Feature

An Obese Market

The obesity surgery market in India is booming, thanks to 8 per cent population being obese and a surge of foreign patients. That it's a low investment business model has also sparked interest of many corporates, says Sonal Vij

As India carves its development story, the repercussions of development are penetrating in India as well. Healthcare wise, it is obesity. It is increasingly posing itself as a grave problem in India, just as in many developed countries such as the US and the UK. Though India's obesity level is approximately at 8 per cent as against over 25 per cent in the US and 15 per cent in Europe, the market is still not fully tapped.

According to experts, obesity is more of an urban phenomenon with a prevalence of at least 30-50 per cent general obesity levels and 40-70 per cent abdominal obesity. Indian women are more prone to abdominal obesity as opposed to men. The obesity levels are half or even lesser than these in rural areas.

The Market and its Drivers

"The present size for the anti-obesity market in the country is estimated to be over Rs 2,000 crore which encompasses surgical correction of obesity, fitness centres, low-calorie food supplements and anti-obesity ayurvedic treatments," shares Pradip Kanakia —National Head of Markets and Member of the KPMG India Leadership Team, KPMG

The driving force for the growing anti-obesity market in India is the dramatic increase in the obese population and increasing desire of the young and rich population to 'look good' from an acceptable norm of the society. Sedentary but fast paced lifestyle and consumption of high calorie and under-nutritious food coupled with lack of exercises have contributed to the rising number of obese and overweight people in India.

According to experts, the favourable demand-and-supply growth dynamics are expected to create a strong business proposition for providers in the anti-obesity market in India. The segment offers a great value proposition in selected pockets of the country—in larger metros and with people who are willing to spend to look 'trim and fit'. According to a National Family Health Survey-3(NFHS) conducted in 2005-06, obesity is particularly prevalent in Delhi, Kerala, and Punjab, due possibly to richness of food content and income levels. Thus there is a huge market waiting to be tapped in these states.

India is already witnessing an increasing number of patients coming from the US and Middle-East who come to undergo surgical procedures for morbid obesity. Experts believe that around 700-800 patients from abroad undergo the procedures in India to control obesity. Explains Pradip Thukral, Executive Director, Indian Medical Travel Association, "These procedures cost anywhere between $ 40,000 to $ 75,000 in the US. However, in India it costs less than $ 10,000." Also, for hospitals, investing in obesity surgeries and procedures is a profitable deal. The investment is about Rs 25 lakh (mainly on the bed and laparoscopic instruments) and one can expect the return of 25 per cent annually.

The Growth

"This niche segment is projected to grow at a rate of 13 per cent CAGR through 2010," shares Kanakia. Previously, patients went only to clinical dieticians to ensure weight management, but today a large number of patients opt for surgical procedures to reduce weight quickly. Previously, the market comprised only foreigners. "Till two to three years ago, the numbers of Indians undergoing these surgeries were quite less. At present, nearly 50-60 per cent of the total obesity surgeries are undertaken by Indians," shares Dr Ajay Kumar Kriplani, Chief, Weight Loss and Laparoscopic Surgery Centre, Indrapastha Apollo Hospital, New Delhi.

The number of patients walking into the hospital to treat obesity surgically has increased to five times in the past five years. Reveals Dr PK Chowbey, Senior Consultant Department of Minimal Access and Bariatric Surgery Centre, Sir Ganga Ram Hospital, New Delhi, "The growth has been dramatic. Till two years ago, we used to get only four to five patients a month. Now, we get 35-40 patients per month." Seconds Dr Ramen Goel, Bariatric and Metabolic Surgeon who operates at Wockhardt Hospital (Mumbai) and Bombay Hospital, "When we started in the year 2000, we used to get one case in six months, but today we treat 15-20 patients a month."

The Players

"Till two years ago, we used to get only four to five patients a month. Now, we get 35-40 patients per month" - Dr PK Chowbey Senior Consultant Minimal Access & Bariatric Surgery Centre SGRH, New Delhi

"We have a separate department with endocrinologists, dieticians & surgeons for weight management" - Dr Ashish Vashishtha Consultant Bariatric Surgery Services Department Max Healthcare New Delhi

Healthcare providers have recognised the importance of targeting obesity as a separate segment. Thus, there are nearly 15 obesity centres pan India. Therefore, major hospitals today have a separate department for obesity and weight management.

In mid this year, Max Healthcare formed a separate department. At present, around five surgeries are being conducted per month. "We have a separate department comprising endocrinologists, dieticians and surgeons to look into the weight management," says Dr Ashish Vashishtha, Consultant, Bariatric Surgery Services, Department of Endocrinology, Diabetes and Obesity, Max Healthcare.

Safe weight loss through surgery requires a strong commitment from the patient and the team of medical experts providing care. Max Healthcare provides education, one-on-one counselling, complete medical exams and testing, and continued support to the patients to understand the requirements, responsibilities and benefits of undergoing bariatric surgery. The care begins months before surgery, which is scheduled to prepare patients and guide them through dramatic changes in their overall health. This care continues through the months and years following surgery to keep patients on course. Sir Ganga Ram Hospital too has a department dedicated to laparoscopy and bariatric surgery. The department is one of the leading bariatric centres in India, with serious focus on managing morbid obesity. These surgeries are also conducted at Mumbai-based Lilavati Hospital and Saifee Hospital.

Apollo Hospitals conducted 1200-1300 surgeries for obesity in 2008. Other than providing surgical procedures, the healthcare provider also runs a wellness centre. For instance, Apollo Hospitals helps patients maintain physical, mental and emotional wellbeing by launching the first Wellness Centre at the Apollo Hospitals, Chennai in February 2005. It is a perfect blend of modern and complementary medicine—the latest medical techniques combined with ancient healing methods like aromatherapy, pranic healing, yoga, and meditation. It also offers complete solutions for lifestyle modification ranging from prevention of disease, control of disease symptoms and anti-ageing solutions.

Fortis Hospitals too is a runner to capture this market. In Delhi, Fortis Hospital conducts bariatric surgeries in Noida and Faridabad facilities. "We get about 7-10 new patients every week for weight management or obesity. Out of this, nearly 20-30 per cent are morbidly obese and nearly 7-10 per cent patients are recommended for surgeries. However, only four to five per cent undergo these surgeries," says Dr Prabal Roy, HOD Surgery, Fortis Hospital, Faridabad. The upcoming hospital in Shalimar Bagh too will have the facility for bariatric surgery.

Wockhardt Hospitals too is expanding the bariatric surgery department. "Bangaluru and Hyderabad facilities have already started this surgery and are doing it independently now since one year," shares Dr Goel. The non-surgical obesity market is also occupied by the wellness centres like VLCC, Fitness First, Personal Point and so on. Though most of the larger hospitals do run a wellness programme, the market share is nearly negligible and not very profitable.

The Roadblocks

A large market share continues to be occupied by foreign patients. "The biggest challenge faced by anti-obesity market in India is the lack of awareness of larger masses wherein a selective part of the affected population would go for any form of corrective treatment in an institutional set up. The rest of the population would wait for related health disorders accruing from obesity to surface before taking medical help," shares Kanakia. This makes the target population as a narrow niche segment, although the affected population base in India is relatively very high.

Right now, obesity is not considered as a disease by the Government of India. For morbid obese people, this is a life saving surgery. Right now, the expenditure for these surgeries is out of the pocket. The insurance companies pay only in rare cases. If the insurance companies start reimbursing for the obesity surgeries too, this market will grow at a much faster pace. An expert opines, "Ultimately, it is the insurance company who will pay for the treatment, so it is going to be ultimately beneficial for them as obesity leads to a lot of health problems like hypertension, type II diabetes, coronary artery disease and so on which will lead to an expenditure for the insurance provider."

The Road Ahead

Though this market will continue to grow in the future, domestically as well as internationally, the players will have to invest in a good business model. As the awareness levels increase and per capita income in the metropolitans increase, this market too shall grow. "Comprehensiveness in the service offerings and a clear customer segmentation need to be the main business priorities for healthcare providers to fully tap the anti-obesity market in India," shares Kanakia.

A strong awareness would also play a vital role in tapping the anti-obesity market in India. "Marginal weight loss can be attained through personal efforts, however, overweight and obesity are increasingly becoming a concern that requires the intervention of professionals and other service providers. Several healthcare providers take customer feedback of their experiences and satisfaction and paste the testimonials at their work place and in various mediums of advertising," concludes Kanakia.

Though the potential is huge, awareness is the need of the hour!

sonal.vij@expressindia.com