Intragastric Balloons May Help Individuals with Obesity Reach the Important Goal of Modest Weight Loss, Improve Obesity-Related Comorbidities

A Message from Dr. Christopher Still

Christopher Still, DO, FACN, FACP, Co-Clinical Editor, Bariatric Times; Medical Director for the Center for Nutrition and Weight Management, and Director for Geisinger Obesity Research Institute, Geisinger Medical Center, Danville, Pennsylvania.
Dr. Still is also a board member of the Obesity Action Coalition, Tampa, Florida.

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Dear Colleagues,
Since the United States FDA Approval of two intragastricballoon (IGB) systems (ReShape® Integrated Dual Balloon System, ReShape Medical, Inc., San Clemente, California, and Orbera™ Intragastric Balloon System, Apollo Endosurgery Inc, Austin, Texas) last summer, we have been learning more about this and other endoscopic therapies and how they may assist patients with lower BMIs. This month, Dr. Jaime Ponce discusses IGB research both in and outside of the United States; details of the procedure and programs; benefits, limitations, and adverse events, as well as a brief description of his personal experience.

I believe that the IGB and other endoscopic therapies help bridge the gap between pharmacotherapy and surgery. In turn, they provide effective treatment to patients afflicted by the disease of obesity that may otherwise not seek treatment. Although such therapies may not result in as much weight loss as bariatric surgery, the modest weight loss is nonetheless significant.

Results from US clinical trials show that patients who have the IGB experience superior excess weight loss at six months compared to patients who diet and exercise alone. It goes back to the message I’ve touted before: modest weight loss is an important and an achievable goal in controlling obesity related medical problems. Recent research agrees. In an article published last month in Cell Biology, Magkos et al1 demonstrated once again that a “moderate five percent weight loss improves metabolic function in multiple organs simultaneously, and progressive weight loss causes dose-dependent alterations in key adipose tissue biological pathways.”

Weight loss produced by IGB and other therapies indicated for patients of lower BMI (30–40kg/m2) may also have a significant impact on improving type 2 diabetes mellitus (T2DM), hypertension, obstructive sleep apnea, and nonalcoholic fatty liver disease (NAFLD). NAFLD, one of the less talked about comorbidities of obesity, encompasses steatosis, nonalcoholic steatohepatitis (NASH), fibrosis, and cirrhosis. Currently NASH is the second most common indication for liver transplantation in the country today.[2] Weight loss is the most beneficial treatment for there are unfortunately no pharmacologic treatments available. The good news is, however, that even modest weight loss has been proven to be beneficial in patients with NASH.
In addition to helping patients achieve their weight loss goals, the IGB may help with patient adherence since it is an implanted device. Unlike pharmacotherapy, the patient does not have to remember to take medications every day. Like all other adjective treatments, patients should be adherent to a comprehensive program for the IGB to be most effective.

Currently, the IGB is approved for six months of implantation. This, and other short-term devices, may also benefit patients that need to lose weight and improve their health conditions before undergoing elective surgical procedure, such as a knee or hip replacement.

Obesity medicine specialists consider IGB to be another tool in the toolbox manage patients with obesity. Just like patients on pharmacotherapy or after bariatric surgery, the more accountable the patient is gives him or her the best chance for sustained success. The IGB, along with other devices, fits into the treatment paradigm of a comprehensive approach.

Sincerely,

Christopher Still, DO, FACN, FACP

References
1.    Magkos F, Fraterrigo G, Yoshino J, et al. Effects of moderate and subsequent progressive weight loss on metabolic function and adipose tissue biology in humans with obesity. Cell Metab. 2016 Feb 22. pii: S1550-4131(16)30053-5. [Epub ahead of print]
2.    Zezos P, Renner EL. Liver transplantation and non-alcoholic fatty liver disease. World J Gastroenterol. 2014 Nov 14;20(42):15532-8.

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