0:00 Even among people who don't drink alcohol, 40% are showing fatty liver. That's very alarming, sir. Why is this happening? If I tell you this figure, you'll be surprised: 50 crore Indians have fatty liver. Fifty crores. Fifty crores. Fatty liver can lead to heart attacks and death. You can get strokes, it can lead to cancers— so many issues. Now what is causing it? Seriously? Absolutely. Let's first talk a little about the value of items in our kitchen. First, cinnamon. It can help lower cholesterol and improve digestion. Then ginger, [Music] garlic, turmeric. This can reduce mortality by 17 to 20%. Wow. Coming to fast-food culture—pizza, burgers, all the “junk” we eat outside. Like you said biryani can be okay, will you say these are okay too? That's one doubt I have. You mean eating grass is good? [Laughs] People think fast food automatically means junk food.
0:48 Wrong. Completely wrong. Why can't it be a full meal? In fact, some of the more dangerous fast food is in India. Okay? Pakoras fried in lots of oil, huge samosas, mirchi bajji—that's fast food. Our fast— food can be much worse. For women it's about 25 grams; for men, 36 grams. In one can of— cola, around 350 ml, how much sugar is there? It can be around 35 grams. All this sugar came just from a soft drink. Absolutely. That's what it is. Another item, sir—if I ask for it, will you scold me? [Laughs] No. What, Vamshi? What are you asking me? Okay. [Laughs] I didn't know the coaching went to this level. Generally, in this— coaching, what do you offer, sir? [Laughs] People with depression can actually have more appetite. Okay? Because, you know... [Music] Is rasam good or not? Does it directly help digestion?
1:36 We end the meal with rasam and curd. What's the meaning behind that? Now science talks about quantum physics, quantum mechanics, quantum— this and quantum that. [Music] A lot of these values and ideas existed in our country long ago. Really, Vamshi, what is this— question? Wonderful question. [Music] Now you've learned everything. I'll— send some of my patients to you. Will you see them once a week? [Laughs] The guest in this podcast said something simple: if you eat biryani ten times a year, that itself can cost around ten thousand rupees. We have car insurance, right? If you drive without insurance, you're penalized. I tell everyone: insurance is— extremely important. It's simple and logical. We don't need a new reminder that health is the real wealth. Today we may feel perfectly fine. The next— day we may suddenly feel uneasy. Only after a check-up do we realize how serious the problem is. Even among people we know, we keep hearing of—
2:25 kidney issues, heart problems, diabetes or some other major illness. Do you know what the real stress is in such situations? It's when the doctor says, “This treatment will be very long and very expensive.” For middle-class families like ours— the stress of arranging money can become bigger than the stress about the illness itself. Even a simple hospital visit is expensive these days. If a serious illness comes, years of savings can get wiped out. Looking at all this, especially the importance of health insurance— doesn't really need to be explained. If you choose a proper plan, even when emergency hospital bills are huge, your savings— don't get wiped out. Along with health insurance, term insurance is also very important. In many families, there is only one main breadwinner. If something happens to that person, we can't even imagine how emotionally and financially vulnerable the family can become. Term insurance keeps your family— financially secure even in your absence. The good part is that these two types of insurance aren't necessarily very expensive. Monthly premiums can—
3:12 start around ₹400–₹500, and families can get coverage from lakhs to crores. This small monthly amount can protect your family from major financial— shocks in the future. There's a link in the description where you can compare trusted plans online and choose what feels best for you. It's very easy. You can also get around 15–25% off. With health insurance, you may also get a health manager who can help you— choose a suitable policy and make the claim process smoother. Take action for your family today and secure their tomorrow. [Music] The link is— in the description. Go check it out. This topic may upset some people: fast-food culture—pizza, burgers— all the “junk” we eat outside. I'm sorry, I'm using that word casually in a friendly conversation. Please don't take it the wrong way. So for people who eat this kind of food regularly and are used to it—
3:58 what's your take? Like last time, are you going to shock us again? Just like you said biryani can be okay, will you say this can be okay too? That's my doubt. You mean eating grass is good? Grass? [Laughs] I'm talking about fast food! What, Vamshi? [Laughs] What did you think I meant? Okay, sir. When we say fast food, why do we call it “fast”? Why is it called fast food? Is it because it's pre-processed and ready? Yes. Fast food simply means food that's easy to get quickly. That's what we call fast food. You walk into a shop and— immediately pick it up. Or while driving, you use a drive-through. Kentucky Fried Chicken— or a burger or pizza—these are fast food because they're already readily available.
4:43 That's all it means. It has nothing to do with digesting fast or being inherently bad food. There is no such definition. That's just what “fast food” means. Why did it become popular? In America, husbands and— wives both started working, and there wasn't much time at home. Americans and other Westerners— saw society change, especially after the Second World War. Instead of only one man working, to support the family— women increasingly had to work too. Correct. When both spouses work, they often don't have domestic help or cooks the way many families here do. So what happened? These kinds of outlets and restaurants—
5:32 and this fast-food culture became more common. On the way to work in the morning, they'd stop at a fast-food place and pick up— something, take it to the office, have a quick breakfast and get on with their day. That's the origin of fast food. We are the ones who started equating “fast food” with “junk food.” That's wrong. Completely wrong. Take a slice of pizza, for example. If you think about it properly, it can be a complete meal. Pizza has a base like our roti, made from— wheat or processed flour depending on what is used. Then there's cheese on top. There are vegetables. If it's non-vegetarian, you can have chicken or mutton; abroad they may use—
6:18 beef, pepperoni or pork. Why is that automatically not a full meal? Two slices of pizza can give you protein from the cheese— and vegetables you need. In India we add even more—mushrooms, tomatoes, garlic— onions, all kinds of toppings. People even make mango pizzas. With so many variations, how can you call pizza inherently wrong? And it also reduces the burden of cooking. Why should a woman at home be treated as if she was born only to cook? Is she supposed to exist just for the kitchen? There's nothing wrong with thinking differently and eating this way. I tell patients this too.
7:06 Many times, youngsters come with their parents— and the parents say, “Doctor saab, he keeps asking for this food all the time.” “He's in high school and always wants fast food.” I spend fifteen minutes explaining it properly to them. Take a burger. A burger is basically bread. If you don't deep-fry it— the bun is just a regular bun, like chapati, phulka or jowar roti. It's not fried. You have two pieces of bun, and what do you put in between? A chicken patty. Okay? If it's a good chicken patty— and not deep-fried in lots of oil, but grilled—
7:55 then you add lettuce, a slice of tomato, some onion. Why is that not good? It's a complete meal. So I basically disagree with this kind of propaganda. Children naturally have cravings. If you completely suppress that desire, what happens? They'll eat it secretly. They'll go out with friends and have it anyway. It shouldn't be like that. Of course, some fast foods—like French fries—are deep-fried in a lot of oil. That's not good. Having two or three fries once in a while is okay, but— if you're regularly having fries with every burger, or—
8:41 any deep-fried fast food, you need to be careful. In fact, some of the more dangerous fast food is in India. Our fast food includes pakoras deep-fried in oil, huge samosas— and things like mirchi bajji, all fried in oil. That's fast food too. If I put our fast food against American fast food— and bring ten witnesses, I guarantee I'll win the argument— that our fast food can be worse. And here, the same frying oil is often reheated and reused again and again. That's even more dangerous. In those countries there are rules and regulations—you can't keep reusing frying oil. So ultimately, if I have to sum it up in one or two sentences—
9:29 not all fast food is bad. You have to look at the composition— protein, carbohydrate, fat, and how many calories are in it. Fast food can actually be healthy. I'll debate anyone on this. What matters is how it's made. Our fast food can be much worse— than some of the foods the rest of the world has introduced. You definitely shock us every time. I'm not trying to shock you; I'm telling you what I genuinely think. First— I explained where the term “fast food” came from and what human need created it.
10:14 Once you understand that history—how it came about and who started using it— and how it's prepared, then compare it with what we have here and what we're doing. Right. Coming to seasonal fruits, sir—yes, seasonal fruits. For example, mangoes— or during this season, ice apples and similar fruits. What about overconsumption— or not eating them at all? What are the benefits? What problems come from overeating them? If we don't eat them, what— are we missing? If you could explain that. In my opinion, nothing tastes better than a raw mango. Nothing beats a good raw mango—
10:59 dipped in salt and chilli. It has good fiber, fills your stomach and reduces hunger. Then you naturally eat less. There are so many ways we use seasonal produce. You can make mango dal. You can cut mango and add it to different vegetable dishes. You can even cook it with meat. Have you had mutton with raw mango? Or mutton with tender tamarind leaves? It's fantastic—a classic Telangana dish. And nutritionally it's very good too. Not just taste. Tender tamarind leaves and raw mango— give you vitamin C, vitamin A and other nutrients. But when you consume anything in excess—
11:46 not just seasonal fruits—that's not good. With mangoes, the biggest issue is sugar. Correct. Fully ripened mangoes— contain a lot more sugar. So especially for people with diabetes, or those who are overweight— excess sugar matters, because ultimately our daily sugar intake should— not exceed, for example, around nine teaspoons or 36 grams for men, and about 25 grams for women. One— mango itself can contain several teaspoons of sugar. So you have to be careful and adjust the portion to your health condition. Even if you have diabetes, during mango season some people really crave it—
12:32 and there's nothing wrong with that. You can simply adjust the other foods you eat that day. Right. If you control the portion, that's enough. But if you've already eaten a lot and then— have two whole mangoes on top of that and your sugar rises, whose fault is it? Okay? You have to do it properly. Same with ice apples. I have such fond childhood memories of them. When I was small, vendors would come right up to our house— carrying those palm fruits on the back of a bicycle. We used to get really tender ice apples. They're so soft they almost melt in your mouth, and— they're very good nutritionally too. Why did God create all these foods seasonally? Because variety is the spice of life. Creation itself has variety. We shouldn't get bored in life.
13:24 This season gives you one thing, another season gives you something else— just like rice cultivation. Every— six months you may get a different variety. Nature was made this way to keep life interesting. Right. Let's move away from food for a bit. There's another very important topic, sir. We've had a lot of debates— and discussions about it within our team. I want to talk about one specific drug—actually, a couple of drugs. Before I name the drugs, I want you to explain something about medicines— the difference between patented and generic medicines. If you briefly explain that, it will make— more sense to viewers and also set up my next question. What exactly is a patented drug versus a generic drug?
14:10 A patented drug is one that a company or researcher discovers through its own research and then patents. For example, you have RAW Talks. If someone else starts another RAW Talks, that doesn't automatically belong to them, right? You registered your company and brand; that's your intellectual property. In the same way, if we invent— a new drug, instrument, or anything else, it can be patented by— the inventor and registered according to that country's laws and regulations. When does it become generic? Every country sets a limit on how long— the patent protection lasts—how many years it remains exclusive. In the U.S., for example, a new drug may have seven or ten years of patent protection. Once that expires—
14:59 anyone can manufacture that particular drug— and that's called a generic. Now we have these new anti-obesity— medications, obesity drugs, and one of the patents recently expired. That's what I wanted to discuss. Around forty companies apparently started manufacturing from April 1. Before we get into that— correct me if I'm wrong. Suppose I'm an expert and I discover a formula, and it's— approved by the relevant medical regulator. That's my patented drug. If, for example, the Indian government says— the patent lasts ten years, then from the eleventh year anyone can use that formula because it becomes available to the public. During those protected years, since I funded and researched the drug, I can earn the initial revenue and set the price and business terms.
15:45 That's basically the difference between patented and generic, right, sir? Right, exactly. So now my question is about these anti— obesity drugs. I've heard of two brands, and I'm sure you know which ones: Ozempic and Mounjaro. Let's treat them as two formulations. If you could explain why these drugs— were originally developed, because the reason they were invented is one thing and the reason people use them now is another. Now that generics are coming, could they be abused? Could they create problems for healthcare? And— what are the side effects? Are they good or bad? Over to you. The main one is semaglutide, a GLP— based drug, which is essentially Ozempic, whereas Mounjaro is a combination of two— mechanisms: GLP-1 and GIP. Ozempic is only a GLP-1 drug.
16:35 These medicines were originally developed for diabetes—to control blood sugar. During clinical— research, researchers observed something as a side effect. The patients were not only controlling their sugar; they were also losing weight. That's how they noticed it. Further research then focused specifically on weight loss, and they found that it was a very effective— medication. That's when it began to be used for weight loss. It was not originally— designed as a weight-loss drug. This happens with many drugs. For example, minoxidil is used for hair growth, right? It was originally used for blood pressure. For a long time it was a blood-pressure medicine. [Clears throat] Then they noticed—
17:22 people were growing extra hair on their hands and chest. That became another benefit. These are what we— call incidental observations. They happen when a medicine developed for one— problem produces a side effect or other observation, and researchers then begin— using it for that particular purpose. Minoxidil moved from blood pressure treatment into hair-growth use. The same happened with these obesity drugs. The research began roughly ten— to fourteen years ago, and with more intense research they recognized this effect— on weight loss. To officially market it for that purpose in the U.S., FDA approval— is required. The FDA reviewed many clinical studies and determined that it was sufficiently—
18:12 safe, so it could also be approved for weight-loss use. Now the patent has apparently expired—around March, I think. You asked another question too. Why do companies get patent protection for so long? Because hundreds of millions of dollars— may have been spent by the company developing that drug. If you look around the world, countries like the U.S. and Europe— and, to some extent, Japan are the ones that have historically brought many original new drugs to market. Even China— is still building up original-drug research. Very few places have been able to do this consistently so far— because it costs an enormous amount. A single new drug can reportedly cost around half a billion dollars—about 500 million dollars— to develop. One million dollars itself is several crores of rupees.
19:03 So just imagine: after spending that much money, the company needs a return on its investment. But now look at the other side of the coin. Why should a patent ever expire? Why do governments force patents to end? Why can't the original company keep making it exclusively forever? Take a steel company as an example. A steel company may develop many different types of rods or new products—say Jindal— Steel or Tata Steel. Their advertisements may say, “This has the highest tensile— strength” or “these are ribbed rods.” They've invented or improved something too, right? But those products don't necessarily get indefinite exclusivity. In the pharmaceutical—
19:51 industry, we don't want permanent monopolies. From a humanitarian perspective, medicines need to become— available to everyone in the future. It's a fantastic principle. Exactly—a fantastic principle. Otherwise, where would countries like ours have been over the last sixty or seventy years? Imagine if every patent continued indefinitely— the cost would remain extremely high. So patent expiry is a good system because prices can eventually come down. Earlier in India, even while a patent still existed— some pharmaceutical companies would manufacture a similar drug by slightly changing the chemical— configuration and market it as a “new” drug of their own.
20:37 Then the WTO—the World Trade Organization—became involved, because these kinds of practices had to comply with international rules. The U.S. argued that this was unfair and shouldn't be allowed until the original patent— expired. They appealed through the WTO roughly eight, ten, twelve or fifteen years ago— somewhere around that period—and the rules changed. You could no longer make a tiny change— to the molecule or its configuration and simply sell it as your own drug. That practice largely stopped. Before that, when a new drug launched in the U.S., within one or two years we sometimes had locally manufactured versions in India. After the WTO-related changes, that became much more restricted. Now generics generally come—
21:25 after the patent expires. Coming back to these weight-loss drugs, there's a lot of discussion about them among celebrities. Some people become defensive or even argue when they're asked whether they use these drugs. Because we see people lose weight very rapidly [Clears throat] and sometimes regain it rapidly too. Looking at all that— this is what I understood, sir; correct me if I'm wrong. I read that the doses are expensive and often taken once a week. I also read that some people may need to stay on them long-term, and when they stop, the weight can come back—similar to how— hair can fall again when minoxidil is stopped. And they're also expensive—around ₹10,000 to— ₹15,000 a month, from what I read. I could be wrong. But once generics enter the market—
22:10 prices should fall significantly because of competition, right? Another question is how healthy these drugs are for the body. They change appetite, so how exactly do they work? What are they doing inside the body? Now that you've learned all this, I'll send some of my patients to you. Will you take an appointment once a week? [Laughs] Okay, send them to me. [Clears throat] Because of these podcasts, you— are becoming an expert in everything. [Clears throat] I should start one too. [Laughs] Okay, let's go. But don't start treating yourself either. Yeah, that's dangerous. So these drugs have been declared to be among— the relatively safe medications. Yes. How do we decide that a drug is safe? By following thousands of patients—
22:57 through clinical research. These medicines have actually been around for roughly ten years. People think— they appeared only two or three years ago, but they have ten, twelve, even thirteen years of research— behind them, with thousands of patients participating in studies. That research showed them to be generally safe, though of course there are side effects. [Clears throat] Now, about those side effects— and how the drug works: in the brain there is an appetite center that regulates hunger. When we're hungry, the brain recognizes that the body needs food— and drives us to eat. We call that the appetite center. These drugs act directly on that appetite center. Many human functions—
23:45 have specific control centers in the brain. When the medicine acts there— it sends signals to the stomach. There are also hormones involved. In the body and blood, some hormones increase hunger while others suppress it. Signals from the appetite center influence which of these hormones should increase— to reduce hunger and which should increase to create hunger. That's where the drug changes the balance. Because appetite falls, the food you eat also stays in the stomach for longer and digestion slows— so the stomach remains full longer. Those signals go back to the brain: “My stomach still isn't empty— I don't need another meal yet.” That's essentially how it works. People taking these drugs often say—
24:32 “I don't feel hungry.” But there is an important distinction. Even though you don't feel hungry, you can still feel satisfied and energetic. That's another key point. Correct. That's the “magic” of these medications. Even without feeling hungry, you don't necessarily feel weak or drained. You can remain in a relatively steady state without that sense of weakness. Why? Because food leaves your stomach more slowly and is digested gradually. That helps keep blood sugar steadier and reduces major insulin fluctuations. When those fluctuations are smaller, you don't feel as much fatigue, tiredness or exhaustion. That's the advantage here. Earlier generations of—
25:23 weight-loss medicines over the last twenty, thirty or forty years— often had a major problem: they caused rapid metabolic fluctuations. People could feel exhausted or their blood sugar could fall too low. Those were major problems, which is why many older weight-loss drugs were not very successful. That's the basic mechanism here. Your appetite is lower, but you still feel satisfied, blood sugar remains steadier, and you— can function normally. So in principle, based on the drug— you're saying it's not a harmful drug. It's not inherently a harmful drug. My doubt, sir, is this: whenever—
26:10 we control or manipulate a natural process in the body, I instinctively feel that it may not be good for health. So what's your take? There may be some side effects, but— I'm still stuck on the question of whether it's ultimately good for health. First, let's ask why the problem exists in the first place. All of us have different DNA. Why do some people gain weight? It isn't only because of food or because they're overeating. There are close to 200 hormones— or more, and the interplay among those hormones in the body— is often dictated by our constitution, our genes and our heredity.
26:56 It runs in families—how your mother and father are, your uncles, your— grandparents—all of that can influence you. And that part isn't under your control. So you're not really “manipulating nature”; you're trying to correct or adjust a problem. Take high blood pressure. It too— can be hereditary. Right. A 30-year-old can develop high blood pressure even when life seems calm and everything else is fine. Why does that happen? Same with diabetes. A person may be very thin— like a beanpole, with normal weight—yet still become diabetic. So these conditions— come from a complex interplay of many factors, including genes—
27:41 and heredity, which influence disease. So how do you manage them? You're not unnecessarily tinkering with nature. Unfortunately, the condition exists, and we try to correct it. Exactly. That's all we're doing. If someone has high blood pressure— we give tablets. If someone has diabetes, we use medication to— control it and help them live their life. Same here. Obesity and excess weight— carry many risks. Everyone knows that. From cancer to strokes, and then heart— attacks, diabetes, kidney failure—obesity can contribute to many diseases.
28:27 So if a medication helps significantly, it can be a valuable tool. You mentioned something earlier— that some people take it but don't tell anyone. That's not necessarily vanity. If I have high blood pressure, do I need to announce it to everyone? [Laughs] If I take two or three medicines or have high cholesterol— why should I have to tell people? That's my private affair. Why should anyone care whether someone loses weight today or gains it tomorrow? If they're using treatment and staying healthy— the important thing is that a doctor prescribes and advises them properly. But once generics arrive, could it become available over the counter? It may become cheaper and might be sold at medical shops or large pharmacy— chains. When something becomes that easily available—
29:15 my concern is whether it could be abused. Who decides whether a person actually needs it, what age is appropriate, or whether their medical condition makes it unsuitable? So from what age can it be used safely— and in what conditions? Especially in our country, pharmacy— dispensing is a concern: how medicines are sold at retail pharmacies. Our policy and enforcement around dispensing are very loose. And that can be dangerous. People can walk into a pharmacy and buy antibiotics— or anxiety medicines, and in many cases practically whatever else they want. There has been somewhat tighter regulation around sleeping pills—
30:03 and certain narcotic or sedating medicines. For those, a doctor's prescription is generally required, and to some extent that is now— being followed. But small retail pharmacies may still hand them out after someone simply writes a name on a slip. In developed countries, regulation is usually much tighter. That protects people and also reduces misuse. We keep talking about antibiotic resistance in India. Why do many infections stop responding well to antibiotics? One reason is that antibiotics are so easily— available that people use them however they want.
30:49 A patient gets a cough or cold, which is viral in perhaps 70–80% of cases, and somebody at home tells them to take azithromycin. The driver, the neighbor—everybody thinks they know what to prescribe. “Take azithromycin,” or— “take erythromycin.” This easy dispensing system needs to be brought— under effective government control. These obesity drugs should never simply be released over the counter without a prescription. Drug companies may push medicines aggressively when prescription controls are weak. The same companies, in countries with tighter regulation— wouldn't do that because the rules won't allow it. Here, if policy can be manipulated— they may push products much harder. So we have to be very careful. I don't think these drugs should become simple over-the-counter products.
31:35 Second, age. Generally, they can be prescribed from around age twelve and above. The original FDA approvals for some of these medicines also include patients aged twelve and above. So children over twelve with diabetes and obesity— or even without diabetes, if obesity itself is the indication, may be treated safely in appropriate cases— but only under proper medical supervision. So twelve is basically— the cut-off. Don't use them in children younger than twelve. Sir, generally I don't— like promoting drugs that feel “unnatural” or interfere with natural processes.
32:20 I usually back away from that kind of thing. But this has become such big news—national media— international media, local media, everywhere—that I thought we should discuss it. There's also a parenting angle connected to this. In families with two or three children, or in joint families, people often compare kids: “You're getting fat— stop eating so much,” or “Eat less, exercise, run.” They make that judgment immediately. But what I've observed is that every child's body type can be different. People may not even consider things like insulin resistance or— hormonal issues. If you directly label a child like that, it can affect them psychologically. So what advice would you give parents? How should they look at the issue if they genuinely feel a child is becoming overweight or has a body-shape concern?
33:08 Are there any preventive steps from childhood? Are there tests— they can do, or should they consult a doctor? What should parents actually do? Wonderful question. Let me tell you about myself. From childhood, I was a little— overweight, while my brother was very thin. He ate very well and never seemed to have a problem. I, on the other hand— could eat a fairly normal amount and still gain weight. I used to wonder— “My brother is so lucky. Why am I like this? Am I really overeating?” “Are there habits I need to change?”
33:55 I struggled with it through my younger years and even in medical college—fasting, cutting things out— trying all kinds of methods. However hard I tried, I could maintain it for a week, a month— or two months, but once I started eating normally again, the weight gradually came back. Then our first son, Rishi—our eldest son—was also very— overweight. He was born in the U.S.; our children were born there. He became so overweight that my wife and I would wonder what was happening. She was quite lenient, and he would literally eat with both hands. He was in third or fourth grade and very heavy. Then later—
34:45 around seventh or eighth grade— something changed naturally. We never constantly criticized him, but— we did wonder why he was so hungry and eating so much. We didn't want to shame him, but we were worried and thought perhaps he was overeating and should— control it. Then around eighth or ninth grade, I think he— read something and became incredibly disciplined. Within the next two years— his weight came down into a normal BMI range. All our family members, relatives and friends kept asking, “How did Rishi change so much?”
35:35 “How did he do it?” That transformation even became the subject of his essay for Ivy League— applications—places like Harvard and Stanford. They were impressed because they saw— a young person with that much determination and thought, “This boy can achieve something in life.” And he did it through discipline. But for years he was extremely strict. No sugar, very little fat—if pizza came, he'd even eat it without cheese. He followed a very strict diet until it became a lifestyle. But how many—
36:22 people can really do that? So coming back to your question, we have to show empathy, especially as parents. We need to understand that obesity is not simply the result of eating too much. It can be a hormonal problem. I spoke earlier about the appetite center in the brain. That center is influenced by nearly 200 chemicals. That's not the child's fault. It's not the girl's or boy's fault. Unfortunately, genes can influence this system, and that can make someone— more prone to overeating or needing more food to feel satisfied. So we shouldn't— criticize a child without understanding the cause. Of course, if there are genuinely unhealthy habits—
37:07 for example, an adolescent who is drinking alcohol just for fun— or indulging in harmful habits for pleasure—we absolutely should control those kinds of behaviors. If we remove genuinely bad habits, then when it comes to food and obesity— we need to be much more sympathetic and understand the person. There are also medical conditions, like adrenal— gland disorders such as Cushing's syndrome. Excess hormone production can cause weight gain, and in younger patients— doctors may not always suspect it initially. Later, when they see an endocrinologist, it may finally be diagnosed. So there can be other causes. We should first think carefully and rule out whether the obesity is due to an underlying condition.
37:53 After that, we work on diet— control, exercise and lifestyle. When those aren't enough, that's where medications come in. There is also obesity surgery. Drugs alone cannot control every case of obesity. If someone has a BMI above 35, for example— then bariatric surgery may also be recommended. A combination of bariatric surgery and these— medications can be used. You mentioned that some people may need to take them long-term. That's true. If they stop, within six— months the weight may start coming back. So what are the alternatives? Even if you have surgery— you may still use these medicines for the next two or three years—
38:41 to maintain and sustain the weight loss. Some patients are extremely obese and think medication alone will be enough. They come to me with a BMI of 40 and say, “Doctor saab, I only want medicine— I don't want surgery.” I explain to them— “Medication may reduce this much weight, but you may need to lose 70 or 80 kilos.” These medicines may help some patients lose 20 or 25 kilos. Some newer drugs— may achieve 40 or even 50 kilos of weight loss in some cases. There are also oral versions that aren't yet available in India. They may help up to—
39:29 that level. But for someone with morbid obesity weighing 300 or 350 pounds— medication alone may not be enough. A combination of bariatric surgery and these— medications can help. Now, people like Kohli may say, “I've stopped eating just for taste.” But I saw a video of an actress saying, [Clears throat] “I eat a lot. I love tasty food— but after eating I go to the washroom and vomit.” That's called bulimia. Yes. It's a disease in itself, called bulimia. Princess Diana— the late British princess—suffered from this problem too. There are many documentaries and films about her. You can watch them. She would attend major royal—
40:16 dinners and functions, and then suddenly disappear for twenty or thirty minutes— to induce vomiting. This condition is called bulimia. For many patients, it's a psychiatric condition. Bulimia is a psychiatric disorder. Treatment usually involves psychologists and psychiatrists— because for some people it's a genuine disorder. Others may do similar things purely— to control weight. We do see it in young women. Most often, though, it appears in people with behavioral disorders. Those are the patients who develop it. Depression and anxiety are also behavioral or psychiatric conditions.
41:06 Not everyone develops anxiety or depression. There has to be some mechanism operating— that makes one person more vulnerable to becoming depressed. It isn't automatic. Ultimately, the brain is involved. That's why some medications can— help these patients. If natural approaches aren't enough—yoga for anxiety— or meditation, for example—then medication may be used to change those body chemicals— biochemically and help manage the patient. Now, connecting this to what you said earlier— you mentioned that the stomach sends a signal to the brain saying it's full. If we think about that— suppose you're eating and suddenly receive terrible news. You immediately lose the desire to eat.
41:54 No matter how hungry you were, something affects the brain— and the hunger itself can disappear. So logically— that means the brain and gut are connected. People often say— the gut is the “second brain.” We call this the gut-brain axis. Exactly, the gut-brain axis. We touched on this in the last episode, but if you could— introduce it again briefly for new viewers. The gut means the entire digestive— system, right? Not only the stomach: the small intestine, large intestine, esophagus— all of these are part of the gut. Research over the last fifty or sixty—
42:42 years has shown that the brain controls— the gut, meaning the digestive system is influenced by the brain. But the digestive system also influences the brain. That's why we call it the brain-gut axis. There is information flowing forward and also signals flowing back to the brain. This was one of the— most important scientific realizations that became clear a few decades ago. Once researchers understood that, they began studying it more deeply, and medicines like these— were developed from that broader understanding. It became part of the foundation for today's— research. Now, coming to stress and anxiety—
43:31 or something life-changing like a death in the family— sudden events can affect us centrally by altering— the brain and the appetite center we discussed earlier. That center is around the hypothalamus, while areas responsible for our feelings— and emotions are located nearby. The appetite center is closely connected to them. There is also what we call sympathetic nervous-system influence. When— major stress or illness happens, appetite can fall dramatically. Think of flu or pneumonia: you often don't feel hungry. Cancer patients may also lose appetite.
44:18 In cancer, certain substances such as cachexia-related mediators can be released and— affect the appetite center, reducing hunger. The same principle applies during illness. When you have a high fever, do you feel hungry? Usually not. With viral infections— the immune system releases inflammatory mediators and cytokines into the blood. They can reach the brain and affect the appetite center. So everything is connected there. And this is not only about obesity. Many other conditions affect appetite. Interestingly, some people with depression— feel more hungry. When stress is high, how do some people—
45:04 relieve it? By eating more. That's what we call stress eating. When you eat, the brain's reward and “feel-good” chemistry changes, which can temporarily make you feel better. That's one reason why in lower socioeconomic groups in the U.S.— where there may be many difficulties, single-parent households and limited resources— parents may have little time to care for children. When people are depressed or stressed— they may eat more. That's one reason obesity can be so high in some of those— groups. Wealthier people can have obesity too, of course, but it can be especially significant in lower socioeconomic—
45:49 populations under severe stress. They may reach for a burger— sugary drinks, French fries and similar foods— and weight increases. With depression and severe stress— people sometimes use eating as a way to occupy the mind and create a sense of comfort. And that can be dangerous. Sir, in another recent interaction I saw you talking about— insurance. Whenever we have a doctor here, I make sure we discuss insurance. I usually ask one general question for the viewers, but today I want to ask one more thing along with it. First, what general advice would you give people who are wondering whether they should take insurance at all?
46:38 Some think, “It's expensive, why pay for something I may not use?” What would you tell them? Insurance is extremely important. For a family, the annual premium for around ₹2 lakh— or a few lakhs of coverage may be somewhere around ₹15,000 to ₹30,000 depending on the policy. With that annual premium, you can often get a few lakhs of insurance coverage for the husband, wife and— two children. A family of four can be covered. If you eat biryani ten times a year— that itself can easily cost around ten thousand rupees. Just imagine that. Yet people hesitate to spend on insurance. Many people think, “Why should I spend this money? If something happens, I'll just go to a government— hospital.” I think that's unfair to yourself. If you can afford such a small amount in your life—
47:30 it's often less than a round-trip flight ticket to Delhi. Think of it from those angles. I keep educating people about this. Telangana's recent per-capita— income figures were reportedly around four lakh rupees or more— among the highest in the country. Many other states may be below three lakh or around two-and-a-half lakh, depending on the figure being used. The point is, many adults are earning a reasonable amount. [Clears throat] If you're earning around four lakh rupees a year, why not spend twenty or thirty thousand on insurance— instead of being forced to beg for financial help when a medical emergency comes?
48:19 That's how I see it. People should think ahead and take insurance. Look at all these young people having motor-vehicle accidents and motorbike accidents. We never know whether it will be one in ten, one in twenty or one in thirty—or when it might happen to us. Why take that risk? Car insurance is mandatory, right? You have to take it. If you drive without insurance, you're penalized. Health insurance should be taken just as seriously. In the U.S., for example, there are strong expectations around coverage. Up to a certain age, children may remain— covered under family insurance, and going without insurance can create financial or legal consequences depending on the system. I've also always been curious about how insurance companies [Clears throat] work with—
49:07 hospitals. I won't call it “friendship,” but collaboration. Is it bill by bill? Do terms change every month? How does it actually work? I also heard that things like a hospital's outcomes or death rates can affect— how insurers trust or rank that hospital and how often claims get rejected. So how does— that relationship really work between hospitals and insurance companies? Having insurance doesn't mean you can just get anything you want done. It doesn't work that way. Insurers and hospitals have contracted rates, usually negotiated once— a year or once every few years with each hospital. For example, for gallbladder— surgery, they may say, “For this procedure, we'll pay your hospital ₹80,000 or ₹1 lakh.” That's the package rate. Hospitals have different package structures, often influenced by accreditation and classifications such as NABH.
49:57 There may be tier classifications and other indicators, and insurers are increasingly expanding how they evaluate these certifications. Going forward, they'll look more closely at hospital quality and outcomes too. The bottom line is that among large tertiary-care hospitals like ours— the rate difference for the same procedure usually isn't enormous. When a patient comes for a procedure under one of these contracted packages, the hospital's responsibility— is to provide the treatment within that package. But there can be exceptions. Sometimes insurance agents or the insurer don't explain all the limits clearly to the patient, so the patient assumes—
50:42 they're entitled to everything. For example, the policy may only allow an economy— or semi-private room, but the patient expects a private room. If the hospital admits them to a private room and bills accordingly, the insurer may reject that part of the claim. If these expectations are explained properly to the patient beforehand— these mismatches can be avoided, and hospitals won't unnecessarily be seen as— cheating the patient. There are faults on both sides. The industry can be at fault, and the customer's expectations can also be unrealistic. Insurers may say, “We explained everything.”
51:27 But when you sign a contract that's ten pages long, how many people actually read every page? Most of us sign on trust. Look at insurance documents—the fine print is so tiny that even with glasses— it's hard to read. That's how business is often done: the longer the document and the smaller the print— the more they know you probably won't read it before signing. Then later, when a dispute comes up, they— point to a clause and say, “It's written here. You signed it.” Then it's difficult even to contest. So the bottom line is that every part of this system has to operate with trust. Even in the insurance industry, there are good companies, and there are companies that create unnecessary trouble. Let's divert slightly from insurance and come back to hospitals. No offense, but these days everywhere I look—
52:17 hospitals seem to be opening like supermarkets. [Laughs] There are so many hospitals and so many branches. I'm not against expansion, but I'm genuinely curious: do we actually need this many— hospitals? On one side, government hospitals are reportedly still waiting for insurance reimbursements. In Telangana alone, there have been reports of around ₹1,500 crore pending. There may be many reasons for that. On the other side, huge new private hospitals are opening—almost like five-star hotels. Where is this culture going? Why are so many hospitals being built? Everyone is asking the same question. Hyderabad has become a major healthcare destination. People are saying Hyderabad is turning into a health city.
53:02 We already talk about Pharma City, and now there's also this massive hospital and healthcare industry. Recently— there was a report saying Hyderabad had some of the costliest healthcare in India. They compared treatment costs and quoted an average healthcare spend of around ₹60,000 or something similar. Then they listed rates for Mumbai, Maharashtra, Delhi and other places. Some newspapers even ran small headlines saying Telangana or— Hyderabad had the highest cost of care. I don't know how exactly those statistics were calculated. But such propaganda can be dangerous for a good city and its healthcare—
53:47 industry. And honestly, I too keep wondering: why are so many hospitals being built? What is the need for this kind of unhealthy competition? Poaching doctors from one hospital to another—how is that fair? In some cases, hospitals offer 40%, 60%, even 80% more to lure people away. And it isn't only— doctor poaching; there's patient poaching too. Hospitals send messages and run targeted digital advertisements— not only to a doctor's existing patients but to people in the surrounding area, saying, “We have this, we have that.”
54:32 They make deals with community associations. If one provider is already there— they try to replace them, and then problems start even inside those associations. People accuse someone in the community association of taking a bribe to shift the tie-up from one hospital to another. All these irregular practices ultimately create problems for the public. That's why I've been suggesting one idea to people. In more than twenty U.S. states, there is something called a Certificate of Need law. If you want to open a new hospital in a city— you have to apply to the government. They conduct a survey over six—
55:18 to nine months and study the population and existing facilities in that area. If another similar hospital isn't needed, permission may not be granted. The same can apply to surgery centers— or diagnostic facilities. That prevents this kind of unhealthy competition. Here, new hospitals open and immediately start aggressive promotion— “We have this, we have that.” There are also issues of poaching. In other systems, doctors generally have contracts. You fulfill your agreement first, and after that— you're free to move to another hospital. There may also be restrictive covenants.
56:03 If a doctor leaves without fulfilling the agreement— they may not be allowed to practice within, say, 10 miles or 10–15 kilometers for a year, depending on the contract. And this principle isn't unique to doctors. Let me tell you an interesting story from another industry. Yesterday, I was flying back from our Chhattisgarh hospital— on an IndiGo flight. A young air hostess was sitting next to me. I found it a little unusual. For the first— half hour, I didn't say much beyond hello. Then she started the conversation. She asked, “Sir, are you from Hyderabad?” I said yes. Then I asked why she was sitting there. She had already gotten up four—
56:51 or five times. I had the aisle seat, so every time she got up— I had to move. She would go and talk to the cabin crew and other staff members. Then she explained, “I'm here on observation duty.” Her job was to observe how the crew served passengers and handled the flight. I asked, “How long have you been working?” She said three years. I said, “If you've been working for three years— why are you still on observation?” She explained that she normally works on international flights. When moving to a different type of short domestic route, they still have to complete about six months of this kind of evaluation. The crew manager on the flight then has to certify that she's competent.
57:38 It's almost like an internship or supervised transition. Why am I telling you this story? Because IndiGo invests six months of training and supervision in that candidate. Exactly. The airline trains her. If she immediately leaves IndiGo and joins Alliance Air or— Air India, who loses that investment? The company does. That's why contracts have clear terms. Hospitals are similar. Why do we have contracts with doctors? Even if a doctor is very senior, when they move from another city— we invest heavily in bringing them into the system. We invest in training, in promoting their services, and in creating public awareness about that doctor. Some doctors come on podcasts like yours. Some are genuinely capable experts—
58:28 and sometimes people also come for promotion or advertising. I'm not saying you do that, but I'm giving an example. All of that promotion costs money. Doctors themselves don't always think about that investment. And I don't blame the doctors alone. I've said many times that the bigger fault lies in hospital management systems. Why are managements creating this bidding culture? Yes, everyone is free to make their own choices. That's not the issue. As a society, we should still question why organizations aggressively poach professionals with no respect for existing commitments. Do they stop to think about— how much disruption this causes to patients? What kind of healthcare practice is that? Is it just so a CEO can impress the board, or a hospital founder or—
59:18 owner can say, “Sir, I pulled this doctor from that hospital and that doctor from another hospital. Look what I've achieved”? I don't think doctors who constantly move like that build lasting success. This is happening openly now, sir. Absolutely. It's happening all over India, not just here, but here the problem is especially intense. There's very little basic respect for professional continuity. After we established Continental in 2013, I've always told my team one thing clearly: no poaching. If a doctor independently approaches us after working at another hospital— we'll speak to them and understand the situation. But I have never called a doctor and tried to pull them over to work for me.
1:00:03 I've said this in many podcasts and interviews because, for me, it's about self-respect and dignity. If I want to prove that I can succeed in healthcare— then my responsibility is to build my own team. Build my own people. Give them opportunities. I don't want to steal someone from another institution— and then proudly say, “Now he's mine.” In ten, twelve or fourteen years, have I done that? No. And doctors aren't slaves either. We aren't saying people can never move. What I'm questioning is this hyper-competitive culture of telling the public— “We have this, we have that, we have this CT scanner,” and constantly pushing audio—
1:00:53 and video advertisements. It distorts the public's mindset. Do you really have to— advertise so aggressively, poach, manipulate and recruit when there isn't a genuine need? I haven't seen this kind of behavior to this extent elsewhere. Thank— God I spent most of my career in America and learned certain professional norms there. As I've told you, I haven't done it and I don't believe in doing it. Whatever we do in life should have a method and some dharma. That's why everyone keeps asking: why are so many hospitals coming up? I actually feel bad for our ministers, including our Chief Minister, because every new hospital invites them— to inaugurate it, and they naturally attend. But we still don't understand where this is heading.
1:01:42 If a truly new specialty hospital opens because an important service doesn't exist anywhere else— that's different. But when everyone offers the same thing, you're just competing and moving doctors from one place to— another. It turns into a war. In some hospital groups— it is literally a war: one group leaves, another hospital recruits that entire specialty team. Fine, the doctors may be happy in the short term because they're earning more money. But over time, even their reputation can suffer. I used to follow one doctor whose content was all on one— hospital's page. Then suddenly, after three or four months, he started appearing under another hospital. That new hospital was much farther away for me, so even meeting him became less convenient.
1:02:32 And I thought, “The first hospital must have spent so much money promoting this doctor and creating content— around that specialty. If he suddenly leaves, what happens to all that investment? They have to rebuild and rebrand again.” I didn't realize poaching was happening at this scale. What do hospitals actually offer doctors in these cases, sir? [Laughs] Of course, money. Money is the basic incentive. That's what most poaching comes down to. A doctor may have been in one hospital for two, three or four years, and generally— most hospitals are already taking reasonably good care of their doctors and paying market-comparable salaries. But because certain specialties are in short supply, hospitals start looking for “ready-made” doctors— and offer one lakh, two lakh, three lakh or even more extra in salary to pull them over.
1:03:22 I genuinely struggle to understand how a system can become this lawless. If you've signed an agreement— and that agreement has no value, what kind of professional system is that? What about the medical council? The medical council may not interfere in a doctor's personal choice of where to work, but it does have— certain rules. The regulations were modified in recent years, and there have been updates around 2023 and after that. The older medical ethics code also laid out professional standards. Those rules describe the expectations and— obligations when a doctor moves from one hospital to another. Proper notice should be given. And the doctor should properly hand over or sign out existing patients to the hospital—
1:04:10 especially patients who are still under active treatment. Doctors are also not supposed to solicit patients by saying, “I'm leaving this hospital; come to my new place.” Yet many people do exactly that, and sometimes hospital managements also facilitate it. Sending letters or messages asking patients to follow a doctor is covered by professional conduct rules. Similarly, doctors who abruptly leave without completing the required notice period— or without fulfilling their contractual obligations are also violating professional norms. They may be violating National Medical Commission regulations too. But then the question is: who enforces this, and through what—
1:04:56 court system or mechanism? We need to think about whether the system truly protects the public. One major consequence is that the cost of care goes up—sometimes dramatically. If a hospital pays huge salaries to recruit doctors in this competition, then someone has to show profits to the CEO or— finance leadership. That's when pressure can start moving in the wrong direction. For the first two or three months, there's a honeymoon period. Then what happens? Management starts asking for production: “Do this many CTs, this many MRIs, this many procedures.” If the numbers don't come, they may replace that doctor after months or a year and bring in someone else.
1:05:41 Then that doctor moves again, and healthcare starts behaving like a pure business. That's completely wrong. Doctors should have— freedom and choice about where they work. But once you sign an agreement with a hospital— fulfill that commitment first, then move. In my own life in America, I can give you a— verifiable example: I have never violated a contract. I did not keep jumping from place to place throughout my career. And if you look at the really— successful and iconic doctors in this country, including in our own city— they usually don't keep moving from hospital to hospital every few months. That's what I teach younger doctors too. Think about why those senior doctors became famous.
1:06:30 We need to learn from them. Look at how truly iconic doctors became respected. They didn't become famous overnight. They didn't become famous through shortcuts or questionable practices. They sacrificed. In healthcare, without sacrifice and hard work— you don't become a great doctor or a truly successful doctor. Doctors who follow a consistent process and build themselves patiently— by caring for patients, educating them, giving them confidence and building trust—
1:07:16 those are the doctors who become successful. That's the point. I don't know how we got into this much detail, but this aggressive poaching is definitely becoming a serious issue. And it's not just doctor poaching. There is poaching of— staff too. When some new hospitals opened, someone told me that in our own hospital— almost 90% of our business-development team had been approached, and around 38 doctors— were interviewed. Thirty-eight doctors! How do they even have the audacity to conduct such interviews inside another hospital's ecosystem? People come into doctors' clinics and offices pretending to be from a pharmaceutical company or some other business.
1:08:01 That's how they get access. That's what they do. My God. Then they meet doctors outside in hotels— take them to dinner, offer drinks to those who drink, and keep following up aggressively. Some even go to the doctors' homes. I've been told that top management or founders themselves sometimes visit— doctors' houses. The whole idea is: if this doctor is producing a lot of revenue— bring him to us so we can show that revenue on our books. This isn't out of love or admiration for the doctor. It's out of love for money and business. That's the—
1:08:47 problem. It's very transactional, right, sir? Absolutely. That's exactly the right word. You're a sharp guy. Yes, this is all transactional. Healthcare cannot be completely transactional. I'm very fortunate because I've built trust and faith with my doctors. We try to create that culture. Some people leave; that's normal. And honestly, sometimes when certain doctors leave, we're relieved and think, “Good, this creates space for someone better.” Sorry, I'm saying this openly on the podcast, but that's the truth. Sometimes it's simply good riddance, and it creates an opportunity for someone else.
1:09:34 Sir, for this next segment of the podcast, we wanted to talk about— the value and importance of everyday items in our kitchen. I brought a few things from our office kitchen. Should I ask item by item, or will you pick them? I'll pick. First, this is cinnamon—dalchini. Cinnamon has a lot of value. Where do we normally use it? You know—biryani. Yes, biryani, and sometimes in other spice mixes. Its value comes partly from— compounds such as cinnamic acid. Cinnamic acid may help with blood-sugar control, especially in people with diabetes. Some people make powders—
1:10:25 combining ingredients like bitter gourd and cinnamon. So for people with diabetes, using cinnamon in some daily form— whether as powder or a small piece of stick—may be helpful. It may also help cholesterol and digestion. I wouldn't call it a weight-loss drug, but these are potentially useful effects. Cinnamon may also have cardiovascular benefits. There are two or three common varieties; Ceylon cinnamon is considered one of the better options. The ordinary cinnamon we commonly get in the market— may not be quite the same quality as true Ceylon cinnamon. Overall, for Indian diets— where spices are commonly used, cinnamon is an important one.
1:11:13 Next is ginger—everyone knows ginger. Garlic and ginger are very important in our cooking. Ginger contains compounds called gingerols— along with several other bioactive chemicals. For decades, research has looked at these components and their potential benefits. Ginger has anti-inflammatory properties and antioxidant activity. Antioxidants help neutralize harmful oxidative substances produced in the body.
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