Why we begged doctors to give our four-year-old son had weight-loss surgery

Why we begged doctors to give our four-year-old son weight-loss surgery Rishi Khatau was constantly hungry and at 44.5kg too obese to walk even a few steps. The only option was to undergo stomach reduction surgery, says his father Dipen Khatau AS TOLD TO HELEN ROBERTS. ADDITIONAL REPORTING BY ANAND RAJ OK.

Seeing my five-year-old son Rishi wobbling on his bicycle, I rushed towards him. I wasn't scared he would fall off and hurt himself, but I wanted to hug him before I started crying. To most parents, seeing their child learn to ride a bike is a milestone to cross off the list, but it was something my wife Henna and I had been dreaming of for around four years - ever since Rishi took his first steps. We never thought it would be possible because until recently he had been so overweight he could only walk a few steps before panting so much he could hardly breathe. Rishi has a condition called Prader-Willi syndrome (PWS), which causes insatiable appetite and leads to chronic overeating and obesity. It meant that he had ballooned to 44.5kg by the age of four and was wearing adult shorts with a size 36 waist - bigger than the average man's. Now, watching my son on his bike, I was enjoying time away from my textile trading business in Kolkata in West Bengal, India, grateful that we'd decided to give him surgery to reduce his stomach by 75 per cent. It sounds drastic, but we'd realised that a gastrectomy was the only way to stop him gorging on or pleading for food. We didn't know how to stop him getting bigger, and couldn't risk losing him from obesity-related problems. Less than a year later, he has shrunk from 44.5kg to 28kg, and does everything normal kids do - run, play, ride his bike - things he had been too fat to do before. We decided to go ahead with surgery, even though it was extreme, to save Rishi. Doctors warned us his life was at risk due to obesity. He had sleep apnoea - where he repeatedly stopped breathing for moments in his sleep - and we feared he wouldn't live to see his next birthday. We knew without the operation he wouldn't be able to control his appetite or be a normal size like our nine-year-old daughter Jhanvi, who doesn't have the condition. This time last year, Rishi would break into a sweat just trying to walk. Simply squeezing into his adult-size clothes would make him out of breath and hungry. "I want a packet of jalebis [pretzel-shaped deep-fried dough dunked in sugar syrup]," he'd cry, and if we said 'no', he'd throw a tantrum until we gave in. "I cannot understand how a child can be so hungry just after a large meal," Henna, 34, used to tell me. She'd feed him large meals of lentils and rice several times a day, but Rishi had a sweet tooth and could polish off a 200g packet of jalebis in one sitting, then ask for more.It was our fault - we always gave in. How could we not? He was a chubby, funny little boy who was always smiling - except when we refused him his sweets. Food was the one thing that made him happy, so we gave him all that he asked. It was our love for him, but we didn't realise until it was too late how much weight he was putting on. Ironically, Rishi was born underweight at 1.7kg and Henna, a housewife, spent the next 12 months making sure that he drank and ate enough to put on weight. "He is a tiny baby so we have to feed him extra to compensate,'' she'd say. Sometimes, she would give him twice, even three times, the regular number of feeds of breast milk and, when he was a bit older, formula feeds - and Rishi would happily finish it all. By his first birthday he was the prescribed healthy weight and we were thankful.But six months later we found that he was putting on weight drastically. At his second birthday, Rishi weighed 19kg - close to the average weight of a four-year-old. "It doesn't matter how much I feed him, he's never satisfied," Henna would say. "He always wants more." At two years old, his usual meals would include four to six idlis (steamed rice cakes) for breakfast and a large glass of milk; a snack of four jalebis and several packets of biscuits; a large serving of rice and creamy lentils for lunch, followed by four jalebis; a snack of a few packets of biscuits, a large glass of milk and more jalebis at around 3pm. Supper was a huge serving of rice and lentils followed by a glass of milk at bedtime. And almost every day, as soon as his plate was empty, Rishi would start crying, insisting that he wanted more. While initially we were happy he was eating, when we realised he was getting bigger we began to reduce his portion sizes. But his plaintive cries and tantrums would move us so much that we would soon give him another bag of sweets or another full meal. "If I deny him sweets like jalebis or smaller meals he just sits in a corner and cries uncontrollably," Henna told me, her voice cracking. But all the food was beginning to take a toll on our little boy, as he was putting on more and more weight. He was finding it difficult to walk or play games. A few friends suggested we put him on a diet, and we did try, but seeing him cry for food would melt our hearts and we'd succumb. We had never seen a child cry for food so much and didn't know how to handle it. After all, in our culture, we are not supposed to deny food to children. But early last year, when Rishi began to tip the scales at 40kg, and the needle kept moving forward, Henna and I realised we needed to seek medical help. "As a mother I loved carrying him around, but he was just so heavy," Henna says. "He'd struggle to walk to the bus stop to catch the playschool bus. He wasn't able to move fast, so I'd carry him. But I used to get tired. Whenever we took him for his regular check-ups and mentioned his appetite to doctors, they would suggest that we feed him less and encourage him to play outside more." Over the next few months, Rishi began to put on so much weight that it began to take a serious toll on him. He could only sleep for 10 minutes before he'd wake up complaining of breathlessness. He would be gasping for breath if he did minor chores such as putting away his toys or running after a ball. Seeing him struggle, even unable to have a good night's sleep, left us in fear for his life. Worried, we took Rishi to a doctor, who told us to put him on a strict diet to help his sleep apnoea as losing a few kilos would help him move around better and improve his life. None of this worked, and it baffled us why he never felt satisfied with the food we gave him. So when he turned four, we decided to seek an expert's opinion. What he told us left us shocked: After conducting several tests, he said Rishi has PWS, a condition where the part of the brain that controls feelings of fullness or hunger does not work properly, meaning sufferers overeat and put on weight. The symptoms include poor muscle tone, lack of height, cognitive disabilities, behavioural problems and a chronic feeling of hunger that can lead to excessive eating and life-threatening obesity. We knew that children who are obese may also suffer from sleep apnoea and could develop diabetes, heart conditions and hypertension.Hearing the diagnosis, Henna broke down in tears. "We must help him," she said. We were told that if his condition was left unchecked, Rishi would continue to balloon and it would only be a matter of time before he developed obesity-related health problems. "I'm scared that Rishi might not even see his next birthday," Henna said. It was at this time that we met a relative at a family function, who told us about bariatric surgery. We had not heard of any child who had undergone this surgery, but we were desperate to save our son's life and were willing to consider any option. We also realised that we had no other way of saving Rishi. He was slowly dying and we had tried diets and failed. In July last year we made an appointment at the Asian Bariatrics hospital in Ahmedabad, western India, where doctors conducted a detailed check-up and concluded that Rishi's condition was serious and required surgery. I had to dip into my savings to pay for the surgery, which cost Rs300,000 (about Dh18,220)."I do not suggest putting Rishi on a diet because you have already tried it, and it has not worked," Dr Mahendra Narwaria, the surgeon, told us. "Rishi is dying because he is putting on weight so drastically. He is suffering from sleep apnoea and also experiencing severe problems related to breathing because of his weight. There are risks involved when going ahead with surgery, but he is in a serious condition, so we have to take this extreme measure."We were in a dilemma after we heard the doctor's prognosis. We were terrified that we would make a wrong decision. At the back of my mind we were scared that the surgery might go wrong. We discussed it with our friends and family, who were very supportive. They knew how much we'd tried to control his eating and to help him lose weight and that we had failed. They too agreed that we should go ahead with it.Finally, in August last year, we agreed to the surgery. Rishi had no idea what was going on. "Doctors are going to drill two holes in your stomach and check where you are hiding all the jalebis,'' we told him, so that he wouldn't be worried. But we were really scared. We had to force ourselves to smile as Rishi was wheeled into the theatre for surgery at the Asian Bariatrics hospital last September. Dr Mahendra performed a two-hour operation, where he removed 70 per cent of Rishi's stomach. Those two hours dragged on. We tried to be strong and prayed that our little boy would survive. "We're doing the right thing," I told Henna, who was in bits. While the gastrectomy would not cure his condition, it would help control it to a certain extent, because he would eat less and thereby lose weight. This would improve his life because he would be able to exercise, play games and do all the things children his age do. Finally the operation ended. "He's in recovery," the surgeon told us. "You can see him soon because the operation went well." Rishi was in intensive care for three days. He was fine but sedated. On the fourth day, he was put on a liquid diet of fruit juices and nutritious smoothies. A week later he was back home and within the first month he lost 3kg. Importantly, he did not complain of hunger and did not seem to be missing his regular large meals. There were more visible changes. Rishi's sleep pattern improved tremendously. He could finally experience a peaceful night's sleep without waking every few minutes because of the sleep apnoea. We were overjoyed to see the changes in his condition.For the next four months Rishi was advised to stick to a semi-solid diet including lentil soup and juices. And he was fine with that. Although there were days when he would crave his favourite sweets, he did not throw tantrums and would be satisfied with just a small portion. Now, a year later and aged five, Rishi weighs 28kg, sleeps through the night, and enjoys playing with his friends. Two of his favourite sports are cricket and cycling. Seeing him run after the cricket ball and swing a bat makes us so happy. As soon as he's back from school, he is off on his bike with friends. Initially we were terrified that we'd made the wrong decision by going ahead with the surgery, but now we know it was the right choice. I see my son swimming, cycling and running and enjoying life again. That is a wonderful feeling.Rishi no longer tires easily. However, there are days when his craving for his favourite jalebis kicks in. Whenever he sees other children eating, he wants the same. We indulge him, but with very small portions. Rishi has to lose at least 6kg before he's classed a normal weight for a child his age.Dr Mahendra admits he believes gastrectomy is not always the right option for children so young, even though he encouraged us to go ahead with the surgery. "Rishi suffered severe difficulty in breathing while sleeping where his oxygen saturation levels dropped below 60 per cent leaving him gasping for breath. Generally, we would avoid bariatric surgery in such a young child, but his problem could have been fatal," he told us."I would say it's better for such young children to be put on a strict diet and learn a healthy lifestyle. But in the case of Rishi, surgery was the only option left."Doctors are also monitoring Rishi's PWS and have told us that it is under control.We are so glad that everything has turned out well. We just hope that Rishi's appetite doesn't grow again as he grows older. We hope he won't have to have any more surgery. Prader-Willi syndrome (PWS) is a genetic disorder that can result in a number of physical and behavioural problems. A key feature of the condition is a constant sense of hunger that the patient feels.A gastrectomy is done under general anesthesia. A cut is made in the abdomen and part of the intestine removed. By making the stomach smaller, it fills more quickly. This may help the patient eat less. However, gastrectomy is only an appropriate obesity treatment when other options have failed, say experts.Sources: www.mayoclinic.org, www.healthline.comreal life'We had not heard of any child who had undergone bariatric surgery, but we were desperate' real life'We just couldn't stop him getting bigger, and feared he wouldn't live to see his next birthday'Pws and gastrectomy explainedBefore44.5kgAfter28kg