Second youngest child in India undergoes bariatric surgery due to rare disorder

The boy, born to Govandi couple Yusuf (36) and Taaj (34), was diagnosed with Leptin receptor (LepR) deficiency, an autosomal-recessive endocrine disorder that causes early-onset severe obesity.

Mumbai: At 20-month-old, Ibrahim Khan on July 18 became the second youngest child in India to undergo bariatric surgery and is presently recuperating at NH SRCC Children’s Hospital, Haji Ali. Interestingly, his elder sister Zoya, who is now 12 years old, also has the same genetic disorder and was the youngest in the country to undergo bariatric surgery at the age of 10 months.

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The boy, born to Govandi couple Yusuf (36) and Taaj (34), was diagnosed with Leptin receptor (LepR) deficiency, an autosomal-recessive endocrine disorder that causes early-onset severe obesity.

The couple lost their firstborn to the disorder when he was 18 months and weighed 22 kilos and their third child is also found to be the carrier of LepR but did not have severe obesity.

“Ibrahim was brought to Brihanmumbai Municipal Corporation-run Rajawadi Hospital, Ghatkopar in May last year with a respiratory infection, a common complication because of excessive weight. He was six months old then and weighed 17-18 kilos. While we treated him for the infection, we found out about his elder sister Zoya and the unique genetic disorder because of which he gained the weight,” said Dr Prashant Patil, a paediatric endocrinologist at NH SRCC Hospital who first treated Khan at Rajawadi Hospital.

Doctors said that on average, his daily calorie intake was 2,500-2,800 instead of the 1,200-1,400 a child of his age should have.

“Because of the disorder, he has an uncontrolled hunger and is in a non-satiated state. He does not understand how much he has to eat and the food he is eating is not getting converted into energy and accumulating as fat, also known as hypothalamic obesity,” explained Dr Patil.

He added that since Dr Sanjay Borude, a bariatric surgeon, who had operated on Zoya, was contacted and Khan was put on a weight management plan.

“The Covid-19 pandemic was on. We first decided to put him on a weight management diet by counselling the parents and giving him some exercise. However, with no control over weight gain, we decided to go for the surgery as the frequency of hospitalisations went up. He was not able to sit too,” explained Dr Patil.

He said as per the medical literature, worldwide, there are 90 reported cases like Khan.

In India, there are three cases, including Khan and his sister. Khan was taken up for sleeve gastrectomy surgery- a kind of bariatric surgery where a part of the stomach is separated and removed from the body.

“The surgery is to delay the progression of excessive weight gain and complications. It will arrest the weight. During the surgery, we removed the upper part of the stomach called fundus where ghrelin (hunger hormone) is secreted,” said Dr Borude.

Doctors said post-surgery, he is on 30 ml fluid every 30 minutes and will continue to be on a liquid diet for the next few months.

“He will not be eating solid food for a long time, maybe six to eight months, depending on his progress. He will also require extensive physiotherapy. He has not learned to walk because of his weight,” said Dr Rahul Borude, who is taking care of Khan along with Dr Patil.

Doctors said Khan will be discharged on July 23. However, doctors are still worried about his sister who needs an injection daily which costs ₹1-1.5 lakh.

“In November 2020, US FDA-approved setmelanotide injection which can help patients like Zoya and Khan. It is available only in the US market and is costly. We are trying ways to help Zoya so that she does not end up gaining excess weight again. Ibrahim will need it once he is six years old,” said Dr Patil.

The doctors have counselled the parents not to have any more children as the future offspring can also have the genetic disorder. “It is a unique family with three cases of LEPR. We are presenting it in a medical journal too,” said Dr Patil.

His father, Yusuf, who does odd jobs for a living, said he never thought Khan too will have a genetic defect like Zoya. “My two daughters weigh normal. After his birth, he was fine. It was from the third month that he started gaining excessive weight. Zoya underwent surgery twice. I wish none of the two has to undergo the surgery again,” he said.

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Zoya first underwent bariatric surgery in November 2011 at the age of 10 months. She then weighed 19 kilos.

Zoya developed sleep apnea and respiratory infections later as she gained weight again. She underwent a revision bariatric surgery in December 2018

Hollywood’s popular weight loss surgeon Dr Mathias Fobi was part of the revision bariatric surgery which was done at MPCT Hospital-Navi Mumbai. She weighed 39.6 kilos then.

Since then, she is maintaining a Body Mass Index (BMI) of 22. She presently weighs 43 kilos. According to her doctors, at her age a BMI above 21 is obese. She has comorbidities like growth hormone deficiency and type 2 diabetes.