparoscopic Sleeve Gastrectomy (LSG)

What it is: The surgeon removes approximately 70-80% of the stomach, leaving behind a small, tube-shaped “sleeve”.
How it works: This is primarily a restrictive procedure (you can’t eat as much) but also metabolic. The removed portion of the stomach is responsible for producing most of the hunger hormone Ghrelin, so your appetite is significantly reduced.
Pros: It is a simpler and faster operation than a bypass. It does not re-route the intestines, leading to a lower risk of dumping syndrome and fewer nutritional deficiencies.15 It provides excellent weight loss (around 60-70% of excess weight).
Cons: The procedure is not reversible. Its main drawback is that it can cause new or significantly worsen existing acid reflux (GERD).

Laparoscopic Roux-en-Y Gastric Bypass (RYGB)

What it is: Considered the “gold standard” for decades, this is the procedure Dr. Ramesh Makam pioneered and introduced to India. The surgeon creates a tiny “egg-sized” stomach pouch and then attaches it directly to a Y-shaped, rerouted section of the small intestine.
How it works: It is both restrictive (small pouch) and malabsorptive (food bypasses the first part of the small intestine).
Pros: It typically results in slightly more total weight loss than the sleeve (50-80% of excess weight).22 It is the most effective procedure for resolving Type 2 Diabetes 21 and is an excellent cure for GERD.
Cons: It is a more complex surgery. It carries a higher risk of long-term nutritional deficiencies, especially in Vitamin B12, iron, and calcium.15 It also has a risk of “dumping syndrome” (discussed later).

Other Advanced Procedures (OAGB / BPD-DS)

For specific patient needs, other options exist:

One Anastomosis Gastric Bypass (OAGB) / “Mini-Bypass”: A simpler, faster version of the RYGB with only one intestinal connection. It has shown excellent weight loss and lower complication rates than the traditional bypass.
Biliopancreatic Diversion with Duodenal Switch (BPD/DS): This is the most complex but most powerful procedure. It combines a sleeve gastrectomy with a very long intestinal bypass. It is typically reserved for patients with “super obesity” (BMI over 50). It offers the highest potential weight loss (70-80%) but also carries the highest risk of severe, lifelong nutritional deficiencies.

What About the Gastric Band? (Lap-Band)

Patients often ask about the Adjustable Gastric Band (Lap-Band), where a silicone band is placed around the top of the stomach. It is important to know that this procedure has “largely fallen out of favor”.61 It produced only “modest weight loss” and had very high rates of long-term complications, failures, and re-operations.

A critical clarification: This obsolete “Lap-Band” is not the same as the “Banded Sleeve Gastrectomy,” an advanced procedure for which Dr. Ramesh Makam holds a world record. Dr. Makam’s expertise is in a specialized, modern technique, not the outdated Lap-Band.

Table 2: Comparison of Common Bariatric Procedures

Procedure	How it Works (Mechanism)	Avg. Excess Weight Loss	Key Pros	Key Cons
Sleeve Gastrectomy (LSG)	Restrictive & Hormonal	60-70%	Simpler; No rerouting; Lowers hunger hormone.	Irreversible; Can worsen acid reflux (GERD).
Gastric Bypass (RYGB)	Restrictive & Malabsorptive	50-80%	Best for T2D remission; Cures GERD.	More complex; Higher risk of nutrient deficiency; Risk of dumping syndrome.
BPD/DS	Restrictive & Highly Malabsorptive	70-80%+	Highest weight loss; Best for T2D remission.	Highest risk of severe, lifelong nutritional deficiencies; Complex surgery.

Exploring Non-Surgical Weight Loss Options

A comprehensive obesity treatment plan considers all pathways. Surgery is not the only solution, but it is the most effective for severe obesity. Here are the other options.

Medically Supervised Diet and Lifestyle

This is the foundation of all weight loss, and a requirement both before and after surgery. A professional, medically supervised program involves customized diet plans, nutrition counseling, and exercise guidance tailored to your health.

Endoscopic Procedures (Non-Surgical)

These are minimally invasive, outpatient procedures performed with an endoscope (a flexible tube through your mouth) with no external incisions.68 They are excellent options for patients with a lower BMI (30-40) who may not qualify for surgery or who do not want a surgical procedure.

Intragastric Balloon (IGB): A soft balloon is placed in the stomach and filled with saline. It takes up space, making you feel full. It is temporary (removed after 6 months) and provides an average of 10% total body weight loss.
Endoscopic Sleeve Gastroplasty (ESG): A specialist uses a device to place internal stitches, folding the stomach to reduce its volume by about 70%. It is more durable than the balloon and provides superior, more predictable weight loss (around 17-20% of total body weight).

A Note on New Obesity Medications (GLP-1s)

You have likely heard about the new, “highly effective” injectable medications like Semaglutide (Wegovy) and Tirzepatide (Zepbound). These GLP-1 drugs are a fantastic medical advancement, providing 15-22% weight reduction in trials.

However, it is crucial to understand two things:

They are a lifelong treatment. Studies show that once the injections are stopped, “about half the lost weight returned within a year”.
Surgery is significantly more effective and durable. Head-to-head studies show that bariatric surgery (Sleeve or Bypass) results in “about five-times more weight loss” at two years than the medications. Surgery provides an average total weight loss of 30-32%, which is maintained for up to 10 years, versus a 15-22.5% plateau for the drugs.

While these drugs are a great tool, “metabolic and bariatric surgery remains the most effective and durable treatment for severe obesity”.

The Reality of Life After Bariatric Surgery: A Lifelong Commitment

The surgery is Day 1. The rest of your life is the true journey. Success is built on an understanding that obesity is a chronic disease that requires lifelong management. The surgery is the tool that makes this management possible.

Recovery and the Post-Surgery Diet

Thanks to minimally invasive laparoscopic techniques, recovery is much faster than patients expect.

Timeline: Most patients spend only 1-2 nights in the hospital.
Activity: You will be encouraged to walk within hours of your surgery to prevent clots and speed recovery. Most patients return to work and light activities in 2-4 weeks.
Diet Stages: Your new stomach needs time to heal. You will follow a strict, phased diet.

Table 3: The 4 Stages of Your Post-Bariatric Diet

Stage	Timeframe	What You Eat	Key Goal
1: Clear Liquids	Hospital / First few days	Water, clear broth, sugar-free drinks	Hydration
2: Full Liquids	Weeks 1-2	Protein shakes, milk, yogurt, thin soups	Hydration + Start Protein
3: Pureed Foods	Weeks 2-4	Scrambled eggs, mashed vegetables, pureed
meats	Healing & Toleration

| 4: Soft Foods | Weeks 4-8 | Ground meat, flaked fish, soft fruits, cooked

veg 81 | Transition to Solid Food |

A Lifelong Commitment: Vitamins and Nutrition

This is the most critical component of long-term health and is non-negotiable for life.

Why? The surgery either reduces your ability to absorb nutrients (Bypass) or limits your intake so much that you cannot get enough from food alone (Sleeve, Bypass).
The Risks: Failure to supplement can lead to severe, life-threatening problems , including:

Anemia (from Iron or Vitamin B12 deficiency)
Osteoporosis & Fractures (from Calcium or Vitamin D deficiency)
Neurological Disorders (from Vitamin B1 or B12 deficiency)

The Daily Regimen:

Prioritize Protein: You must consume 60-100 grams of protein daily to protect your muscle mass.
Stay Hydrated: Sip at least 2 liters (64 oz) of fluids between meals, not with them.
Take Your Supplements: You will need a specific regimen of a multivitamin, Vitamin B12 (often as an injection or sublingual), Calcium Citrate (1200-2000mg), Vitamin D3, and possibly Iron.

Navigating Potential Complications

Dumping Syndrome: This is most common with the Gastric Bypass. It is a collection of unpleasant symptoms that occurs when food, particularly sugar or fat, “dumps” too quickly into the small intestine.

Early Dumping (10-30 min after eating): Nausea, abdominal cramps, diarrhea, flushing, dizziness, and a rapid heartbeat.
Late Dumping (1-3 hours after eating): This is reactive hypoglycemia (low blood sugar), causing sweating, shakiness, confusion, and hunger.
The Solution: Dumping syndrome is “not life-threatening”. It is a powerful, self-correcting feedback tool that teaches you to avoid high-sugar, high-fat foods.

Acid Reflux (GERD) after Sleeve: As mentioned, the high-pressure sleeve can cause new or worse GERD in 15-30% of patients. This is a key consideration. If you already have severe acid reflux, a Gastric Bypass is almost always the superior choice because it cures GERD.21 For the few who develop severe, persistent GERD after a sleeve, the “most effective therapy” is a surgical conversion to a Gastric Bypass.

Why Choose Dr. Ramesh Makam for Your Bariatric Surgery in Bangalore?

The decision to have bariatric surgery is one of the most important decisions you will ever make for your health. The skill, experience, and philosophy of your surgeon are paramount.

Dr. Ramesh Makam is not just a surgeon; he is a true pioneer in laparoscopic and bariatric surgery in India. When you choose his practice, you are choosing a leader with:

Unmatched Experience: With over 35+ years of experience and more than 12,000 advanced minimally invasive surgeries, his expertise is unparalleled.
Pioneering Legacy: Dr. Makam introduced Bariatric Surgery to India and performed the country’s first-ever Gastric Bypass Surgery. You are being treated by the surgeon who helped write the book on metabolic surgery in this country.
World-Record Expertise: He holds the world record for Banded Sleeve Gastrectomies, a globally recognized achievement demonstrating his advanced technical skill.
A Global Educator: Dr. Makam is a “surgeon’s surgeon” who has personally trained over 1,500 surgeons from around the world.
Holistic, Patient-Centric Care: Dr. Makam’s philosophy is one of “compassionate, patient-focused care”. He and his team adopt a “comprehensive and holistic approach… integrating functional and holistic medicine” to ensure you are supported physically and emotionally “before, during, and after surgery”.

Your journey to health is the most important one you can take. Begin that journey with a consultation with a true pioneer and one of India’s most trusted experts.

Contact Dr. Ramesh Makam’s office at Arka Anugraha Hospital in Bangalore today to schedule your comprehensive evaluation and take the first step toward reclaiming your health.

Frequently Asked Questions (FAQ) About Bariatric Surgery

Q: How much does bariatric surgery cost in Bangalore?
A: The cost of bariatric surgery in Bangalore can vary significantly based on the specific procedure (e.g., Sleeve vs. Bypass), the hospital, and other factors. On average, the cost can range from approximately INR 2,00,000 to INR 4,50,000.104 A precise, personalized quote can only be provided after a full consultation and evaluation.

Q: Is bariatric surgery covered by health insurance in India?

A: Yes. Following the 2019 IRDAI guidelines, most health insurance policies in India are now mandated to cover bariatric surgery, provided it is medically necessary and not for cosmetic purposes. Generally, you are eligible for coverage if your BMI is 40 or higher, or if your BMI is 35 or higher and you have at least one significant comorbidity like Type 2 Diabetes, hypertension, or sleep apnea. A policy waiting period may apply.

Q: What is “dumping syndrome”?

A: Dumping syndrome is a side effect most common after Gastric Bypass surgery. It is a group of symptoms like nausea, cramping, dizziness, and a rapid heart rate that happens when food especially sugar “dumps” from the stomach pouch into the small intestine too quickly. It is not dangerous and is effectively managed by avoiding high-sugar and high-fat foods.

Q: Can I get pregnant after bariatric surgery?

A: Yes. In fact, fertility often improves dramatically after weight loss surgery. However, it is strongly recommended that you wait 12 to 24 months after your surgery before trying to conceive. This allows your weight to stabilize and ensures your body has the nutritional stores needed for a healthy pregnancy.

Q: Will I lose my hair after weight loss surgery?

A: It is common to experience some temporary hair thinning (a condition called telogen effluvium) about 3-6 months after surgery. This is not permanent hair loss. It is a temporary response by the body to the stress of surgery and rapid weight loss. The hair will grow back as your weight and nutrition stabilize, especially if you are diligent with your protein and vitamin intake.

Q: How long is the recovery from bariatric surgery?

A: With modern minimally invasive (laparoscopic) techniques, recovery is relatively fast. Most patients stay in the hospital for 1-2 nights. You will be encouraged to walk the same day as your surgery. Most patients can return to a desk job or light activity within 2-4 weeks, though you will have restrictions on heavy lifting for longer.

BEST Institute was started with the intention of sharing my knowledge with
other fellow surgeons. During this journey, many conferences and workshops
have been conducted. Skills training is the highlight of this Institute.