Doctors at the All India Institute of Medical Sciences (AIIMS), New Delhi, have successfully treated a 32-year-old man weighing 209 kg after carrying out a carefully planned bariatric surgery following 32 days of intensive medical preparation. The case highlights how a coordinated, multidisciplinary approach can make complex weight-loss surgery possible even in patients with life-threatening obesity-related complications.
The patient, Vivek, had super-super obesity, with a Body Mass Index (BMI) of 74 kg/m². Along with excessive weight, he was living with multiple health conditions, including high blood pressure, prediabetes, abnormal cholesterol levels, acid reflux, depression, knee pain and severe Obstructive Sleep Apnoea (OSA). Because of OSA, his breathing repeatedly stopped during sleep, causing dangerous drops in oxygen levels.
According to the treating team led by Dr Manjunath Maruti, Additional Professor, Department of Surgery at AIIMS, the patient's condition had deteriorated to the point where Continuous Positive Airway Pressure (CPAP) support was no longer enough to maintain adequate oxygen levels. Doctors first had to perform an emergency tracheostomy, a procedure in which an opening is created in the neck to help the patient breathe.
His condition presented another major challenge. His abdominal size was so large that he could not be positioned safely on a conventional operating table. As a result, the tracheostomy had to be performed on his hospital bed.
Rather than rushing into surgery, AIIMS assembled a multidisciplinary team that included bariatric surgeons, anaesthesiologists, physicians, pulmonologists, dietitians, physiotherapists and other specialists. For the next 32 days, the focus remained on improving his overall health before surgery.
During this period, doctors treated recurrent infections, closely monitored his breathing, managed his blood pressure and placed him on a Very Low-Calorie Diet (VLCD). He also underwent breathing exercises and continuous medical monitoring. This intensive preparation resulted in a significant reduction in his weight—from 209 kg to 172 kg—while his abdominal circumference reduced enough to make surgery technically feasible.
Doctors then performed a One Anastomosis Gastric Bypass (OAGB), a bariatric procedure that reduces the size of the stomach and changes the digestive pathway to support long-term weight loss. The surgery was completed successfully without major complications.
The patient's recovery was encouraging. Within 13 days of surgery, he no longer required CPAP support, was breathing independently, walking without assistance and was able to resume basic self-care. By the time he was discharged, his weight had fallen further to 160 kg, representing an overall loss of 49 kg from the time of admission.
Associate Professor, Anaesthesiology, Pain Medicine & Critical Care, AIIMS, Dr Sulagna Bhattacharjee says, "This patient came with very severe respiratory failure. Because of his weight, he had obstructive sleep apnea and hypoventilation. We had to secure his airway and intubate him. We had to perform a tracheostomy, a procedure to insert a tube into the trachea. Initially, we faced the challenge of putting him on mechanical ventilation. He also developed pneumonia, for which he required ICU care. We later shifted him from the ICU to a high-dependency unit, where he stayed for 32 days..."
Speaking about the case, Dr Manjunath Maruti says, "Super-super obesity is defined as having a BMI of over 60, and this patient's BMI was 74. Over the past year, we have performed surgeries on 18 such super-super obese patients. The team at AIIMS is very robust and highly experienced, having conducted these surgeries for 10–15 years. This particular case seemed especially complex because the patient was unable to breathe properly. We had to administer high-pressure ventilation; standard methods weren't working, so we performed a tracheostomy. There was also an issue with the abdominal size- the patient's girth was 198 cm. Operating tables of that size are not currently available in India or anywhere else in the world. Our dietitians administered a Very Low-Calorie Diet (VLCD), which reduced the abdominal girth from 198 cm to 178 cm. This significant reduction allowed the patient to fit onto the operating table..."
Dr Manjunath said patients with a BMI above 70 kg/m² who require prolonged respiratory support are among the most challenging candidates for bariatric surgery.However, he emphasised that severe obesity, the need for prolonged CPAP support or even a tracheostomy should not automatically rule out weight-loss surgery. With careful planning, proper optimisation and a multidisciplinary approach, such patients can still undergo successful treatment.
Doctors also pointed out that severe obesity affects nearly every organ system. Excess weight increases pressure on the heart, lungs, joints and bones, making breathing, mobility and day-to-day activities increasingly difficult. Conditions such as obstructive sleep apnoea can further increase the risk of serious complications if left untreated.
The AIIMS team believes the case demonstrates the importance of early medical intervention and coordinated care for people living with severe obesity. They hope it encourages patients with advanced obesity to seek timely evaluation instead of delaying treatment until complications become life-threatening.
