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•Nigeria charts new path to metabolic care
By Doris Obinna
For years, obesity and metabolic diseases such as diabetes, hypertension and fatty liver disease were largely overlooked in Nigeria’s healthcare conversations, often dismissed as lifestyle concerns rather than serious medical conditions requiring specialised intervention.
But that narrative is gradually changing.
At the annual conference of the Bariatric and Metabolic Surgery Society of Nigeria (BMSSN), medical experts, nutritionists, surgeons and healthcare professionals gathered to assess the progress made in the country’s bariatric surgery space and map out the future of obesity treatment in Nigeria.
Held under the theme, “Exploring Pathways Towards Growth and Prosperity for Metabolic and Bariatric Surgery in Nigeria,” the two-day conference also marked 15 years since Nigeria recorded its first bariatric surgery procedure.
From a virtually non-existent service in 2010 to an emerging multidisciplinary healthcare field, stakeholders say Nigeria is gradually building a credible framework for obesity and metabolic care despite daunting financial and infrastructural challenges.
President, BMSSN, Dr. Abuchi Okaro, described the journey as one built from “zero to proof of concept.” According to him, the conference theme was deliberately chosen to reflect the need to consolidate gains already made while strategically positioning the sector for future expansion:
“We needed to make sure that we had alignment among key players and show proof that bariatric surgery services can actually work in Nigeria to a very high standard. All our results over the last four years are independently monitored and collected data. They show clearly that the Nigerian bariatric and metabolic healthcare space is active and can stand up to international scrutiny.
“Bariatric care goes beyond surgery and requires a coordinated team approach involving nutritionists, dieticians, cardiologists, physiotherapists, anaesthetists, behavioural therapists and surgeons. This is a fully integrated team approach. We are now seeing more engagement, more research presentations and abstract sessions. That is an evolution for us.”
Reflecting on the early days of bariatric surgery in Nigeria, Okaro, who pioneered the specialty in the country, recounted the difficulties of introducing a completely new field into the healthcare system.
“When I came into the Nigerian system in 2010, there was no bariatric surgery service. Zero,” he said, while adding that in 2011, he performed the first case. “It was a solo expedition. Nobody invited us. There was no red carpet. Starting something like this alone takes courage because you are the one in the firing line if things go wrong.”
He continued: “Fifteen years later, however, the field has evolved into a growing professional network with increasing patient acceptance and multidisciplinary collaboration. What we have now is a transformation from nothing to a functioning service with measurable outcomes.”
Okaro said although patient volumes remain relatively small compared to developed countries, Nigeria’s complication and mortality rates remain within globally acceptable standards.
“Our results align with international benchmarks, and that is a major achievement considering the limited resources we work with,” he said.
Okaro further stressed that the conference represented more than a scientific gathering; it symbolised the steady emergence of a once unfamiliar specialty into mainstream Nigerian healthcare.
Fifteen years after its first bariatric surgery, Nigeria’s obesity and metabolic care landscape may still be evolving, he reiterated that the foundation has finally been laid.
“For patients battling obesity, diabetes and other metabolic disorders, that foundation could represent a new chance at healthier living,” he added.
Nutrition as centre of the success
A major highlight of the conference was the emphasis on nutrition before and after surgery, which experts described as critical to successful outcomes.
Clinical Nutrition Consultant and Bariatric Nutritionist, Sherese Ijewere, explained that patients undergo detailed nutritional assessments before surgery to identify unhealthy eating patterns and tailor suitable meal plans using familiar local foods.
“We look at what the patient is currently eating and what may have contributed to obesity. Then we customise healthy meal plans based on their ethnic background and local food preferences,” she explained.
According to her, patients selected for surgery must undergo a strict two-week pre-operative diet designed to reduce body weight and prepare the liver for surgery.
“The pre-operative diet includes proteins, vegetables, healthy fats and fruits. Patients must lose weight within those two weeks before they can proceed for surgery. That is what makes the procedure safer,” she said.
Ijewere noted that after surgery, patients are placed on a carefully staged liquid diet beginning with water, protein shakes, bone broth and soups before gradually transitioning to thicker liquids and eventually regular foods. “It is a staged process because the body needs time to heal and adjust,” she explained.
She also highlighted the rising concern of childhood obesity, attributing it largely to increasing consumption of processed and fast foods. “We advise parents to return children to home-cooked meals and local foods. We discourage fried and processed foods and create customised programmes that involve both parents and children,” she said.
According to her, many children willingly embrace healthier lifestyles once they begin to see improvements in their weight and self-confidence.
Lifestyle diseases, diabetes prevalence on the rise
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Health experts warned that Nigeria is witnessing increasing cases of lifestyle-related illnesses driven by poor diet, sedentary living and unhealthy habits.
Ijewere stressed that prevention remains the most effective strategy against obesity, diabetes and hypertension. “If you do not want to develop lifestyle ailments like diabetes, arthritis or fatty liver disease, you must become intentional about your daily living.”
“From the moment you wake up to when you sleep, you need to pay attention to what you eat, when you eat and how active you are,” she added.
Medical experts also explained that bariatric surgery offers benefits beyond weight loss, including improvements in diabetes control, blood pressure, arthritis symptoms, fertility issues, sleep disorders and overall quality of life.
Reiterating further, Consultant Endocrinologist, Dr. Nkem Okoli, added that diabetes prevalence continues to rise at an alarming rate worldwide, with obesity remaining a major driver of the disease.
According to her, figures from the International Diabetes Federation (IDF) showed that about 589 million adults were living with diabetes in 2024, a figure projected to increase to 853 million by 2050.
She added that diabetes accounted for nearly $1 trillion in healthcare spending globally, representing about 12 per cent of worldwide health expenditure.
Both expressed hope that increased awareness, stronger collaborations and improved healthcare policies would expand access to obesity treatment services across the country.
Cost still major barrier
Despite the progress recorded over the years, affordability remains one of the biggest obstacles facing bariatric surgery in Nigeria. Okaro lamented that many surgical materials and consumables used in the procedures are imported, making costs highly vulnerable to foreign exchange instability.
“There was a period when the naira devalued significantly. Equipment and consumable we bought for one price suddenly doubled,” he recalled. “When that happens, who absorbs the extra cost? The patient eventually bears it.”
He added that healthcare financing in Nigeria remains largely out-of-pocket, limiting access for many patients who need the procedures.
“The biggest obstacle is affordability. We need stronger government support, insurance involvement and better healthcare financing structures,” he said.
Although discussions with government agencies and healthcare stakeholders are ongoing, he acknowledged that sustained advocacy would be required before bariatric procedures become widely accessible.
“Nigeria’s economic indicators are improving gradually. Stability in foreign exchange and better access to healthcare funding will help this field grow,” Okaro added.
Metabolic surgery important
Okoli explained that many patients with Type 2 diabetes are either overweight or obese, noting that despite advances in drug therapy, several patients still fail to achieve optimal blood sugar control. “We are not hitting the curve in diabetes management, and that is why metabolic surgery has become increasingly important,” she said.
She stressed the need for physicians to view bariatric procedures beyond weight reduction, describing metabolic surgery as an evidence-based treatment for metabolic diseases such as diabetes, obesity, and metabolic syndrome.
According to her, metabolic surgery works by altering gastrointestinal anatomy and gut hormone signalling, thereby improving insulin sensitivity and glucose regulation even before significant weight loss occurs.
She explained that the shift from the term “bariatric surgery” to “metabolic surgery” in 2007 helped gain wider acceptance among physicians because of growing scientific evidence showing its anti-diabetic benefits.
Okoli said international medical bodies formally incorporated metabolic surgery into diabetes treatment guidelines following a 2015 consensus meeting involving over 45 global organisations.
She noted that current guidelines recommend metabolic surgery for patients with severe obesity and poor glycaemic control, while selected patients with lower body mass index (BMI) but uncontrolled diabetes may also benefit.
Highlighting findings from major clinical trials including the Swedish Obesity Study, Okoli said patients who underwent metabolic surgery recorded significant improvements in blood sugar control, weight reduction, and reduced dependence on diabetic medications compared to those on medical therapy alone.
She added that some patients achieved long-term diabetes remission lasting up to five years after surgery.
“Metabolic surgery is no longer just about weight loss. We are now talking about diabetes remission, improved cardiovascular outcomes, and better quality of life,” she stated.
The endocrinologist also identified several factors associated with successful diabetes remission after surgery, including younger age, shorter duration of diabetes, better pancreatic reserve, and good pre-operative glycaemic control.
She however disclosed that the procedures have shown benefits beyond diabetes management, including improvement in hypertension, sleep apnoea, fatty liver disease, mobility, and obesity-related cancers.
Experts during panel discussions noted that misconceptions about obesity and weight loss remain widespread, stressing that obesity should be treated as a disease rather than a lifestyle issue. They identified inadequate training, poor exposure to bariatric procedures and limited multidisciplinary collaboration as major barriers to growth, while also reassuring the public that modern anaesthesia is safe when handled by experienced professionals.
