Dr Muffi's Blog

The official blog of Dr Muffazal Lakdawala

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How do you deal with PCOS?

Have you heard of PCOS? Chances are, you not only have, but also have female family members and/or friends who have been diagnosed with it. Because Polycystic Ovary Syndrome is one of the most widely-diagnosed and discussed lifestyle conditions of the modern world.

What is it? Simply put, PCOS causes a woman's ovaries to produce more than normal amounts of androgens, which are a kind of hormone that is similar to testosterone. This causes increased hair growth, acne, and irregular periods. The kinds of symptoms and effects that PCOS brings really differs from one woman to the next. You can get PCOS because of genetic factors, or hormonal imbalances that can be brought about by a variety of factors. The most important thing to know about PCOS is that, no matter the intensity and the impact which are hard to generalise, every body system is affected by it, as also are weight and blood sugar levels.

I am interested in talking today about the insulin-related, and weight-related aspects of PCOS. Insulin resistance - which, as you know by now, is the condition in which blood sugar is not regulated properly - is very common in women with PCOS. This, of course, puts you at risk for Type 2 diabetes, high cholesterol, metabolic syndrome, and cardiac problems. This also could cause obesity.

Obesity in patients with PCOS creates a very vicious cycle because weight gain causes the condition to get worse. If you gain weight, your menstrual cycle goes awry, and if this continues for a prolonged period of time, you can either face complications in getting and staying pregnant, or be infertile.

Most women with PCOS are prescribed the same medicines given to diabetic patients. but this is not an ideal long-term treatment plan. Treating PCOS needs a holistic approach, which will also involve changing what you eat, exercising often, and lifestyle changes to stay more calm and focused.

If PCOS persists for long, and the patient is now obese, bariatric surgery is a good option to consider.

In 2009, the Androgen Excess and Polycystic Ovary Syndrome Society of the American Society of Reproductive Medicine said, “A meta-analysis of the effects of bariatric surgery in more than 22,000 procedures found an average weight loss of more than 50% was associated with complete resolution or improvement of DM2, hyperlipidemia, hypertension, and obstructive sleep apnea in more than 60% of patients.”

I would recommend women with PCOS and very rampant weight gain to consider the option by visiting a good doctor. (Our clinic is completely equipped to help with all information.) If a surgery can help you deal with weight gain, infertility and hirsutism, a conversation cannot be a bad place to start, can it?

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Obesity is determined by various factors. I break them down for you.

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Is your BMI and/or weight above recommended levels? Can you start and/or sustain a healthy eating plan? Do you have the motivation to stick to a rigorous fitness routine? 

I spell out a very simple way to determine whether you need bariatric surgery. 

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CODS is more than a physical institution. It is the spirit of my philosophy, and the shared passion and belief of my wonderful team. In this video, I talk about what CODS stands for, and my hopes for it.

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My annual pilgrimage

I spent the last few days of March at my annual camp at Sumerpur, Rajasthan. It is held at the Bhagwan Mahavir Hospital, a 150-bedded facility that caters to medical needs of the poor and needy in Pali district.

My association with this hospital started about 10 years back. I was then a surgeon who had started his private practice but, as with any new professional, had time to spare. I wasn't as busy as I am now. I was approached by my teacher, Dr Buch, whom I tremendously respect and admire; not only as a doctor who taught me basics of surgery but more as one of the best human beings I have met. A prominent gastroenterologist had backed out last-minute from going to Sumerpur, so I filled in.

What followed, as they say, is history.

I did about 100+ gastroscopies in a single day on my first trip and that set the tone of things to come. It was peak summer, the temp was about 40 degree C, but the air was fresh, as we slept out in the open under clear, enveloping skies. The hospitality was impeccable and the food was classic Rajasthani Jain cuisine.

This hospital is run by a trust which is currently presided over by Dr ML Singhi, a surgeon who has dedicated his life to the welfare of this facility and their patients. The trust also runs a free school, a nursing college, an eye hospital and more, all thanks to the vision of a man called Rajmaljee Jain, fondly called 'Bhaisa', by all he came in contact with.

The first time I was introduced to him I expected to see a powerful impressionable personality who ran so many things successfully. To the contrary I saw a frail man in a dhoti kurta sitting on a tiny wooden table in a small little corner of the eye hospital - unassuming and very humble!

In the nine years that I interacted with him I was more impressed by him every year. He believed that helping his fellow human beings would get him salvation and he tried his best till his last breath.  I had planned to start an old age home with his guidance. Now, after his demise, I am even more determined to do so.

In the Sumerpur camp we operate on patients for ailments of the gall bladder, appendix, uterus, hernias, etc. The patients pay nothing for surgery, drugs or investigations; many cannot afford to even pay 50 Rs for their bus fare to come to the hospital. With God’s grace, the numbers have only increased every subsequent year and we operate about 75 cases in two days. What gives me immense pleasure and satisfaction is the fact that we give to these poor patients the best surgical option currently available which they would not be able to afford. Also, because of the wonders of laparoscopy, they feel almost no pain, and can experience a very early recovery. Which means they can go back to work quicker, to earn their livelihood.

It is my biggest endeavor especially while we operate on these patients to ensure that we have a zero percent complication rate. Because as ridiculous as it may sound, it's my belief that a rich man may get away with an odd complication but a poor man may die as a result of it. Over the last few years we have built an enviable reputation and it's funny as everyone waits for Dr Lakdawala's camp but probably have never seen him as I remain the face behind the surgical mask. My family forms an integral part of this camp.

My wife Priyanka (Lakdawala, nee Kaul) has been an active member of this camp now for years! One would wonder how a hedge fund manager would figure in a medical camp? Well, she not only motivates me and pushes me to deliver more every year but also looks after the organisational aspects and makes sure that everything runs according to plan and schedule.

My father, my uncle Burhani, my cousins Mash and Shabbir all have contributed in their own right.

I remember this one instance, when my father who had accompanied me for a camp was made chief guest. We told him he needed to go on stage and announce that he would donate an entire laparoscopy set to the hospital. Little did he know then how much this cost!  It's only when he came to know was he proud of his son and daughter-in-law and just said with an emotional timber, “The more you give, the more you shall get son.”

I have used my influence with companies and am thankful they do their own bit of CSR and give us the best equipment currently available! Just imagine operating in the middle of the biggest desert in the country with the most hi-tech equipment available in the best of hospitals in India and abroad.

My team keeps growing every year: the regulars have been Aparna, Rajesh Shrivastav, Rajesh Mahida and Sharad Mehta. May god bless them all.

I have realised that giving back to humanity comes naturally to every doctor and he or she has the best chance to do so. We are blessed as god has given us the power to heal. I keep urging my fellow doctors that let’s not waste this chance of serving mankind for we can make a difference if we want to. As Gandhiji said, "Be the change that you want to see in the world”

To me just the sight of an old Rajasthani woman standing in front of me with folded hands and a tear in her eye without saying a word is a sign from god saying, child, you are blessed.

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Why sugar is bittersweet

I am not a fan of fad theories. Neither do I believe in being alarmist. However, a raging current debate that I would like to participate in is the one about sugar.

A recent study published in the noted journal, JAMA Internal Medicine, states that higher sugar intake increased the risk of death from heart disease. (The study was conducted by Quanhe Yang and colleagues from the Center for Disease Control and Prevention.)

The study notes that the percentage of daily calories from added sugar grew from 15.7% in 1988-1994 to 16.8 percent in 1999 to 2004 but then fell back to 14.9 percent in 2005-2010. The report finds a very strong relation between the amount of added sugar in a person's diet and their cardiovascular mortality.

The bottomline: People who consumed between 10% and 25% of their calories from added sugar had a 30% increase in cardiovascular mortality. For people who consumed more than 25% of their calories from added sugar the risk nearly tripled

In an editorial that accompanies the study, Laura Schmidt – “Too much sugar does not just make us fat; it can also make us sick.”

Its publication has catalysed the always-noisy conversation about sugar, and the role it plays in our daily diet.

Let’s talk facts, and then I trust you to gauge the amount of sugar in your daily diet, before deciding what to do.

Starting with a simple example, as we head into summer – a can of an aerated drink contains 8 spoons of sugar. This is also the amount of sugar found in a serving of low-fat breakfast cereals. (Take a look at this page, for more information.)

As an aside, this is why I say that buying into the low-fat/low-sugar processed foods deal is not really wise. Sugars can be hidden, and the consequences are the same within your body.

Quickly, let us understand what are the kinds of sugar, and which ones are the most harmful.

Glucose - A simple sugar found in whole grains and vegetables. It stimulates the pancreas, which causes secretion of insulin, the hormone that regulates glucose levels. A very important source of energy, glucose produces hunger-suppressing leptin. If you are always on the move, and need to stay on top of things, glucose is key.

Fructose - This is the sugar in fruit, which is converted into energy by the liver, and is broken down into glucose and lactate. It is great to get your fructose from fruit because it is combined with fibre and nutrients in that natural state. Which is why eating a fruit before a workout is a great idea.

Sucrose - Glucose and fructose are chemically combined to form sucrose, or table sugar. It is an empty food because it gives you a shot of energy, but no nutrition. (Note that whether you use white sugar, castor sugar, or raw/brown sugar, you are essentially absorbing sucrose.)

High fructose corn sugar (HFCS) - With equal amounts of sucrose and fructose, and made from corn starch, HFCS is the most dangerous form of sugar. It is very addictive, and completely devoid of nutritional value. If you read the labels on processed foods, you will find they contain HFCS.

When people say things like, “My sweet tooth is addictive”, or “I really need a box of cupcakes when I am depressed”, they are expressing a very basic bodily need for a source of energy. My advice would be, when you crave that, reach for fruit, and not a jar of cookies.

It is difficult to eliminate all forms of sugar from your diet and, in my opinion, not necessary to do so unless you have pressing health concerns. Such diabetes, or obesity, or heart disease and even the risk of these. Talk to your doctor and nutritionist before you make a decision, and seek their support.

I think that if you control the consumption of sugar – hidden or not – in a conscious, daily manner, you can treat yourself to the occasional moderately-sized scoop of ice-cream, or piece of barfi, or bowl of halwa. Two to three bites are sufficient to satiate any sweet tooth.

Balance, and moderation are, as always, the keywords to good health.

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You all know by now that moderation is almost my favourite word! I tell you why, with reference to your diet post bariatric surgery. 

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As I have emphasised earlier, too, diabetes cannot be taken lightly or ignored any more. Every 10 seconds, someone is dying because of it. 

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I explain the key differences between bariatric and cosmetic surgery, so you can make an informed decision.

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The Perfect 10

As a doctor, I celebrate every small win in my sphere of work because each one is about giving hope or life to someone else. Especially in the niche that I operate in, where every kilo lost by the patient and every reduction in prescription or dosage is a victory.

Which is why Perfect 10, the new calendar from CODS is very special to me.

It’s a new initiative started by my team to give back to all these women who trusted us with their lives and give them their dream years back. It is a platform for these women to step out of their comfort zones and express themselves. It is not about showcasing them in bikinis with perfect bodies, but about showing the world 10 perfectly happy women with a new sense of confidence. They are ready to take on the world on their terms.

As a concept,  the calendar is a big victory not only for every single woman in it but also for all the 250 who applied.

You may well ask - why not feature men as well? Why just women?

I believe that obesity affects women much more psychologically and socially, than it does men. A few cases that come to my mind are an obese daughter who hated her thin mother and the mother's consequent despair. O r a sibling who loathed her younger sister, because she was not so plump, which drove her towards suicidal tendencies. And then there is the large number of young girls who compromise on their choice of life partners as they believe that their obesity will never get them the man of their dreams.

I have noticed that these women, and others like them, shrink into their own cocoons. They are ridden with complexes, and are robbed of the joys of life. They fear that their friends are judgmental, and people do not care for them, which, in some unfortunate cases, is true.

The world of fashion and beauty, too, creates these mirages in which thin is beautiful. The women who come into our clinic battle to conform, and lose out. This causes depression, and, often, binge eating. The vicious cycle gets worse – you feel depressed because you are obese, and overeat, becoming even more so.

For women, these issues also get complicated medically, especially in the age bracket of 20 to 40. Lifestyle diseases such as PCOS are aggravated by obesity. Pregnancy gets tougher, and the resulting weight gain is disastrous.   

Until a few years ago, parents in India needed convincing about the benefits of surgery. Now, I find that they have become more supportive. They understand the unique problems of obesity and encourage their children to undergo surgery. They are aware it will not impact their sexual lives or chances of getting pregnant, but instead, give them healthier and happier lives. I believe that as a bariatric surgeon, I not only cut their stomachs, but also, quite literally, years of regrets and bitterness.  I inject a whole new reason to live and smile.

Last week, I was on the sets of the calendar, watching the bustle. There were fittings, hair, make-up and clothes designed by Sheetal Design Studio. It was very magnanimous of my friends Dhiren and Jeetu Shah to have helped me in this endeavor. (Did you know that these were the folks that dressed all the pageant queens that India sent on to Miss Universe and Miss World?)

I absolutely loved to see the looks on the faces of the 10 women. The excitement, and energy were palpable. I was moved to think about the fact that a few years ago, these women would never have imagined they’d be participating in a professional fashion shoot. And yet here they were, getting makeovers and feeling like the most beautiful women in the world!

The calendar has made them feel special. It is their moment in the sun and we are happy to be a part of it. I am thrilled that I accomplished a promise I made to them years ago, when I told them that they were beautiful and would make them believe that in due time.

The CODS calendar is our tribute to all these fabulous women on Women’s Day.

If you would like one, do reach us to our team at [email protected]

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The Numbers Game

How many of you made a new year’s resolution to lose weight, and now, nearly two months in, are giving up?

If you see the above infographic, you’ll find that it’s a common problem. Though these statistics originate in the US, they’re true for much of the rest of us, too.

I’d like to clarify something right at the start, though, before I talk about weight loss. Most women are never as fat as they imagine they are, and most men are always as fat as they think they are. So, that said, focusing on your weight staying within reasonable limits is something I, of course, always advocate.

Regular readers will, by now, be familiar with the consequences of extreme weight gain, and why you need to steer clear of it. Given modern lifestyles and stress, however, all of us experience fluctuations in our weight, and today, I want to tell you how you can tell for sure if you need to skip sweets for a while, or start exercising for 30 minutes a day, or visit a medical team, such as mine at CODS.

There’s so much data available these days on weight gain and loss that it is easy to be misinformed. Should you consider BMI the best way to tell? Or just trust the bathroom scales? Or the fit of your clothes?

To me, the safest way to know if you are okay or in trouble is to measure your waist. The average waist size for a woman should be 34” or less, and for a man, 38” or less.

If your waist is above this size, you need to start moving.

I advocate this method for laymen and laywomen because it’s the least complicated. The problem with calculating BMI is that only a trained professional will be able to correctly interpret the result. If you are muscular from working out often, or because you are an athlete, your BMI is usually high. This, of course, does not mean you are overweight. Conversely, your BMI might be low but the fat content in your body might be unhealthily high. And just reading a number off a calculator cannot tell you these nuances.

So, check your weight, for sure, at regular intervals and always ideally on an empty stomach. Calculate your BMI, too, if you like. Both done, measure your waist. If you feel uncomfortable with even one of these results, visit a qualified professional who will be able to help you.

That done, it might be a wonderful surprise for you to make a resolution to stay at your current weight because it’s just right. Or, if not, you will have someone to guide you to lose those extra pounds, or inches. And there’s no better way to stick to your resolution than to have someone cheering you on with advice, support, and encouragement.

(Image via here)

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The greatest gift

We are two days away from Valentine's Day, and I really want to talk about a priceless gift that we can all give our loved ones.

Good health. For ourselves, and for them.

By now, regular readers of my blog, and those who follow CODS on Facebook, are aware that nothing matters to me or my team more than knowing that each patient who comes to us leaves us healthier, happier, and full of a renewed love for life. As a surgeon, I see the crushing disappointment, fear, and sorrow that overwhelms family and friends when a loved one is ill. I also see the hope, doubt, fright, and questions in the eyes of patients. Nothing in the world can make these feelings go away except a commitment to good health.

It really is the biggest sign of love.

So, what can you do to keep yourself and your loved ones healthy? We've discussed quite some ideas here - implement my five rules for wellness, set a standard of good health as early as you can, stay aware of any diseases in your family and talk to qualified doctors about it, do whatever you can to keep lifestyle diseases and obesity at bay, and just learn to make good health your right.

That is the only way to see it. If you truly believe that you deserve good health, and so do your family and friends, you will do everything you can to achieve that goal.

Bring the same determination and focus into your personal life. Refuse to sacrifice your time to work out. Plan ahead and make sure you eat healthy, balanced, wholesome meals cooked at home as much as possible. Take time out to relax, spend time with people you love, cultivate a hobby, laugh, unwind. (Remember I went diving with my daughter last December?) Meditate. Focus on your mental and spiritual wellness, as much as your physical. Good health is holistic.

Often, we cannot help the external stressors in our lives. This is a fast-paced world, and you need to not only survive, you need to win. And you will fall by the wayside if you neglect your own health, and that of your loved ones.

So this February 14, aside from any other celebration, do take a moment to be grateful for everything you have, and promise to always value good health above all other goals.

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Hope, faith and coffee

A very interesting initiative that we started five years ago at CODS has become bigger, and better, than we’d ever imagined it would.

Coffee with Muffi gets its name from my favourite drink and my nickname. The idea is to offer a medium, or platform, of communication to people battling obesity. My team and I meet a multitude of patients, who battle depression; are in self-imposed exile; lack confidence; and feel completely alone. All, on account of being obese.

What Coffee with Muffi allows them is a safe space in which to discuss anything that they want to. The CODS team is present, to provide a kind word, or a joke, and to organise everything from games to photo booths. Our patients – old and new – have formed wonderful friendships, and they look forward to seeing one another again each meeting. There are no medical discussions, or lectures – it’s just about meeting people who have fought similar battles and encouraging them to come out of their shells. There is an air of camaraderie, and happiness that is truly rewarding.

We’ve been very particular about frequency and constancy. Coffee with Muffi meetings are conducted every six weeks in Mumbai, and last month, we had another first.

My team and I travelled to four cities, every Sunday of January, taking Coffee with Muffi to Delhi, Nagpur, Surat and Dubai. As I perform surgeries in both Mumbai and Delhi, and people travel to consult the CODS team from all over, we wanted to make sure that as many of our patients as possible get the Coffee with Muffi experience.

My team and I at the meeting in Gurgaon last month

As I have said earlier, bariatric surgery differs from other kinds of surgery in post-operative care matters. We have to stay in touch with our patients, and they have to know that we are there for them. It’s very important for me and my team to touch base personally. The core team travelled to all four cities with me, and, really, Coffee with Muffi is all about our patients. It’s their meeting. We just organise it for them.

I love being at these meetings, because the nature of obesity and the work we do at CODS is intensely personal. When an obese patient loses weight, it changes their lives. It’s not just that clothes fit better, or they can take a walk, or eat without fear. The key point is that their confidence and faith in life are restored. Obesity is an uphill, lifelong, arduous battle. When our patients fight it, they get a second chance at life.

Which is why, at Coffee with Muffi, they want to take pictures with me and the team. They want to share stories of triumphs – big and small. The laughter, stories and hope that we see at each meeting are blessings, and affirmations. 

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On a prayer

What makes a man stand out from the ordinary common man, the Aam Aadmi. Is it who he is born to? Or how he leads his life or how he reacts to situations he is faced with?

I believe true leaders of men are made here on earth, by their words, thoughts and actions. They don't necessarily do different things, they just look at things differently from you and me.

One such man I knew was His Holiness Syedna Dr Mohammed Burhannuddin, leader of the Dawoodi Bohras, a community of peace- loving people, mainly businessmen and traders. The Syedna passed away on January 17. 

I was very fortunate to be involved in his medical care over the last five years. Imagine treating someone who was 102 years old, had a massive following and someone I was taught to pray to since I was born! He, in short, was the closest human form of God I knew of, and here I was operating on God himself. It was not only challenging but also an intimidating experience. Let me start from the beginning.

I was a kid, no more than 5 years old, running behind his car as were scores of others screaming Moula Moula only for him to catch a fleeting glimpse of me through a half-opened car window. I believed that if he even so much as looked at me I would be blessed.

I would attend his sermons during Muharram and Ramzaan religiously. The qualities he had even then were kindness, charisma and patience, which lasted with him till he breathed his last. He treated kings, presidents, men of honour with the same grace as he cared for the underprivileged. Years back, my parents had got an interest-free loan from him to pay for my medical fees and my books in first year of MBBS came from a library of old books, which was something the community ran. A fact that probably he would have never known. That the man who would operate on him years later actually became a doctor thanks to one of the innumerable charity initiatives he ran. Like me, there would be millions who would have benefited from his generosity.

Today with God's grace, I am Chairman of the Institute of Minimal Access Surgical Sciences and Research Centre at Saifee hospital and the Director of the Department of GI, Minimal Access and Bariatric surgery at the Fortis Memorial Research Institute Gurgaon.

I have had the honor of performing live surgeries in almost all Asian countries and the privilege of operating on a host of dignitaries, politicians and religious leaders across religions.

Five years back, when I was in Taiwan when I got a call from Dr Moiz -- who happened to be His Holiness' son-in-law -- seeking my opinion and advice for a medical problem he had. It was 2.30 am then. I stumbled out of bed and called back just to make sure I was not dreaming. He had the means of seeking the best of medical opinions from across the world so I was elated that they sought my opinion.

Dr Moiz is a man of few words, the backbone and shadow of His Holiness for the last 15 years or so. I believe that the Syedna was blessed to have a son-in-law like him. He was a picture of selfless devotion to just one cause -- his father-in-law's health and wellbeing. I gave my advice to the best of my medical ability which differed for some other opinions at that time. Mine turned out correct and that's what got the family to trust my judgment even more.

Managing him was -- I believe -- one of my toughest assignments to date. It was a test of my medical skill and risk-taking abilities. I had to treat him like any other normal 100 year old man still remaining cognizant of the fact as to who he was.

As it would be with any patient but more so a VVIP secrecy was of utmost importance. There were times when my mother had called to say that she had heard that His Holiness was not well did I have any clue. My answer almost always was, “Mom, I have no clue” when at that very moment I could have been standing right in front of him.

I visited him late at nights or early mornings so that nobody saw me as that would have set tongues wagging with all sorts of stories.

When he reached his 100th birthday, I was elated as I felt I had played a small part in getting him there. I particularly, remember this one instance on his birthday when he had stepped out to meet his followers. He was not particularly in the pink of health but had a promise to keep to the millions who were there to catch a glimpse of him.

If you happened to even glance on the newspapers and saw the sea of humanity at his funeral, you would know what I was talking about. I realised then as to how difficult your life can be if you have a God-like status. All credit to the man himself. He was patience personified in the worst of times, always smiling through all the pain. If I inquired on how he was doing he would want to know how was my day and if my father was well. I had the rare opportunity to hold his hand without being pushed around sitting alone by his side. I was indeed privileged and blessed.

In his son Mufaddal Aliqader -- I have seen many a quality his father possessed, poise, grace and kindness. It is my belief that he shall lead this community forward in this era with the same vision his father had done in the past.

My tribute to the late Syedna, which was published in The Speaking Tree.

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DIY

Muesli is my breakfast of choice, and I start my day with a bowl of it, with milk and some fresh fruit. Why muesli? It's healthy, tasty and not fussy. In one bowl, you get a lot of nutrition and the energy you need to get through your day.

European in origin, muesli is a mix of grains and dried fruit. The American version is granola, and in commercial versions, it can be very sweet, which muesli is usually not. The main difference between the two, though, is that granola is baked, and muesli is not. If you can buy some organic, homemade granola, though, it's as good as muesli. 

While you get excellent brands of both in the market, this year, I am very interested in trying to make my own. Here's the simplest recipe I could find for granola/muesli, and I can promise you that the results are excellent. 

You can either eat your bowl with milk and fruit, as I do. Or you can soak it in fresh orange juice for 30 minutes. Or, in the summers, mix it up with cold yoghurt. If you've a sweet tooth, a handful of this homemade version trumps any dessert. It also makes for an excellent snack to carry with you to ward off mid-day munchies and your children can take it to school, too. 

Try it, and I hope you like it as much as I do.

2 cups quick-cooking or rolled oats 1 cup extra-virgin olive oil 1 cup organic honey 2 cups chopped mixed dried fruit - almonds, walnuts, pistachios, raisins, figs Half cup of mixed seeds, such as sunflower, pumpkin and flax 1 teaspoon salt

Toast the oats until fragrant and a light brown in colour. You can either do this on a hot pan, or in an oven, or even in a microwave.

On a large plate, let the oats cool a bit. When they are still warm, mix in the rest of the ingredients and use your hands to combine them all well.

Working in batches, toast the mixture until it is very fragrant but be very careful not to burn it. 

Let it cool on a large surface, until crisp. Store in a well-sealed box.

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This is me at a panel I moderated at the Hindustan Times Leadership Summit in December 2013 in Delhi. My co-panelists were nutritionist Dr Anjali Mukherjee and Dr Arya Sharma, who is a professor at University of Alberta, Canada. It was a wonderfully productive discussion. Our session was called 'Trimming the Nation', and obesity was at the centre of the talk.

I have spoken, several times on this blog, about obesity, its causes, its dangers and why we must caution against it.

At the panel, we took this discussion further. While I emphasised that the number of obesity cases in the country have doubled over the years, we spoke about how difficult it is to understand and prevent this lifestyle disease. While diet, exercise and lifestyle choices play a significant role in battling excess weight, finding a cure for it is still an uphill task. All three of us agreed that sticking to a traditional diet which is rich in nutrition is vital, as is monitoring children's diets from a very young age.

At the session, we also discussed matters such as body image issues, societal and peer pressure to stay a certain size, and the complications of understanding a difficult disease such as obesity.

As always, I emphasise on the basics - a nutrition-rich diet, a regular exercise regimen and cutting down on stress as much as you can. 

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Into the Blue

As it is for a very busy professional, time off from work is a real luxury for me as a surgeon. Doctors in India never have the option of switching their phones off, or asking their offices not to disturb them. I love every aspect of my life as a doctor and surgeon, so I am not complaining, but who does not love having some time away with their family? I am no exception.

Last month, I went away for a quick year-end holiday to Bali with my wife and children. It was fabulous to leave the city and routine behind. I eagerly await and look forward to this annual opportunity , it helps me rejuvenate.

I had promised my 14-year-old daughter, Kiara, that I would learn scuba-diving with her and get a PADI certification. This was one of the most memorable things I did this year.

To give you some background, the most common and respected certification for divers is PADI, which stands for Professional Association of Diving Instructors. For the Open Water Dive, which is the most basic level of certification, which is what Kiara and I can now boast of, you sign up for a four-day course with a minimum of four dives.

Learning diving can be quite a daunting and intimidating task to begin with. You start off by unlearning the most basic thing essential for life from birth - breathing from your nose. Underwater, you have to learn how to breathe from your mouth. The instructor makes you do various exercises underwater in a swimming pool after teaching you the nuances of the hardware required for diving, from the mask and snorkel, to the O2 cylinder and your jacket.

When you have your fins on, it is impossible to move around and you wonder how your instructor is so adept with them when you look so clumsy! It's surprising how no toothpaste company has thought of marketing through the scuba guys as you consume more toothpaste cleaning your masks than you do brushing your teeth. It's true!

Signs and symbols practiced in scuba are very different; for example, a simple wave of your hands to say you are enjoying the dive above water might be interpreted as an SOS by your partner underwater. A thumbs-up means you want to go back up, and not that you are doing well.

When you have completed your written tests and your practice dives in the pool you are ready for the real stuff , that shall make all this worthwhile . The excitement builds up, and so does the fear of the unknown. Soon, I will explain why you must discover the pleasures of life underwater, if you have not done it yet.

Underwater Temple Garden, Pemuteran Bay, Bali

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