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The two-surgery strategy works: on an average, his patients in the 200kg-plus category have lost over 100kg in two years.

One of his patients, Sheela Natrajan, who weighed 192 kg in 2010 has lost 114kg since then.

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"It is not technically possible for people with a body mass index of over 60 lose their excess weight easily.

Most need two surgeries, done a few years apart," said bariatric surgeon Dr Muffazal Lakdawala, whose tweet last week ensured that 36-year-old Egyptian woman Eman Ahmed Abd El Aty got a visa to fly to India.

"Our endocrinologists have looked at her present prescription and suggested some new medicines," he said, adding that talks are on with various airlines to arrange a special chair and raise funds for her.

Most morbidly obese patients first undergo a sleeve gastrectomy and then a relatively new procedure called SADI (Single Anastomosis Duodenal-Ileal Bypass) to lose around 80% of their excess weight, said the doctor.

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