Metabolic Clinic 2.0
By Arunima Rajan
In an interview with Arunima Rajan, Dr. Ankit Potdar, Consultant, Laparoscopy, Bariatric and Robotic Surgeon, Kokilaben Dhirubhai Ambani Hospital, Mumbai talks about the rise of metabolic clinics in India.He also points out that GLP-1 receptor agonists are the future of medical obesity management in India, provided they are prescribed responsibly, monitored rigorously, and integrated into a multidisciplinary framework.
What prompted Kokilaben Hospital to start a dedicated obesity or weight-management programme, and how has the institutional goal evolved over time?
The inception of Kokilaben Hospital’s dedicated obesity and weight-management programme stemmed from a growing recognition that obesity in India is not merely a cosmetic concern but a chronic, progressive disease with serious metabolic and psychological implications. Over the last decade, clinicians at the hospital were witnessing an alarming rise in patients presenting with diabetes, hypertension, fatty liver, and orthopaedic complications all rooted in underlying obesity. These clinical encounters revealed a gap: India lacked a structured, evidence-based and multidisciplinary model to treat obesity comprehensively.
Initially, the institutional aim was to create an advanced surgical programme that could safely deliver bariatric and metabolic surgery to those who met international criteria. However, as the caseload expanded, the philosophy evolved. The hospital realised that surgery, while transformative, is only one part of the continuum. Today, the goal is broader and more holistic to provide a complete obesity management ecosystem integrating prevention, early diagnosis, non-surgical medical therapies, behavioural interventions, and long-term post-surgical care.
This evolution reflects a shift in focus from weight loss alone to sustainable metabolic health. The programme now emphasises early identification of high-risk individuals, lifestyle modification through personalised diet and exercise planning, and ongoing counselling to prevent relapse. By aligning with global best practices and tailoring them to Indian body composition and lifestyle realities, Kokilaben Hospital has transformed its initiative into a comprehensive “Centre of Excellence” in obesity and metabolic care.
Who leads the clinical decision pathway — when a patient arrives, which expert(s) set the treatment trajectory?
When a patient first seeks help for obesity at Kokilaben Hospital, the approach is collaborative rather than physician-centric. The clinical decision pathway is led by a multidisciplinary team comprising endocrinologists, diabetologists, bariatric surgeons, clinical nutritionists, physiotherapists, and psychologists.
The process begins with the endocrinologist or diabetologist, who conducts a detailed metabolic and hormonal assessment, including evaluation for thyroid, adrenal, and insulin-related disorders. This ensures that secondary causes of obesity are ruled out. Once the baseline parameters are established, the nutritionist and physiotherapy teams undertake a comprehensive dietary and physical evaluation to assess lifestyle patterns and readiness for behavioural change.
If the patient meets the criteria for surgical intervention for instance, a BMI exceeding 37.5 kg/m², or 32.5 kg/m² with significant comorbidities the bariatric surgery team becomes involved. They review anatomical and surgical fitness aspects through imaging and clinical investigations. In parallel, psychologists assess mental preparedness, eating behaviour, and potential risks of post-surgical maladaptation.
All decisions are made collectively through multidisciplinary case discussions. This ensures that the treatment trajectory be it conservative, pharmacological, or surgical is guided by consensus and anchored in the patient’s long-term health goals, not short-term aesthetic desires.
Do you follow India-specific guidelines (e.g. ICMR, IAS, others) for diagnosis, thresholds, and interventions — or adapt global protocols?
Kokilaben Hospital follows a hybrid framework that integrates both India-specific and international guidelines. The diagnostic and intervention thresholds are adapted to the unique metabolic characteristics of Indian patients, who tend to develop obesity-related complications at lower BMI levels compared to their Western counterparts.
The hospital’s clinicians use modified WHO Asia-Pacific criteria, endorsed by the Indian government, to determine obesity thresholds. These guidelines consider BMI ≥25 kg/m² as obese and ≥23 kg/m² as overweight for Indian populations. Similarly, for surgical interventions, the hospital adheres to global bariatric standards but applies Asian-specific cut-offs: patients with a BMI above 37.5 kg/m², or above 32.5 kg/m² with diabetes or hypertension, are eligible candidates.
For medical management, protocols are drawn from leading bodies such as the International Diabetes Federation, the American Diabetes Association (ADA), and the Indian Association for the Study of Obesity (IASO), with necessary localisation. Nutritional frameworks, for example, are customised to align with Indian dietary preferences and metabolic profiles.
Thus, while the backbone of clinical practice is global evidence, its execution remains distinctly Indian, ensuring that treatment remains both scientifically robust and contextually relevant.
How do you track and report outcomes: how many patients maintain weight loss or metabolic improvement at 1, 3, 5 years?
Outcome monitoring forms the backbone of Kokilaben Hospital’s obesity management philosophy. Every patient enrolled in the programme is entered into a long-term follow-up registry that captures weight, BMI, metabolic parameters, and quality-of-life indicators at regular intervals — typically at 6 months, 1 year, 3 years, and 5 years post-treatment.
For surgical patients, data include percentage of excess weight loss, changes in HbA1c, lipid profiles, and blood pressure control. For non-surgical patients, adherence to dietary and exercise plans, body composition analysis, and metabolic improvements are tracked. Early data indicate that over 70% of patients maintain more than 50% of their excess weight loss at three years, while a significant proportion show remission or improvement in diabetes and hypertension.
Beyond numbers, qualitative assessments also matter. Dieticians and psychologists monitor behavioural adherence, emotional health, and relapse risks. These follow-ups are done through in-person consultations, telemedicine sessions, and digital monitoring tools, ensuring that patients remain engaged with their care pathway.
While public dissemination of long-term results is ongoing, the hospital’s internal analytics show that sustained success correlates strongly with continued post-intervention follow-up highlighting the necessity of ongoing multidisciplinary engagement rather than one-time treatment.
What checks and balances exist to prevent overtreatment, overmedicalization, or unnecessary surgery?
Kokilaben Hospital has embedded ethical safeguards to prevent overtreatment or unnecessary procedures. Every surgical case must first undergo a comprehensive non-surgical trial phase, including medically supervised diet, exercise, and pharmacotherapy. Only when these fail, and comorbidities continue to progress, is surgery considered.
Pre-surgical evaluation involves cardiology, anaesthesia, endocrinology, and psychological assessments. Patients are required to attend structured pre-operative counselling sessions where the risks, benefits, and long-term lifestyle commitments of surgery are explained in detail. Consent is fully informed and documented.
Moreover, a peer-review mechanism is in place: no bariatric surgery proceeds without clearance from the multidisciplinary board, ensuring decisions are collective and clinically justified. For medical therapies, prescription of newer weight-loss drugs, including GLP-1 receptor agonists, is regulated through strict protocols that demand baseline investigations and regular safety monitoring.
This ethical governance framework not only builds patient trust but also upholds Kokilaben Hospital’s institutional reputation as a centre for responsible, evidence-based obesity care rather than commercialised weight-loss services.
How affordable and accessible is your service — in terms of cost structure, insurance coverage, and geographical reach?
Affordability and access remain complex challenges in obesity care. Kokilaben Hospital has attempted to address these through a tiered service model. For preventive and lifestyle management, the hospital offers relatively affordable packages covering diet counselling, physiotherapy, and periodic check-ups. These allow patients from diverse economic backgrounds to receive structured guidance without major financial strain.
However, bariatric and metabolic surgeries remain higher-cost procedures due to the need for advanced technology, specialist teams, and intensive post-operative monitoring. Insurance coverage, though improving, is still uneven across India. Many insurers now recognise obesity surgery under the umbrella of comorbidity management, but reimbursements vary based on BMI, medical necessity, and policy clauses. The hospital assists patients in navigating this process through dedicated insurance coordinators.
Geographically, Kokilaben’s flagship centres in Mumbai, Navi Mumbai, and Indore offer comprehensive services, while teleconsultations have extended access to patients from Tier-II and Tier-III cities. The hospital is also exploring digital nutrition counselling and remote follow-up solutions to reduce travel barriers.
While the cost of treatment remains a deterrent for some, the hospital’s position is clear: long-term health outcomes and prevention of chronic disease complications ultimately yield better economic and social value than untreated obesity.
What are the main obstacles — staffing, infrastructure, patient adherence, regulatory hurdles — that you face in running this programme?
The foremost challenge is patient adherence. Sustained weight management requires behavioural transformation something far harder to achieve than surgical success. Many patients relapse when external supervision declines, and long-term commitment to diet, exercise, and counselling can wane over time.
Staffing poses another obstacle. Obesity management demands a broad range of specialists: endocrinologists, surgeons, psychologists, physiotherapists, and nutritionists who must coordinate seamlessly. Recruiting and retaining such interdisciplinary talent in adequate numbers is resource-intensive.
Infrastructure is a continuing investment. Advanced operating theatres, minimally invasive and robotic surgical systems, and metabolic testing labs require significant capital and maintenance costs.
On the regulatory front, India’s evolving policy environment around new pharmacotherapies (such as GLP-1 receptor agonists) can slow adoption. Pricing, import licensing, and safety guidelines are still being streamlined.
Despite these hurdles, Kokilaben Hospital continues to scale its programme through continuous staff training, digital health integration, and community outreach that promotes obesity awareness and early intervention.
If you had to make one systemic reform in India’s health policy to shift the paradigm of obesity care — what would you push for?
The single most transformative reform would be the recognition of obesity as a chronic disease under India’s national health policy not merely a lifestyle issue. Such recognition would mandate the creation of standardised national guidelines for screening, treatment, and reimbursement.
If obesity were formally categorised as a chronic condition, it would unlock greater insurance coverage, promote early diagnosis through primary healthcare systems, and catalyse government investment in multidisciplinary obesity centres across the country. Moreover, public health campaigns could focus on prevention and education rather than reactive treatment.
Kokilaben Hospital advocates for a “whole-system” approach integrating healthcare, policy, and community-based prevention to break the stigma that still surrounds obesity. This systemic recognition would redefine care from episodic weight loss to lifelong metabolic management.
How do you view the role of GLP-1 receptor agonists in your treatment portfolio — are you prescribing them, and under what protocols or safeguards?
GLP-1 receptor agonists represent a major advance in obesity and diabetes therapy, and Kokilaben hospital has cautiously integrated them into its treatment portfolio. These drugs, such as liraglutide and semaglutide, are prescribed for patients who have failed to achieve meaningful weight loss through lifestyle modification alone, or who are unfit or unwilling to undergo surgery.
Prescription is protocol-driven. Before initiation, patients undergo comprehensive evaluation including renal and hepatic function, pancreatitis risk assessment, and cardiovascular screening. The drug is introduced gradually with close monitoring for gastrointestinal side effects, glycaemic response, and adherence.
Use of GLP-1 RAs is always adjunctive never standalone. Patients continue to receive nutritional counselling, physical activity guidance, and psychological support. Safeguards include routine laboratory follow-ups and a clear discontinuation plan if adverse effects arise.
Cost remains a limiting factor; many of these medications are not yet widely covered by insurance and can be expensive for long-term use. Nonetheless, their efficacy in appetite suppression, glucose regulation, and sustainable weight loss makes them a valuable bridge between non-surgical and surgical interventions.
GLP-1 receptor agonists are the future of medical obesity management in India, provided they are prescribed responsibly, monitored rigorously, and integrated into a multidisciplinary framework.
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