Eman being brought to a hospital in Mumbai
Eman Ahmed Abd El Aty was only a little overweight (5 kilos) when she was born and she remained overweight during her childhood despite being a moderate eater. She started developing lymphedema at 11, a medical condition in which a fluid called lymph starts collecting in tissues in both her legs.
Her growing weight reduced her mobility and she stopped going out of her home in Alexandria in Egypt. She has been suffering from various diseases, including type 2 diabetes, hypertension, hypothyroidism, restrictive lung diseases, gout since her childhood. Two years back, she suffered a stroke which further restricted her mobility and affected her speech.
Now 36, Eman, who weighs 500 kilograms, has been brought to India for a weight loss surgery. After stroke, her younger sister Shaimaa started a social media campaign to get her medical help. This caught attention of Mumbai-based bariatric surgeon Muffazal Lakdawala who initiated a fund raising campaign to arrange money to fly Eman to India.
Eman is currently at Saifee hospital in Mumbai, where a team of doctors led by Dr Lakdawala is helping her lose excessive weight.
She is undergoing extensive evaluation for determining the cause of obesity. There are many syndromes such as Prader Willi Syndrome, Bardet Beidle Syndrome, MoMo syndrome etc that can lead to severe obesity. Besides, the doctors will also evaluate her for monogenic causes of obesity such as congenital leptin deficiency.
Eman with her younger sister Shaimaa
She is also undergoing genetic testing. There are 91 different types of genes responsible for obesity-related syndromes. The test could help doctors identify the exact gene, if any, responsible for her obesity.
“Research shows that genes can control appetite, body temperature and insulin. The advancement in molecular genetic testing can diagnose rare genetic variations that can lead to obesity. Doctors can use the findings to customize therapy for obese patients,” says Zoya Brar, Founder, CORE Diagnostics, Gurgaon, where Eman's blood samples are being tested.
Eman, reportedly the heaviest woman in the world, has been put on a special high protein ketogenic diet. "We have kept her on a 1200 K Cal liquid diet as of now. We will be adjusting the diet on a regular basis depending on her clinical condition as the days progress, says Dr Aparna Govil Bhaskar, a senior surgeon in the team.
Doctors say that it is going to be one of the most challenging surgeries they have ever performed. The challenge starts right from arranging an appropriate operation table that could bear her weight. "We have tables that can take upto 450 kg. Hence it is important that she loses at least 60 to 70 kg during the pre-operative liquid diet phase," says a doctor.
Senior nephrologist Dr Hemal Shah and endocrinologist Dr. Shehla Shaikh are trying to reduce water retention in her body--which constitutes 60-70 kilos of her weight.
Another major challenge doctors may face during the surgery could be to reach her abdomen. She might have a large liver and high degree amount of intra abdominal fat, which may make the surgery very difficult.
Administering and maintaining the right dose of anaesthesia will be another major challenge and a dedicated team of anaesthetists-- Dr. Sonal Shah, Dr. Sharmila Nair and Dr. Swati Kudalkar-- is preparing for it.
"Unfortunately there are no precedents or manuals that we can refer to in her case as this has never been done before. We have to create our own line of thinking about her treatment," says Dr Aparna.
But Eman's positivity and grit to get back to health is keeping everyone's spirit up. She has already made friends with all nurses around her. She sticks to each and every prescription given to her and makes sure that she doesn't give in to the temptation to taste her favourite Arabic food.
"She inspires a lot of confidence in doctors because we can only do that much but positivity in a patient makes so much difference," she says.