Mahendra Narwaria often conducts at least one weight loss surgery every day. As director of Ahmedabad-based Asian Bariatrics, which he claims is Asia’s largest weight loss and diabetes surgery speciality centre, he has operated on patients whose body mass index (BMI)—a measure of body-fat based on height and weight—and the diseases they suffer from classify them as obese. Patients both young and old walk through his doors, their weight anywhere between 60 to 1oo kilograms. Hundreds each year. But Narwaria believes many more Indians need access to bariatric surgery.

In India, Narwaria is a pioneer of sorts when it comes to bariatric surgery—a procedure that reduces the size of the stomach, curbing appetite to help patients shed excess weight and manage conditions such as hypertension, diabetes and fatty liver disease. When Narwaria isn’t operating on people, he trains other surgeons to conduct these surgeries. Just last week, he held classes at a 3-day-long conference to assess and upgrade the bariatric surgery skills of 70 surgeons. No small feat, give that there are only about 500 trained bariatric surgeons in the entire country as most medical colleges don’t train surgeons in these new branches of surgery.

Narwaria, though, has had help in his attempts to popularise bariatric surgery. “Johnson & Johnson supported my training and all our conferences,” he says. Without them, training surgeons for bariatric surgery would not have been possible, he adds.

Indeed, medical device companies often train and certify surgeons to get them to use the the companies’ products. And medical device major Johnson & Johnson (J&J)—which earned $76.5 billion in revenue last year—is no different. A surge in bariatric surgeries means a surge in sales of the company’s surgical staplers which are used in the procedure. Along with fellow medical device manufacturer Medtronic, J&J dominates the surgical stapler market in India.

To this end, J&J has trained surgeons in bariatric surgery, and then these surgeons have trained junior surgeons under a proctorship programme as well. This is how the pool of bariatric surgeons has swelled to around 500 now, accounting for close to 20,000 surgeries annually, explains Manish Jain, J&J’s former director of health policy.

Training surgeons, though, is just one part of the puzzle the company is trying to solve. In the case of bariatric surgery, J&J has decided to walk the extra mile and promote the procedure in India, says Jain. Since they brought the staplers to India in the early 2000s, they have jumped through one hoop after another to develop, lead and grow the fastest-growing market for bariatric surgeries—Asia. Still only a small part of the $1.64 billion global bariatric surgery device market which is growing at 5.7% annually, Asia is growing faster than Western countries. And if the Asian market is to continue this trend of rapid growth, India will prove to be a key market.


Ruhi Kandhari

Ruhi writes on the impact of healthcare policies, trends in the healthcare sector and developments on the implementation of Electronic Health Records in India. She has an M. Sc. in Development Studies from the London School of Economics.

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