Chest pain, severe breathlessness or confusion needs emergency care immediately. Also seek urgent care for a swollen painful calf, which may indicate a clot.
Obesity severe enough to cause or threaten other disease. It is a medical condition driven by biology, environment and genetics rather than a failure of willpower, and it is treated accordingly.
This page sets out who meets accepted criteria for surgery and what medical treatment exists first. It is written to help you work out where you stand rather than to persuade you towards an operation.
Body mass index is calculated from height and weight and is used to categorise obesity. It is a crude measure — it takes no account of muscle, fat distribution or fitness — but it remains the basis of most treatment criteria because it is simple and reproducible.
What matters clinically is not the number alone but what it has caused. Type 2 diabetes, obstructive sleep apnoea, fatty liver disease, high blood pressure, joint disease and reduced fertility are the conditions that determine whether treatment is needed and how urgently.
Ethnicity changes the thresholds. People of South Asian origin, and to a degree those from parts of the Middle East, develop insulin resistance, diabetes and fatty liver at a lower BMI than European populations, because fat is distributed more centrally. Guidelines therefore apply lower cut-offs, and using European thresholds for a patient from Bangladesh or India would underestimate their risk.
It is also worth saying plainly that obesity is not a simple matter of choice. Appetite and energy storage are regulated by powerful hormonal systems, and after weight loss those systems act to restore the previous weight. That biology is why sustained loss through effort alone is difficult for most people, and it is the reason medical and surgical treatments exist.
Medical treatment for obesity has changed substantially. Newer injectable medications produce meaningful and sustained results for many people, and for someone at the lower end of surgical eligibility they are worth a proper trial first. They are not free of drawbacks — cost, side effects, and the fact that weight is usually regained when they are stopped — but the decision between medication and surgery is now a genuine one rather than a formality. Any clinic that moves straight to booking an operation without discussing medical options is not giving you the full picture. Equally, medication is not a substitute where diabetes is advanced and surgery would produce a much larger metabolic effect.
The assessment is about what obesity has already done, not just the number.
Height and weight give the BMI, but what decides whether surgery is appropriate is the combination of that number with the conditions obesity has caused. Send your HbA1c, liver function tests and ultrasound, blood pressure readings, lipid profile and any sleep study, alongside a full list of medication. Also tell us your ethnicity, because the thresholds differ and applying European criteria to a South Asian patient underestimates the risk.
Treatment is a sequence, and surgery is one part of it rather than the whole.
Supervised dietary change, increased activity within what your joints allow, and treatment of the conditions already present — diabetes, blood pressure, sleep apnoea. Structured programmes with professional support achieve considerably more than unsupported attempts, and this foundation is needed whether or not surgery follows.
Newer injectable medications produce meaningful sustained results for many people and have changed the treatment landscape. They suit patients at the lower end of surgical eligibility and those who do not want surgery. Weight is usually regained after stopping, so they are best understood as long-term treatment rather than a course.
Sleeve gastrectomy or gastric bypass, considered where accepted criteria are met — generally a BMI of 40 or above, or 35 and above with related conditions, with lower thresholds for South Asian patients. Its strongest effects are metabolic, particularly on type 2 diabetes, and it commits you to lifelong supplementation and monitoring.
Sleep apnoea treated with CPAP, diabetes controlled, blood pressure managed, and joint problems addressed. These need attention regardless of what else is decided, and treating sleep apnoea in particular is essential before any general anaesthetic.
Diabetes, sleep apnoea and fatty liver drive the case for treatment far more than the BMI figure alone.
South Asian and some Middle Eastern patients meet criteria at a lower BMI, because metabolic complications appear earlier.
Surgery without lifelong supplementation and monitoring causes preventable harm. This must be settled before, not after.
If your BMI is in the lower range and you have not tried supervised medical treatment, we will suggest that first. Surgery is permanent and medication is not.
Untreated obstructive sleep apnoea makes general anaesthesia considerably more dangerous. It must be diagnosed and treated before any operation is scheduled.
Photographs taken on your phone are fine. Reports in Arabic, Russian or Bengali are fine — we translate them ourselves.
Accepted criteria generally use a BMI of 40 or above, or 35 and above where obesity has caused conditions such as type 2 diabetes, sleep apnoea or severe joint disease. Lower thresholds apply for people of South Asian and some Middle Eastern backgrounds. Send your measurements and blood results and we will tell you plainly where you fall.
Often, yes, particularly if you are at the lower end of eligibility. They produce meaningful sustained results for many people and avoid a permanent alteration to your digestive system. Weight is usually regained after stopping, so they are long-term treatment rather than a short course. Where diabetes is advanced, surgery generally produces a larger metabolic effect.
Because insulin resistance, type 2 diabetes and fatty liver develop at a lower BMI in South Asian populations, largely due to a more central distribution of fat. Applying European thresholds to a patient from Bangladesh, India or Pakistan systematically underestimates their metabolic risk, which is why international guidance sets lower cut-offs.
Yes. Appetite, energy storage and body weight are regulated by hormonal systems that actively defend a previous weight after loss, which is why sustained loss through effort alone is difficult for most people. Framing it as a failure of willpower is both inaccurate and unhelpful, and it delays people seeking treatment that works.
Two things. Sleep apnoea, because untreated it makes anaesthesia considerably more dangerous and it is very commonly undiagnosed. And follow-up — confirming that you can obtain supplements and blood tests near your home. That second question decides whether surgery abroad is sensible for you at all.
It frequently produces remission, particularly where diabetes is of shorter duration and insulin is not yet required, and the effect begins before much weight is lost. Remission is not the same as cure — diabetes can return over years — so continued monitoring is needed. It is nonetheless one of the strongest arguments for surgery in the right patient.
Send your height and weight together with your HbA1c, liver tests and blood pressure. What obesity has caused matters more than the number itself.
Your reports go directly to our medical team. We do not share your records with hospitals until you tell us to.
WhatsApp +91 83035 86344 · Phone +91 83035 86344 · Email tibhind@gmail.com
Coordinators available 9:00–20:00 IST. We speak Arabic, English, Russian and Bengali.