Updated: Dec 6, 2020
This week’s blog is to congratulate everyone who has participated in a Rainier Medical Program in the past! Our results were accepted for presentation at The Obesity Society Annual Meeting in November, 2020! I will share our results below and share an article in the Journal of the American Medical Association on the Gastric Balloon for Weight Loss as well. While these are not a “head to head” trial and so the results should not be directly compared, it may be interesting to see the articles side by side. Keep in mind, the poster abstract was not “peer reviewed.”
"Weight Loss Outcomes of an Insurance Based Obesity Medicine Private Practice"
Valerie Sutherland, MD
There are multiple settings in which the disease of overweight/obesity may be treated. In this retrospective review, the weight loss outcome of an intensive medical intervention administered within a solo private practice was analyzed.
All patients during one year seen at two locations of the practice were included in the analysis for whom at least two weight measurements were available. To be included, patients had to meet one of the following criteria: (1) BMI>/= 27 with a weight related medical condition, (2)BMI>/= 30, or (3) percent body fat >25 for men or >32 for women. All patients were enrolled in a supervised medical weight loss program which included a low calorie diet, typically 800 kilocalories for women and 1000 kilocalories for men, weekly intensive behavioral therapy, monthly body composition analysis, monthly laboratory evaluation, and an exercise prescription. Patients were allowed to self select their nutrition program from a complete meal replacement program, a grocery meal program, or a combined approach. They had access to online education modules and a mobile app for self monitoring. A physician or physician assistant oversaw the progress and adjusted each program accordingly.
Weight loss results were as follows: 467 patients included, 12% had weight loss under 5%, 15% had weight loss of 5-9%, 22% had weight loss of 10-14%, 25% had weight loss of 15-19%, and 26% had weight loss of 20% or more. The average weight loss was 15%. Results were based on the last weight obtained.
While modest weight loss of 5%, which is typical for a lifestyle intervention, confers health benefit, weight loss of 15% is more likely to result in dramatic health changes such as the remission of Type 2 Diabetes Mellitus or withdrawal of medications. This demonstrates a non surgical medical intervention resulting in >/=15% weight loss in 51% of participants who lost at least 5% of their body weight. Further studies are needed on weight regain prevention and application to large populations.
This article in the Journal of the American Medical Association (JAMA) summarizes the efficacy and safety of the gastric balloon for weight loss. There are two balloons currently approved for people with a BMI of 30 to 40 who have been unable to lose weight through diet and exercise and who participate in a multidisciplinary weight loss program.
Orbera is a fluid filled balloon placed endoscopically while a person is under mild sedation. It is temporary and has to be removed within 6 months. Obalon is an air-filled balloon which is swallowed and then inflated via a catheter and then removed endoscopically within 6 months. Up to three balloons can be swallowed.
The fluid filled balloon is most studied. A study of 66 patients showed weight loss average of 14.2% in those with the balloon and 4.8% in those with the sham device after 6 months. At 12 months, the weight loss was 9.2% in those who had had the balloon and 5.2% in those who had the sham device.
The air filled balloon study of 419 people included 387 who were able to successfully swallow the device. The weight loss was 6.6% in those who had the balloon and 3.4% in those who had the sham device.
Safety analyses showed that 91% of people undergoing the gastric balloon system had mild to moderate adverse effects. Most concerns are related to nausea, vomiting, dyspepsia, and pain. The majority are prescribed proton pump inhibitors. The FDA has received reports of 12 deaths that have occurred worldwide following placement of liquid filled gastric balloon systems and so there is additional manufacturer labelling about the possible risk of death.
I have another blog about bariatric surgery if you would like my perspective on that topic. Next week, stay tuned for information on how estrogen changes leads to body composition changes, in men and women!