Update on weight management options

This post has been updated so please choose this link

approaches to weight loss.

First and always are lifestyle changes involving food choices, and eating habits.

Along with that, one needs to start or increase physical activity.

There are many different ways to achieve these, from books, videos, group activities, online programs, counselling and many combinations of these.

For those folks who still can’t reach goal, the next options are weight loss medications, and surgery.

someone standing on a scale
New weight loss options are good news.

Now there are FDA approved options which do not involve drugs or invasive surgery. These medical devices aid weight loss by affecting the amount of food that gets eaten and/or absorbed into the body.

The ReShape Integrated Dual Balloon System was approved by the U.S. Food and Drug Administration in July 2015. . Candidates for the device are

  • Adults
  • BMI 30-40
  • At least one obesity-related condition- hypertension, diabetes, elevated cholesterol

It is a device placed into the stomach by going through the mouth and down through the esophagus through a tube called an endoscope. It takes about 30 minutes and requires on a mild sedative, not general anesthesia. Once in the stomach the “balloons” are inflated; by taking up space in the stomach it can trigger a feeling of fullness.

Patients still continue to follow their eating and exercise plan and the device is removed in 6 months.

Like any medical procedure, there are potential adverse effects including headache, muscle pain, and nausea from the sedation and procedure; in rare cases, severe allergic reaction, heart attack, esophageal tear, infection, and breathing difficulties can occur. Once the device is placed in the stomach, patients may experience vomiting, nausea, abdominal pain, gastric (stomach) ulcers, and feelings of indigestion.

The Orbera Gastric Balloon works in a similar way, with a single silicone balloon. Potential adverse effects are similar to the ReShape.

The Maestro Rechargeable System is implanted under the skin; an intermittent pulse generator delivers an electrical signal to the vagus nerve in the abdomen. The vagus nerve controls stomach action; when slowed down, one feels full sooner and theoretically will eat less.

 

Another interesting device is AspireAssist.

This is a tube inserted into the stomach, from which a portion of the stomach contents can be “aspirated” (removed) after eating.

This device helped 10 out of 11 people loss 18% of total body weight in one year.

An application has been submitted to the FDA but it has not been approved for use in the United States.

People lost weight with all of these devices largely due to the intensive counseling and support they received along with use of the device.

tape-403591_1280
Obesity is defined using BMI, body mass index, but waist circumference is also important and may be more accurate.

A success story

After gaining weight with her pregnancies, one woman , J.T. ,successfully lost weight with gastric bypass surgery.

Read about the lifestyle changes she made at this article from American Family Physician journal

 

IN THE NEWS- BIG LOSSES, BIG GAINS

Many news sources have reported  a recently published study about contestants in “The Biggest Loser” weight loss contest. In this contest, severely obese people have lost huge amounts of weight with strict diets and vigorous exercise.

Unfortunately, the study found that most of them gained most of the weight back over time, due to what the scientists called “metabolic adaptation”, popularly called slowed metabolism. This is discouraging news.

However, they also point out that even though the contestants regained a “substantial” amount of weight in 6 years post competition,

“they overall were quite successful at long term weight loss compared with other lifestyle interventions.”

Even though they regained weight, they still weighed less than when they started.

If you want to read the full report with all the graphs and statistical analysis, here is the link

Persistent metabolic adaptation 6 years after “The Biggest Loser” competition

statues of athletes jumping
Contestants in the Biggest Loser competition exercised several hours daily but did not continue this after it ended.

Finf other posts about weight management at these links (info current as of the publication date)

Obesity and BMI defined

How we should view excess weight 

How effective are weight management programs? 

A success story; how a doctor helped her patient lose weight

When diet alone doesn’t work

How my friend lost weight and inspired others with her example

 

Dr. Aletha

Heartburn, hernias, and how to lose weight – a Q&A post

Today I am answering a medical question about my recent post on a new option for weight loss without using drugs or invasive surgery.

The ReShape Integrated Dual Balloon System was approved by the U.S. Food and Drug Administration in July 2015.  The device can be  offered to adults with

  • BMI 30-40
  • At least one obesity-related condition- hypertension, diabetes, elevated cholesterol

The device is placed into the stomach by going through the mouth and down the esophagus with a tube called an endoscope. It takes about 30 minutes and requires only a mild sedative, not general anesthesia. Once in the stomach the “balloon” is inflated; by taking up space in the stomach it can trigger a feeling of fullness.

ReShape Dual Balloon
The balloon sitting in the stomach. The esophagus is at the top entering the stomach.

Patients  follow their eating and exercise plan and the device is removed in 6 months.

My reader asked if people with heartburn, reflux or a hiatal hernia can use the device safely and effectively. So first let’s understand what these mean.

Heartburn should probably be called “esophagus burn”. It’s that painful sensation in the chest due to acid from the stomach flowing backwards into the esophagus- that’s called reflux, or gastro-esophageal reflux, aka GERD (the D is added to call it a Disease if it’s frequent, persistent, or severe).

A hiatal hernia is related to GERD but not the same thing. To enter the stomach, the esophagus passes through a hole or hiatus in the diaphragm – the large flat muscle that separates the chest from the abdomen. Sometimes this hole becomes stretched so much that part of the stomach gets pulled up into the chest (where it should not be). This enlargement is called a hernia, in this case a hiatal hernia.

In many cases a hernia is associated with  reflux of stomach contents but the person may not experience heartburn. Or,a person can have reflux  and heartburn without the hernia.

Here is an overview of heartburn from FamilyDoctor.org.

Thanks to Pixabay for this nice illustration of the digestive tract.

digestive organs
the human digestive system

Now to answer the question.

ReShape Medical writes on the web site that the device should not be used if the hiatal hernia is larger than 5 cm, about 2 inches.  Even with a smaller hernia, it should not be used if reflux symptoms are severe and persistent.

Persons with any condition affecting the esophagus, stomach or intestines, or previous surgery in these organs probably should not consider this weight loss method. Unfortunately, since so many people experience gastrointestinal disease, this method’s use will be limited.

But there are other weight loss options so just because this one won’t work, don’t give up trying. Here are some other ideas to consider if you want to lose weight.

breaking up with junk food

using weight loss medication

how motivation helps manage weight

Thanks for asking and please, ask another medical question soon.