New Delhi, Dec. 16: Should diet and exercise fail to control his obesity, Pappu Yadav has the option of allowing a surgeon to staple his stomach and prevent him from consuming more than a cupful of food at a meal, obesity specialists have said.

The Supreme Court today asked the director of the All India Institute of Medical Sciences (AIIMS) here to consider whether the Rashtriya Janata Dal MP could be provided treatment to tackle his obesity. Yadav had sought permission from the court to get himself treated for morbid obesity in a private hospital in Delhi.

Doctors believe surgery is the most effective treatment for morbid obesity, a condition in which a person is about 45 kg heavier than the ideal weight.

“It does not respond to diet and exercise,” said Pradeep Chowbey, a surgeon at the Sir Ganga Ram Hospital here and president of the Indian Obesity Surgery Society.

Doctors who have evaluated Yadav declined to speak on his specific condition but said that while morbid obesity is believed to emerge from a combination of gluttony and sedentary lifestyle, a genetic component is also plausible.

“People with morbid obesity have an addiction to food and find it difficult to control it,” said a senior obesity specialist. “Although a low-calorie diet and rigorous exercise may be tried on such patients, this strategy usually does not work.”

In the stomach stapling surgery, doctors staple the wall of the stomach or use a silicon band to create a small pouch that significantly reduces the volume of the stomach. “After the surgery, even small amounts of food entering this pouch make the person feel absolutely full,” said Chowbey.

The surgery allows patients to reduce their intake of food without having to suppress excruciating urges to eat. The food takes about six to eight hours to pass through the pouch and patients don’t feel like eating during this period. Their bodies draw energy from stored fat and they begin to lose weight ? up to 2 kg a week.

But surgical success will depend on whether patients stick to a prescribed diet. While the pouch can hold only a small volume of food, some foods are loaded with calories. “The small pouch can accommodate a 30-calorie chapati or a chocolate with hundreds of calories,” said Chowbey. “Patients have to choose the right food.”

Doctors recalled cases where lack of compliance to diet has prevented patients from losing weight after surgery. A 21-year-old girl was so addicted to chocolates that she lost only half the targeted weight loss. A 44-year-old man consumed liquor each day, adding calories that counteracted the effect of the surgery.