Dr. Mumtaz Maher runs the Obesity clinic at South City Hospital. Here is a transcript of a few questions one patient asked him before her surgery.

Patient: Will the surgery help my PCOS?
Dr. Mumtaz Maher: Losing weight will help your PCOS. How? As fat cells secrete hormones, they plug the effects of other hormones. This PCOS is thus linked to the fat cells. When you lose weight, the fat cell population doesn’t go down. The fat cells will not go down in number but if they are starved they will shrink in size. When they shrink, they produce less of the hormones that are interfering with the others that will help you conceive.

Patient: How many of these surgeries have you done?
Dr. Maher: Over 500.

Patient: Would you recommend this surgery for me?
Dr. Maher: You’ve inherited certain genes. You have PCOS and are trying to conceive. Losing 25kg is difficult but not impossible. The problem is keeping your weight there. The surgery will help you keep the weight down.

Patient: How quickly will I lose weight after the surgery?
Dr. Maher: We don’t target the numbers or weight loss but a lifestyle change. Losing 30kg, for example, is not the goal. We want you to lose but we want you to keep it down. There was a woman who had planned a vacation to Italy but thought she’d spend that money instead on weight loss—now that, for me, is not the right way to go about this. Another woman landed from abroad, said she’d have the surgery, and lined up a darzi or tailor to get a new wardrobe. It doesn’t work like that either.

Losing weight will happen with the surgery but you have to eliminate high calories. No soft drinks, for example. One person had the surgery but kept eating M&Ms and they lost the advantage.

Patient: Why can’t I just diet and exercise?
Dr. Maher: If you get on the treadmill, you will normally burn 200 calories. But then you go and reward yourself with a blueberry muffin which is 600 calories. Yes, exercise is good for many things but it doesn’t burn that much and won’t work if you eat the wrong things.

Patient: How soon can I have a baby after the surgery?
Dr. Maher: In pregnancy, the body wants to put on weight. In the surgery, it loses it. It isn’t a good idea to make the body do two of those things at the same time. So, we would wait until you have lost 30kg, say in six months, and fall into a routine. Then you’d get a diet in which you eat for yourself and the baby.

Patient: I’ve heard that when you get pregnant the baby pushes upwards into the ribcage so won’t that damage the staples?
Dr. Maher: I use very fine titanium staples and bury them under another layer. Then the baby doesn’t go in that direction but descends. So this is not an issue.

A diet is semi-starvation and so you are hungry all the time.

Patient: How long do I have to stay hospitalized after the surgery?
Dr. Maher: We don’t shunt people out. We first ensure that you are able to take enough fluid without a drip. That is two bottles a day. A nurse will record how much you drink. If you manage it in one day, you can go home. But it can take one, two, or three days.

Losing weight takes time. It’s not happening in a week. If you said you wanted to make Rs1,000,000 in a month that would take time. Give yourself time.