Dr. Premkumar Balachandran is a well known Bariatrician with a vast experience of 27 years. He completed his MBBS from PSG Institute Of Medical Science, Coimbatore in 1990. After which he pursued MS in General Surgery from Sri Ramachandra Medical College And Research Institute in 1997 and Master Of Minimal Access Surgery from Ninewells Medical School, Dundee UK in 2003. But his eagerness for learning did not stop there. He holds a Diploma in Minimal Access Surgery and has completed 5 fellowship programs- Fellowship in Minimal Access Surgery and Fellowship In Robotic Surgery from World Laparoscopy Hospital, Gurgaon, FICS from The International College of Surgeons, USA, F.I.A.G.E.S from Indian Association Of Gastrointestinal Endosurgeons and FARMASI from Association Of Minimal Access Surgeons Of India.
In his long career he has won prestigious awards like The Chikitsa Rattan Award and Gold Medal for Excellence in Medical Science by The International Study Circle, New Delhi. He is a member of various medical associations like Association of Surgeons of India, Indian Medical Association. He runs Gastro - Bariatric-Hernia Speciality Clinic in Chennai. He can be reached at his clinic on Monday to Saturday from 9 AM to 4 PM. He also provides online consultations.
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Many people gave very positive feedback for this Premkumar Balachandran. He is not just friendly, but also is very motivating. Premkumar Balachandran has so much knowledge that for everything my family takes his reference. he immediatley started the gain weight treatment for it. Over the period of time I noticed a number of changes in myself. Thanks to him that the gain weight treatment he gave me has given brilliant results.
The problem was severe and unmanageable, as I was not able to lose weight, but Dr BalachanDran was able to handle it. The interior of the Gastro Clinic was so nicely done, it was so clean. I read about him on one of the social media platform. He is a very practical doctor. My case was extremely serious, but he really handled it very nicely. Over the period of time the lose weight treatment has helped me a lot.
He did my weight loss treatment. He ensures that he listens to his patients. I have had this obeesity from quite some time. I saw Premkumar BalachanDran clinic's advertisement in newspaper and that is how we referred him. Even though there was a long queue, still the staff was very pleasant.
Over the period of time I noticed a number of changes in myself. Everything was just spick and span in the Gastro Speciality Clinic. The guidance Premkumar sir gave me has helped me immensely with my situation. I was obese before the treatment. He is a very practical doctor.
He is not just friendly, but also is very motivating. The interior of the Gastro - Bariatric Clinic was no nicely done, it was so clean. I had lost hope, but the diet chart given by Premkumar Balachandran has helped me regain my confidence and eliminate my obesity.
I was in search of an experienced bariatrics as I was getting fat because of thyroid disorder. One of my colleague referred Dr Premkumar, His treatment for obesity was very effective. My condition has improved to great extent after the treatment.
My mom is having a stone in gallbladder. I would like to know if we can remove or dissolve stones in gallbladder with medication or is surgery the only option.
Some people find it harder to lose weight as compared to others. Gastric sleeve surgery is a viable option for such people. This surgery involves reducing the size of the stomach to control the intake of food.
Here are 10 ways this surgery will affect you.
- You’ll need a special diet for the first few days: You will need to follow a special diet for 8 weeks after the surgery. This gives your stomach the time to heal properly. Normal food will have to be reintroduced slowly. However, alter, you can eat anything you like.
- You can eat lesser: You’ll find yourself taking smaller servings at all meals as your stomach is much smaller than it was. This does not mean that you’ll be able to eat more frequently. It simply means that you will eat a lot lesser. A smaller stomach also means that you will feel less hungry.
- Weight Loss: After a gastric sleeve surgery, patients typically lose up to 75% of their excess weight. In the first three months itself, you should see yourself lose up to 33% of excess body weight. Thus, it can help cure obesity and reduce your BMI.
- Resolution of obesity-related health issues: As your weight reduces, so does the impact of other diseases. Patients suffering from diabetes, high cholesterol, high blood pressure and sleep apnea report a large amount of improvement in their conditions after this surgery.
- Stronger joints: Excess weight puts additional pressure on your joints. This can cause joint pain and increase the wear and tear of joint cartilage. By reducing your weight, there is less pressure on your joints. Improved mobility and lesser knee pain are commonly experienced benefits.
- Lowered cancer risk: The risk of some types of cancer is associated with the patient’s weight. As a result of this surgery, the risk of colon cancer, pancreatic cancer, breast cancer and endometrial cancer reduces by up to 33%.
- Improved fertility: Women with obesity of overweight issues typically find it difficult to conceive. A gastric sleeve surgery can improve these fertility rates. Studies have shown that more than 50% of the women who underwent this procedure could conceive a child successfully within the next year.
- Improved mental health: Your weight also affects your self-confidence. In many cases being overweight or obese contributes to depression. Undergoing this surgery can improve a patients’ self-image and relieve symptoms of depression, anxiety etc.
- Better sleep: Losing body fat makes it more comfortable to get a good night’s sleep. Weight loss also helps treat conditions such as sleep apnea that can keep you from sleeping restfully.
- Your weight loss will plateau after 2 years: As time passes, your stomach will begin to expand. Hence you may not see yourself losing too much weight after the first year. If you are not careful, you may begin to put on weight again after the 2nd or 3rd year.
In case you have a concern or query you can always consult an expert & get answers to your questions!
Being overweight is becoming a common sight. However, opting for bariatric surgery is not the first option for everyone who is obese. Also to remember is that morbid obesity is not an isolated condition. It affects a person’s overall physical and mental health in various ways, and therefore bariatric surgery becomes an option only as a last resort.
Some defining criteria for this surgery would be:
- A male who is at least 100 pounds overweight for his height or a female who is at least 80 pounds overweight for her height. This puts them at a body mass index (BMI) of more than 40.
- If the BMI is in the range of 35 to 39 and if there are significant health issues like metabolic syndrome, then bariatric surgery can be done. For BMI less than 35, other conservative measures are usually tried before resorting to a surgical approach.
- Most people with BMI in the range of 35 and above will have health issues like sleep apnoea, heart disease, lipid disorders, and metabolic syndrome.
- Conservative measures to lose weight including diet changes and exercise have failed to produce any desired results.
- The person, in addition to physical health, should also be emotionally strong to undergo the demands of bariatric surgery. There are changes involving almost all body systems including digestive, respiratory, cardiac, and musculoskeletal, and so the person needs to be prepared for a lifestyle change.
- Strict lifestyle changes including diet and exercise are required, so the person needs to be counseled and convinced about these. A person who can see the long-term benefits will be willing to take the effort.
- It is also essential that the person has a strong social support system. For immediate post-op care when skin flaps need to be managed, and for long-term emotional support to manage emotional issues, it works wonders if there is a strong social network. The results are usually better in such people.
- A person’s overall health would be screened to make sure the lab tests are well within acceptable limits before surgery. It would be unreasonable to get these numbers within limits, if they are way too beyond acceptable limits.
- Not the least consideration, but bariatric surgery is an expensive affair. It requires not just surgical costs, but also post-op costs. The good thing, however, is that overall healthcare costs would come down, once the results are visible.
Identifying the right candidate for a bariatric surgery is very essential, as doing this extensive surgical approach on an unsuitable candidate would be a failure.
In case you have a concern or query you can always consult an expert & get answers to your questions!
If you have taken the big decision to go ahead with bariatric surgery, one thing you need to prepare for well in advance is the additional effort that is required after the surgery to ensure it is a success. The results will be evident only after a few months post the surgery. This period requires your constant attention.
Listed below are some after-care measures that are essential for the success of a bariatric surgery.
- Hospital stay: Most patients are advised hospital stay for four days, during which the hospital staff will ensure the sleeve is working fine. No food is allowed for 48 hours. Diet is gradually advanced from water to clear liquids, about 50 ml to 100 ml and then to 150 ml.
- Wound care: Depending on whether a laparoscopic or open surgery was done, the number and location of incisions will vary. However, the wound should be maintained clean and it should be ensured that there is no infection of the site. Wound care should be done by the nursing staff if required. Suture removal, if required, should be done as per doctor’s advice.
- Pain management: Finish the course of antibiotics and pain killers to ensure infection is completely gone. Pain would continue, if the infection is not completely controlled.
- Diet: The first two weeks would be a completely liquid diet. The next two weeks will consist of a pureed diet. After these four weeks, solid foods will be introduced.
Foods to avoid after a bariatric surgery include anything with a higher protein content and anything that has too much oil as the stomach’s ability to digest these is reduced. Refrain from:
- Carbonated beverages
- Hard meat
- Nuts and seeds
- Fried foods
Food items to include post bariatric surgery include those which are easy on the stomach, including:
- Liquids such as soups, broth, juice and milk
- Pureed cooked vegetables and eggs
- Soft mashed food including meat and vegetables
Adherence to this will reduce complications. While eating, the patient should also remember to chew nicely, eat and drink slowly, increase water intake throughout the day, and avoid fats and sugar. It is advisable to eat three proper meals a day and avoid snacking during the day.
Remember that the need for bariatric surgery arose in the first place due to uncontrolled eating of oily food. After undergoing a bariatric surgery, diet pattern is definitely going to move to a healthier side with reduced fat and sugars. It is not an easy shift, but definitely required, if the surgery is to be a success. Imagine the new you and you will be able to do it! In case you have a concern or query you can always consult an expert & get answers to your questions!
Bariatric surgery is a procedure that involves modifications to the digestive system so that the food intake can be restricted or the nutrients absorbed by the body is reduced. This surgery is recommended when exercise and diet may not cause the desired results with weight loss. Bariatric surgeries is a group of surgeries that are procedure to reduce weight in the body.
The various types of surgeries that come under this category are
- Gastric bypass: The most common bariatric surgery, gastric bypass is a procedure used to reduce the size of the stomach pouch in the body. Once the size is reduced, it leads to reduced consumption of calories. This procedure also causes alterations in the behavior of the gut hormones resulting in appetite reduction.
- Adjustable Gastric band: This procedure involves placing an inflatable band around the upper stomach to make a small stomach area above the band. This causes one to feel full just after eating a small amount of food.
- Sleeve gastrectomy: In this procedure, almost 80% of the stomach area is removed surgically, resulting in a small stomach pouch being left. It reduces the stomach size which cause an overall reduction in the amount of calories. Modifications also occur in the behavior of the gut bacteria linked with reduced appetite.
- Biliopancreatic Diversion with Duodenal Switch: This procedure involves surgical removal of a large area of the stomach along with bypassing a major portion of the smaller intestine. This procedure may reduce fat absorption of up to 70%. The behavior of the gut hormones change resulting in a decrease in appetite and improved satiety.
1. May cause infections in the body
2. Clots may form in the blood
3. It can result in bowel problems
4. Ulcers can form in the stomach
In case you have a concern or query you can always consult an expert & get answers to your questions!
The risk of developing heart problems has increased to a great extent and this is mainly due to obesity, which leads to other diseases. A gastric bypass surgery is a medical procedure, which is commonly known as Roux en-Y surgery. It aids in reducing the size of the stomach. The reduction in the size of the stomach makes an individual feel full even when they have eaten very little.
Gastric Bypass Procedure
The stomach bypass surgery is generally known as a bariatric surgery and it guarantees weight loss of about 30-40% within a year. For this procedure, the patient has to be in the hospital for 4-5 days and it takes about 2-3 hours for the medical procedure. It is through this procedure that the size of the stomach is reduced permanently and is performed laparoscopically.
Five small holes are made in the stomach under general anaesthesia. The procedure is conducted only after tests like ECG, blood and urine tests, chest X-Ray chest, abdominal scan and echocardiogram are carried out.
The patient can be discharged from the medical centre on the fourth day. However, it is necessary that calcium, vitamins and supplements are included in the diet plan, mainly to prevent malnourishment and tiredness. In the medical procedure, the surgeon divides the stomach into two sections using surgical staples. The sections are divided into a small upper pouch and a large remnant. The medical procedure makes use of surgical staples, which is why the procedure is sometimes referred to as stomach stapling.
The small intestine is re-arranged in a manner that the stomach pouches are connected to the intestine. The intake of food is reduced by the reduction in the functional capacity of the stomach and by the re-arrangement of the small intestine that causes food to go through the first portion of the small intestine. The procedure is mainly targeted for people with body mass index of 50 and above. It is important that the individual should not drink water for next 24 hours of surgery.
Benefits of Gastric Bypass Procedure
Results in reduced calorie absorption and helps in weight loss. It is generally advised for people who are unable to accomplish weight loss through diet and exercise.
Risks involved in gastric bypass procedure
- Inflammation of the stomach lining
- Nausea and vomiting
- Nutritional deficiency
- Development of gallstones. This occurs mainly due to loss of significant weight within a short span of time.
The procedure is a little expensive, but it is a reliable medical procedure for weight loss. It is always better to know about the risks involved in this surgery before opting for a weight loss program.
Bariatric surgery is advised only in cases of morbid obesity, which has various severe health effects. Undergoing bariatric or weight loss surgery requires effort not just prior to surgery, but also after surgery to ensure its success. This includes significant diet and lifestyle changes, which often involves moving from one end of the spectrum to another end. However, for a person who is willing to do this, the long-term benefits are multiple.
Read on to know how bariatric surgery can turn your life around.
- Weight loss: Bariatric surgery is advised only for people who are obese. One of the first benefits they would see is weight loss. The tendency to eat less is one of the important ways to reduce eating. Nutrition planning should be meticulously done to achieve two things – avoid weight gain and promote weight loss.
- Emotional gains: For a person who is used to seeing an obese image in the mirror, it is a great morale booster to see that image changing to a slender version. This is a big boost to continue the effort towards diet and exercise, which will only improve the confidence and esteem levels.
- Overall health: Morbid obesity is not an isolated condition. It brings with it a host of medical issues including sleep apnoea, diabetes, hypercholesterolemia, etc. With obesity under control, these conditions also begin to improve and the person’s overall quality of life begins to improve. This in turn provides a big boost for the person to continue working at weight loss.
- Reduced healthcare expenses: Obese people often need to eat various medications to manage overall health. There could also be emotional health management issues. With this controlled, the patient spends less on overall health and feels good again.
- Social connect: Morbid obesity isboth a physical and an emotional blockage for a person to engage socially. Once it is controlled, the person is more confident in meeting people and participating in social activities. This further leads to increased overall happiness.
- Active life: With reduced weight, the person’s level of activity improves. What seemed difficult earlier is suddenly doable. A person who could not walk some steps is able to, and this is a big booster.
People who undergo bariatric surgery require quite a bit of effort to change their overall lifestyle. However, the benefits are for them to see for themselves, and that is the biggest motivator to continue working towards their goal. Support is definitely required both medically and socially to ensure that it works. The benefits are there for all to reap. If you wish to discuss about any specific problem, you can consult a Bariatrician.
A weight loss program is a marathon. While making up the mind to go for a weight loss program is the first step, there are other things to consider before plunging into the diet and exercise regime. Here is a list of 10 things to consider before a weight loss program--
- Not everything works for everyone- Just because a strict diet program helped someone to lose 5 pounds, doesn’t necessarily mean that it will work out for every single person. It is important to figure whether diet, exercise, workout or a combination of everything is required to lose weight.
- Make the environment conducive to match the goal- If the goal is to lose weight, it is essential to skip old habits. For instance, keeping a fruit bowl close by will refrain the thought of having a candy bar, skipping the idea of weekends parties for a while will help to stay away from few extra drinks, a leafy and salad rich lunch would help to stay away from the thought of fast food etc.
- The combination of exercise and diet is necessary- It is necessary to have a healthy mix of diet and exercise. This helps the body to lose weight fast while ensuring that the health is maintained at the same time.
- A plan comes handy- It is necessary to chalk out a plan to get into the weight loss program. For instance, 3 days of gym, 2 days of salad consumption for lunch, 3 days of walking after dinner etc. This will help to beat the monotony and keep the motivation going.
- Set a realistic goal- Losing too much weight in a short span of time is neither healthy nor realistic. It is, therefore, necessary to keep patience and work steadily towards the weight loss goal. An ideal time-frame could range from 3-6 months to attain the desired weight.
- Find the right reason- Since a lot will depend on the long-term discipline, it is, therefore, necessary to find the right reason to lose weight. Looking good or fitting into a skinny-jeans is not the right set of motivational factors to lose weight.
- It is necessary to have coping strategies- There should be a backup plan ready when a craving for chocolate, fast food or ice cream crops up. Healthy alternative such as custard, icy fruit salad, cool drinks can help to cope up with the craving face.
- A workout buddy can prove to be extremely beneficial- Since the process of losing weight is a lonely affair, it makes sense to find a workout buddy. This keeps the boredom of working out at bay and helps to get into a healthy competition.
- A food diary comes handy- While it is practically impossible to keep track all calorie consumption, a food diary will give a rough estimate of the calorie count consumed in a day. This will further help to design a diet for the week.
- Keeping many options open- It is not necessary to spend hours in the gym or only consume fruits to lose weight. Other alternatives such as cycling, swimming, adventure sport also help to lose weight. If you wish to discuss any specific problem, you can consult a bariatrician.
Weight loss surgeries or bariatric surgeries sound nothing short of miraculous. Research proves that they help you lose oodles of sticky fat and you are also able to toss away your type 2 diabetes medications just days after undergoing a weight-loss surgery.
Just the idea of becoming svelte again after a lifetime of being obese is a good inducement to going under the knife, even if you are not a diabetic. But before you take this big risk- bariatric surgery is a major surgery with its own attendant risks- understand whether you are a good candidate for it, which type of bariatric surgery is most effective? And what are the long-term effects?
Rushing in for surgery without having complete knowledge about it could end up causing more problems than it is intended to solve.
Read on to get answers to the fundamentals of bariatric surgery-
Bariatric surgery is digestion redesigned
Bariatric surgery is a work in progress. The procedures are still being fine-tuned since the first bariatric surgery which was carried out in 1956 in America. There are at least seven procedures in bariatric surgery at this time, out of which four are very common. Let’s have a quick look at these four-
1. Gastric Bypass
This is the most frequently performed bariatric surgery. Most gastric bypasses are done laparoscopically in which your surgeon uses a laparoscope to see and work inside your body through just a small incision.
He leaves only a very small part of the stomach, the pouch after a bypass.
As it shrinks the size of the stomach by over 90 percent, from roughly the size of a fist to that of a thumb, a bypass reduces the amount of food you can eat at a time as you feel full faster because the pouch can't hold a lot of food. And also the food you eat bypasses the rest of the stomach, going straight from the pouch to your small intestine which means that lesser calories are absorbed. It also leads to dramatic and quick weight loss and diabetes mellitus reversal.
The re-routing of the food also hinders the absorption of vitamin and minerals, which is why you have to take vitamins to stop deficiencies after a bypass. About 1 out of 5 bypass patients also develop "dumping" syndrome, in which too much-undigested food goes into the small intestine causing diarrhoea and abdominal cramps.
2. Adjustable Gastric Banding
This surgery is also performed laparoscopically and here a fluid-filled belt is wrapped around your stomach. Tightening this belt divides your stomach into two pouches, a small upper pouch that receives food from the esophagus and a larger lower pouch that opens into the small intestine.
This belt's tightness can be adjusted by adding or subtracting saline solution by your doctor. If you tighten the belt, you eat less and lose more weight.
Banding can lead to gastrointestinal distress, such as nausea or bloating especially if you eat too much quickly. Complications with the band can also happen like it might slip out of place or become too loose, or begin to leak. You may have to undergo correction surgeries and infection is always a risk.
3. Sleeve Gastrectomy
This is another form of restrictive weight loss surgery and in this the surgeon removes about 75% of your stomach. What remains of your stomach is a narrow tube or sleeve, which connects to the intestines.
For people who are very obese or sick, this surgery is a heaven send opportunity to lose weight. It has fewer complications as compared to other weight loss surgeries.
It’s an irreversible surgery.
4. Maestro Rechargeable System
Electrical devices are implanted like pacemakers to deliver electrical pulses to the vagus nerve between the stomach and brain. Vagus tells your brain when the stomach is full. The electrical device is implanted in your abdomen and has a remote control that you can adjust from outside. It works by controlling hunger.
You can die of a bariatric surgery even though it’s considered a safe surgery. Death rates are higher for gastric bypass as compared to banding. Therefore, you must take the decision to have this kind of surgery after serious consultations with doctors.
You are an ideal candidate if-
- You're an extremely obese adult with a BMI of over 35
- If you have a weight-related condition like type 2 diabetes
- You have tried everything and failed.
After Bariatric surgery
Life changes forever after such a surgery. You have restrictions imposed on what types of food you can have and in what quantities. Like, you may only be able to have soft foods, less simple carbs than before and other such dos and don’ts which you have to follow for the rest of your life.
If you don’t obey these diet restrictions your operation can fail or you may not get any benefit. Other long-term side effect of weight loss surgery is nausea, vomiting and digestive distress. You also have to exercise regularly after this surgery to rep benefits. If you wish to discuss about any specific problem, you can ask a free question.
Diabetes is a gnawing problem that affects millions throughout the world. It is a disorder that if overlooked can lead to serious diseases; cardiovascular ailments, problems related to vision, kidney problems and many more. While medication tries to regulate your blood sugar levels, it is not always unfailing. Medication along with changes in your diet and lifestyle can still not improve your condition in certain cases. At times it is hard to increase the insulin production in a person's body even after administering medicines solely known for their efficacy. Such kind of diabetic patients can therefore benefit from a Bariatric surgery.
What is a Bariatric surgery?
Bariatric surgery doesn't refer to a single operative method. It involves a host of surgical procedures conducted on a person to rid him or her of obesity. Obesity in combination with diabetes can make a person's life miserable. The treatment of one can come in the way of curing the other. A diabetic patient who also suffers from obesity usually finds it hard to lose weight in spite of exercising or being on diet. Surgery comes to their rescue. This kind of surgery should be fallen back upon as the lender of last resort that is to say when other solutions have not helped. Bariatric surgery is always performed under skilled supervision. It might include reduction of the size of your stomach, removal of a portion of the stomach, or even gastric bypass surgery.
How does Bariatric surgery help reduce Diabetes?
Diabetes can be of three basic kinds;
Type 1 diabetes in which the body produces no amount of insulin.
Type 2 diabetes in which the body produces an insufficient amount of insulin or Gestational diabetes that pregnant women tend to contract.
Bariatric surgery proves to be very advantageous for patients of Type 2 diabetes:
1. Surgery lowers blood sugar levels considerably. Research shows people with acute diabetes made huge improvements after having undergone a Bariatric surgery. Their blood sugar levels dropped by a noticeable percentage and they felt healthier. Reduced blood sugar is an almost immediate effect in some while for others it does take some time.
2. Bariatric surgery exercises a control over cholesterol, blood pressure and triglyceride levels.
3. The impressive benefits of this operation for a Type 2 diabetes patient are not superficial or temporary. If the patient adheres to the lifestyle prescribed by a doctor, takes medication regularly and follows the basics of post- operative care he or she is likely to remain beyond the ambit of this metabolic disorder.
4. It successfully takes care of ailments resulting from diabetes.
5. Bariatric surgery can eliminate the need for medication or it can reduce the dosage of medicines you take. If you wish to discuss about any specific problem, you can consult a Bariatrician.