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Changes in Body Adiposity, Dietary Intake, Physical Activity and Quality of Life of Obese Individuals Submitted to Intragastric Balloon Therapy for 6 Months

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Marcella Rodrigues Guedes
Marcella Rodrigues Guedes
Marcella Rodrigues Guedes
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Ricardo J. Fittipaldi-Fernandez at Endogastro
Ricardo J. Fittipaldi-Fernandez
  • Endogastro
Cristina Fajardo Diestel at Rio de Janeiro State University
Cristina Fajardo Diestel
Márcia Regina Simas Torres Klein at Rio de Janeiro State University
Márcia Regina Simas Torres Klein
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Abstract and Figures

Background Obesity is an important risk factor for several chronic diseases and also is associated with worse quality of life. Intragastric balloon (IGB) is an effective method for weight loss. Although changes in lifestyle are critical to weight loss during and after IGB therapy, only a few studies evaluated dietary intake and none evaluated changes in physical activity with a validated questionnaire during the treatment. The aim of this study was to evaluate changes in total and central body adiposity, dietary intake, physical activity, and quality of life of patients with obesity submitted to IGB treatment for 6 months. Methods Prospective observational study involving 42 patients with obesity using IGB for 6 months. The patients were evaluated, on the day of insertion and withdrawal or adjustment of IGB for total and central body adiposity (anthropometry and bioelectrical impedance), dietary intake, physical activity (Baecke questionnaire), and quality of life (SF-36 questionnaire). Results There was a significant decrease in total and central body adiposity. The mean % total weight loss and % excess weight loss were 15.88 ± 1.42 and 56.04 ± 4.90, respectively and waist circumference decreased 13.33 ± 1.39 cm. There was a reduction in energy intake, an increase in physical activity, and an improvement of quality of life during IGB treatment. Conclusion The present study suggests that IGB treatment during 6 months in individuals with obesity is effective for decreasing total and central body adiposity being associated with reduction in energy intake, increase in physical activity, and improvement in quality of life.
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ORIGINAL CONTRIBUTIONS
Changes in Body Adiposity, Dietary Intake, Physical Activity and Quality
of Life of Obese Individuals Submitted to Intragastric Balloon Therapy
for 6 Months
Marcella Rodrigues Guedes
1,2
&Ricardo José Fittipaldi-Fernandez
1
&Cristina Fajardo Diestel
3
&
Márcia Regina Simas Torres Klein
3
Published online: 7 December 2018
#Springer Science+Business Media, LLC, part of Springer Nature 2018
Abstract
Background Obesity is an important risk factor for several chronic diseases and also is associated with worse quality of life.
Intragastric balloon (IGB) is an effective method for weight loss. Although changes in lifestyle are critical to weight loss during
and after IGB therapy, only a few studies evaluated dietary intake and none evaluated changes inphysical activity with a validated
questionnaire during the treatment. The aim of this study was to evaluate changes in total and central body adiposity, dietary
intake, physical activity, and quality of life of patients with obesity submitted to IGB treatment for 6 months.
Methods Prospective observational study involving 42 patients with obesity using IGB for 6 months. The patients were eval-
uated, on the day of insertion and withdrawal or adjustment of IGB for total and central body adiposity (anthropometry and
bioelectrical impedance), dietary intake, physical activity (Baecke questionnaire), and quality of life (SF-36 questionnaire).
Results There was a significant decrease in total and central body adiposity. The mean % total weight loss and % excess weight
loss were 15.88 ± 1.42 and 56.04 ± 4.90, respectively and waist circumference decreased 13.33 ± 1.39 cm. There was a reduction
in energy intake, an increase in physical activity, and an improvement of quality of life during IGB treatment.
Conclusion The present study suggests that IGB treatment during 6 months in individuals with obesity is effective for decreasing
total and central body adiposity being associated with reduction in energy intake, increase in physical activity, and improvement
in quality of life.
Keywords Intragastric balloon .Obesity .Weight loss .Quality of life .Dietary intake
Introduction
Obesity is a public health problem with high and increasing
worldwide prevalence, being considered a pandemic [1,2].
Excessive adiposity is an important risk factor for several
chronic diseases such as type 2 diabetes mellitus, hyperten-
sion, dyslipidemia, osteoarthritis, obstructive sleep apnea, and
some types of cancer, leading to a negative impact on morbid-
ity and mortality [3–5], and to an increase in the costs of health
care [6,7]. Moreover, obesity may decrease the quality of life,
interfering in physical, social and psychological components
[8,9].
Although a body mass index (BMI) ≥30 kg/m
2
is used to
define obesity [10], this anthropometric parameter has impor-
tant limitations as it does not distinguish between lean and fat
mass and also does not evaluate body adiposity distribution.
Total body adiposity can be evaluated by bioelectrical imped-
ance (BIA) and central distribution of body adiposity
*Ricardo José Fittipaldi-Fernandez
ricfittipaldi@hotmail.com
Marcella Rodrigues Guedes
marcella.rg@hotmail.com
Cristina Fajardo Diestel
crisdiestel@hotmail.com
Márcia Regina Simas Torres Klein
marciarsimas@gmail.com
1
Gastroenterology Endogastro Rio Clinic, 43/1101, Siqueira Campos
Street, Rio de Janeiro, RJ 22031-901, Brazil
2
Post Graduation Program in Clinical and Experimental
Pathophysiology, Rio de Janeiro State University, Rio de
Janeiro, Brazil
3
Department of Applied Nutrition, Nutrition Institute, Rio de Janeiro
State University, 12th floor/524, São Francisco Xavier Street, Rio de
Janeiro, RJ 20550-900, Brazil
Obesity Surgery (2019) 29:843–850
https://doi.org/10.1007/s11695-018-3609-x
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
... The 20 studies were published between 2008 and 2019 with a total number of 876 patients (77% female). Intragastric balloons were the predominant endoscopic therapy (n = 14) [2,20,[33][34][35][36][37][38][39][40][41][42][43][44][45], followed by aspiration therapy (n = 2) [46,47], TOGA (n = 2) [12,48], ESG (n = 1) [13], and TPS (n = 1) [49] (Table S2). ...
... All studies in the meta-analysis were neutral quality except two studies [2,20]. Studies reporting the most significant changes in QoL and mental health were rated neutral [34,40]. All studies reported a significant decrease in weight as changes to total body weight, BMI, TBWL%, or EWL%. ...
... All studies reported a significant decrease in weight as changes to total body weight, BMI, TBWL%, or EWL%. The two studies (Guedes et al. [40] and Deliopoulo et al. [43]) with the largest improvements in mental health also had the greatest weight loss; however, associations with strength of weight loss and change in mental health were not consistent thereafter. The largest improvements in QoL did not coincide with the highest mean weight loss. ...
View
... The remaining 58 articles were evaluated for inclusion by reviewing their full-text and resulted in the exclusion of 42 records for the following reasons [1]: they were not the original study -but systematic reviews of the literature (n = 8) [2] and did not include any psychological predictor or outcome measure (n = 34). References for the 16 remaining articles [44][45][46][47][48][49][50][51][52][53][54][55][56][57][58][59] and retrieved systematic review/meta-analysis [14,36,41,42,[60][61][62][63] were further screened for relevant records, but none was found. In accordance with the PRISMA guidelines [64], the flowchart presented in Figure 1 provides step by step details of the study selection process. ...
... Selected studies were published between 2001 [51] and 2018 [53,54]. Seven out of 16 investigations used a prospective comparative design [48-50, 55-57, 59], while the remaining 9 records employed a prospective single-group observational design type. ...
... Three studies [45,50,59] aimed at assessing the predicting role of anxiety [45] and depression [45], binge eating disorder (BED) [45,59], HRQoL [45], and motivation to change [50] on IGB outcomes, while 12 articles [44,46,47,49,[51][52][53][54][55][56][57][58] investigated the impact of the IGB treatment on psychological indices including anxiety [44] and depression [44], HRQoL [44, 47, 52-54, 56, 58], and QoL [55,57]. Satisfaction with treatment was also explored in 1 record [51]. ...
Systematic Review Psychological Aspects of Treatment with Intragastric Balloon for Management of Obesity: A Systematic Review of the Literature
Article
Full-text available
Introduction: Optimizing maintenance of weight loss for people with obesity following intragastric balloon (IGB) therapy hinges on the degree to which health care providers can recognize both the impact of emotional problems and mood difficulties on their capacity to self-manage, and requirements for additional support. However, there is limited research on the psychological correlates of IGB therapy. This systematic review, for the first time, attempts to identify and synthesize the empirical evidence for the reciprocal influence between psychological variables and IGB outcomes. Methods: A literature search was performed in the PubMed, SCOPUS, MEDLINE, and Google Scholar databases. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed using rigorous inclusion criteria and screening by at least 2 reviewers. The selected articles were assessed for quality using the Strengthening the Reporting of Observational Studies Epidemiology (STROBE) checklist. Data were extracted to address the review aims and presented as a narrative synthesis. The review protocol was preregistered (Prospero CRD42019121291). Results: A total of 16,179 titles, 14,369 abstracts, and 51 full-text articles were screened, of which 16 studies were included. Findings suggest that female gender, older age, basic educational level, and single/divorced civil status, together with lower levels of depression, binge eating, higher perceived quality of life, and motivation to change were predictors of enhanced IGB treatment outcomes. Dissatisfaction with treatment was higher in those with impaired obesity-related social-life difficulties. The IGB treatment was effective in reducing weight and improving depression, anxiety, eating disorder symptoms, and the overall life quality of patients with obesity - mainly within 6 months from the device positioning and in conjunction with conventional therapies. Discussion/conclusion: In line with the available literature on obesity and bariatric surgery interventions, poor mental health appears to be an important barrier for successful weight loss among patients with obesity undergoing IGB treatment. In order to improve the efficacy and effectiveness of the IGB therapy, more comprehensive and standardized studies are needed to provide insight into the psychological mechanisms maintaining weight management issues.
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... The 20 studies were published between 2008 and 2019 with a total number of 876 patients (77% female). Intragastric balloons were the predominant endoscopic therapy (n = 14) [2,20,[33][34][35][36][37][38][39][40][41][42][43][44][45], followed by aspiration therapy (n = 2) [46,47], TOGA (n = 2) [12,48], ESG (n = 1) [13], and TPS (n = 1) [49] (Table S2). ...
... All studies in the meta-analysis were neutral quality except two studies [2,20]. Studies reporting the most significant changes in QoL and mental health were rated neutral [34,40]. All studies reported a significant decrease in weight as changes to total body weight, BMI, TBWL%, or EWL%. ...
... All studies reported a significant decrease in weight as changes to total body weight, BMI, TBWL%, or EWL%. The two studies (Guedes et al. [40] and Deliopoulo et al. [43]) with the largest improvements in mental health also had the greatest weight loss; however, associations with strength of weight loss and change in mental health were not consistent thereafter. The largest improvements in QoL did not coincide with the highest mean weight loss. ...
Do Endoscopic Bariatric Procedures Improve Postprocedural Quality of Life and Mental Health? A Systematic Review and Meta-analysis
Article
Full-text available
  • Oct 2020
  • OBES SURG
Quality of life and mental health are important outcomes of bariatric therapy. This review aimed to determine endoscopic bariatric procedures’ impact on postprocedural quality of life and mental health. Four electronic databases were systematically searched. Studies with adults > 18 years who underwent an endoscopic bariatric procedure and reported pre- and postprocedural quality of life and/or mental health using a validated tool were included. Meta-analyses were conducted using RevMan and study quality was assessed. Twenty studies evaluating five different endoscopic procedures were included (N = 876 total sample size). Intragastric balloon placement was associated with a large improvement in postprocedural quality of life and mental health. Endoscopic bariatric therapies may improve short-term quality of life and mental health alongside weight loss and comorbidity improvement.
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... Excess weight loss of 38.5% was the results for the study by Al-Sabah et al. 3 , which is lower than the values in the current study, while Guedes et al. 17 reported percentage of EWL of 56.04±4.90, which is higher than ours. Al-Sabah et al. 3 also found statistically significant differences between gender regarding percentage of EWL, while we did not 35 . ...
INTRAGASTRIC BALLOON AND IMPACT ON WEIGHT LOSS: EXPERIENCE IN QUITO, EQUADOR
Article
Full-text available
  • May 2023
BACKGROUND Obesity is associated with different medical conditions, such as cardiologic, respiratory, gastrointestinal, and genitourinary, and constitutes a severe health problem. AIMS This study aimed to evaluate the use of intragastric fluid-filled balloon in the reduction of weight and other measurements related to body composition. METHODS This is a retrospective, monocentric study involving all patients who opted for the intragastric balloon Spatz® placement from January 2018 to July 2019, with fulfillment of inclusion and exclusion criteria. The patients were analyzed after 6 and 12 months after the intragastric fluid-filled balloon placed. RESULTS A total of 121 subjects were included in this study, with 83 (68.6%) females and 38 (31.4%) males. The mean age was 36 years and height was 1.64±0.09. Weight mean and standard deviation was 89.85±14.65 kg, and body mass index was 33.05±4.03; body mass index decreased to 29.4 kg/m² with a mean weight of 79.83 kg, after 12 months of follow-up. There were statistical differences between body mass index and the 12 months in fat percentage, fat-free mass (kg), visceral fat area, and basal metabolic rate. There was a significant variation according to gender, with males having highest reduction. The percentage of excess weight loss was 46.19, and the total weight loss was 9.24 at the end of the study. CONCLUSIONS The study demonstrated a benefit of intragastric fluid-filled balloon on weight loss after 12 months. At the end of treatment, body mass index and the measurements of body composition were significantly lower. Men benefited more than women from the treatment. HEADINGS: Endoscopy; Body mass index; Digestive system; Body weight; Obesity
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... Gadd et al [79] tried to analyze the impact of endoscopic bariatric procedures, IGBs included, in the improvement of quality of life (QoL) and mental health, assessed by using a validated tool. Twenty studies published between 2008 and 2019 with a total number of 876 participants (77% female) were included, evaluating five different endoscopic procedures. ...
Six intragastric balloons: Which to choose?
Article
Full-text available
  • Aug 2021
Endoscopically placed intragastric balloons (IGBs) have played a significant role in obesity treatment over the last 30 years, successfully bridging the gap between lifestyle modification/pharmacotherapy and bariatric surgery. Since they provide a continuous sensation of satiety that helps the ingestion of smaller portions of food, facilitating maintenance of a low-calorie diet, they have generally been considered an effective and reversible, less invasive, non-surgical procedure for weight loss. However, some studies indicate that balloons have limited sustainable effectiveness for the vast majority attempting such therapy, resulting in a return to the previous weight after balloon removal. In this review we try to summarize the pros and cons of various balloon types, to guide decision making for both the physician and the obese individual looking for effective treatment. We analyzed the six most commonly used IGBs, namely the liquid-filled balloons Orbera, Spatz3, ReShape Duo and Elipse, and the gas-filled Heliosphere and Obalon - also including comments on the adjustable Spatz3, and the swallowable Obalon and Elipse - to optimize the choice for maximum efficacy and safety.
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... This prospective observational study was conducted with patients suffering from obesity that were submitted to IGB treatment for 6 months at a private clinic, between March 2016 and October 2017. The design of this study has already been described in a previous publication [29], in which data about changes in body adiposity, dietary intake, physical activity, and quality of life during IGB treatment were evaluated. The data of our study were divided into two papers to allow a comprehensive discussion of the different results. ...
Impact of Intragastric Balloon Treatment on Adipokines, Cytokines, and Metabolic Profile in Obese Individuals
Article
Full-text available
  • Aug 2019
  • OBES SURG
Background Obesity is accompanied by adipose tissue remodeling characterized by increased production of tumor necrosis factor-alpha (TNF-α), interleukin (IL)-6, leptin and resistin and reduced secretion of adiponectin, which favors inflammation, metabolic disorders, and cardiovascular diseases. Although intragastric balloon (IGB) can be considered safe and effective for weight loss, its effect on serum levels of these biomarkers has been evaluated only in a few studies, while no previous study evaluated its effect on circulating levels of resistin, TNF-α, and IL-6. The aim of this study was to evaluate the changes in serum levels of metabolic and inflammatory biomarkers in obese patients submitted to IGB treatment. Methods A prospective observational study involving 42 patients with obesity using IGB for 6 months. The patients were evaluated, on the day of insertion and withdrawal or adjustment of IGB, for the following: anthropometric measures and serum levels of adiponectin, leptin, resistin, TNF-α, IL-6, high-sensitivity C-reactive protein (hs-CRP), glucose, insulin, uric acid, triglycerides, and total cholesterol and fractions. Results The body mass index decreased from 35.15 ± 0.41 to 29.50 ± 0.54 kg/m². There was a reduction (p < 0.05) in leptin, hs-CRP, glucose, insulin, HOMA-IR, and triglycerides, while the adiponectin/leptin ratio increased (p < 0.05). Moreover, weight loss presented (1) a positive association with the decrease in leptin, hs-CRP, glucose, insulin, HOMA-IR, uric acid, and total cholesterol and (2) a negative association with the reduction in adiponectin/leptin ratio. Conclusions The present study suggests that 6 months of IGB treatment in obese individuals reduce serum leptin and hs-CRP and improves insulin resistance and lipid profile which may decrease cardiovascular risk.
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A Systematic Review on Intragastric Balloons and TransPyloric Shuttle in Obesity Treatment
Article
Full-text available
  • May 2022
Endoscopic bariatric procedures in the treatment of obesity have become widespread in recent years. In this systematic review, it was aimed to assess the role of intragastric balloons and transpyloric shuttle in the treatment of obesity. A comprehensive search was conducted using the search terms “Intragastric Balloon” and “TransPyloric Shuttle” in PubMed, Cochrane Library and Web of Science databases from 1st of December to 25th of December in 2020. Twenty-seven clinical studies (24 studies on intragastric balloons and 3 studies on transpyloric shuttle) were assessed. It is clear that both methods have significant positive effects on obesity-related comorbidities and weight loss. These techniques also have potential to reduce comedications in patients with type 2 diabetes mellitus and obesity. The most important differences between intragastric balloons and transpyloric shuttle are in the severity and frequency of the complications they cause. While the most common complications related to intragastric balloons are vomiting, nausea, bloating, and abdominal pain, the most common complications due to transpyloric shuttle are gastroduodenal ulcers, gastroesophageal reflux disease, and sore throat. In addition, one of the most important finding is that the type and structure of the balloon, as well as the application period and position of the balloon in the stomach, may cause changes in the adverse and practical effects of intragastric balloons. As a conclusion, intragastric balloon application is a relatively effective short term treatment and relatively safe endoscopic technique used in patients with obesity to improve comorbidities accompanying obesity, but with risks of adverse events. On the other hand, the safety profile of the transpyloric shuttle still needs to be improved.
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Intragastric balloon for weight reduction: rationale, benefits, risks and indications
Article
  • Oct 2020
Intragastric balloon (IGB) placement under endoscopy is a non-invasive method for weight loss.By placing a space-occupying balloon in the stomach, IGB treatment can achieve better effect of weight loss than medications.Herein we review the development of IGB, its effect on weight loss and the mechanism, and the eligible individuals for IGB treatment.We also examine the high-intensity postoperative management following IGB placement, which is important for maintaining long-term weight loss, and discuss the future development of IGB.The patients should understand that on the basis of ensuring a high safety, the weight-losing effect of IGB can be limited and relies heavily on postoperative management.Patients should make a decision on IGB placement after careful consideration of their own physical, economic, and psychological conditions, lifestyle and the line of work in addition to the indications of IGB.IGB placement combined with high-intensity postoperative management and active interventions of lifestyle and dietary habits help to achieve long-term effect of weight loss and improve obesity-related complications.
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Patients undergoing intragastric balloon achieve approximately 50% of their target weight loss in the first month postoperatively: a MBSAQIP® analysis
Article
  • May 2019
  • SURG OBES RELAT DIS
Background: Intragastric balloon (IGB) placement can provide a mean percent total weight loss (%TWL) of 10.2% at 6-month follow-up. Objectives: We aimed to evaluate 30-day outcomes and safety of patients undergoing IGB placement. Setting: Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program. Methods: The 2016 to 2017 Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program was queried for adult patients who underwent primary IGB placement. Demographic characteristics and preoperative risk factors were collected. Postoperative outcomes included %TWL, percent excess weight loss, and complications rates and causes. Subset analysis was done for outcomes comparison between surgeons or gastroenterologists performing the procedure. Statistical analysis was performed using SPSS 25.0. Results: A total of 1221 patients were included. The majority was female (81.9%), Caucasian (81.2%), with a mean age of 48 ± 11.3 years and a mean preoperative body mass index of 34.9 ± 11.2 kg/m2. Of patients, 98.8% were discharged within 24 hours of the procedure. Two patients were admitted to the intensive care unit, and 7.2% received postoperative treatment for dehydration. Reoperation and readmission rates were 1.1% and 7.2%, respectively, mainly due to nausea, vomiting, and poor nutritional status (n = 22). The intervention rate was 6.2%. Patients in this cohort achieved a mean %TWL of 6.2% (standard deviation, 5.52%) and mean TWL of 6.8 kg within 30 days postoperatively (n = 147; 24-30 d). Conclusions: Our data show patients met approximately 50% of their target weight loss 30 days after IGB placement. Nausea, vomiting, and poor nutrition status were the most common complications within 30 days of the procedure. Long-term follow-up is necessary to determine if these patients are able to sustain their weight loss and for how long.
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Endoscopic Bariatric Therapy: A Guide to the Intragastric Balloon
Article
  • May 2019
Intragastric balloons (IGBs) are the most widely available endoscopic bariatric therapy for class I and II obesity in the United States. Although simple in application and reversible by nature, these devices may help patients initiate the important first steps in weight loss maintenance, provided that parallel efforts are in motion to prevent weight recidivism. Too often, therapeutic nihilism stems from unrealistic expectations of a given therapy. In the case of IGBs, this sentiment may occur when these interventions are applied in a vacuum and not within the purview of a multidisciplinary program that actively involves dieticians, endocrinologists, gastroenterologists, and surgeons. There is a clear and present need to apply different tactics in the remissive strategy to control the obesity pandemic, more so in a struggling landscape of an ever-widening gap in bridging interventions. With such demand, the IGB is an available tool that could be helpful when correctly implemented. In this exposition, we summarize the current state of IGBs available worldwide, discuss their mechanism of action, relay evidence for their short- and long-term efficacy, address safety profile concerns, and suggest procedural considerations in the real-world quotidian application.
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Improving Weight Loss by Combination of Two Temporary Antiobesity Treatments
Article
Full-text available
  • Dec 2018
  • OBES SURG
Background It is generally accepted that the efficacy with an intragastric balloon decreases after the first 4 months of treatment. Aim of this study is to evaluate if the association of a very low-calorie ketogenic diet (VLCKD) can improve the results in terms of weight loss parameters and co-morbidities, as compared to usually prescribed low-calorie diet (LCD). Methods For the present study (January 2016–June 2017), 80 patients (20 M/60 F, mean age 37.8 ± 6.1 years; excess weight 56 ± 10 kg; mean BMI 37.2 ± 3.8 kg/m²) underwent Orbera positioning. After 4 months, they were randomized into two groups according to the type of treatment: group A (Bioenterics intragastric balloon – Orbera + VLCKD) (n = 40), and group B (Orbera + LCD) (n = 40). Results All patients completed the study with good adherence to diet therapy treatment allocation. After the 6-month treatment period, at time of Orbera removal, mean weight loss was 19 kg and 12 kg in groups A and B respectively (p < 0.05). Mean BMI was 28.9 ± 2.8 and 31.6 ± 3.1 kg/m² (p < 0.05), and %EWL was 33.1 ± 3.3 and 21.1 ± 2.9 (p < 0.05) in groups A and B respectively. During the last 2 months in group A, the mean weight loss was 8 kg, while in Group B, the main weight loss was 3 kg (p < 0.001). The VLCKD treatment induced a more significant reduction of major comorbidities related to metabolic syndrome. Conclusions This study clearly indicates the efficacy of the prescription of very low-calorie ketogenic diet improving the efficacy of intragastric balloon positioning.
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Intragastric Balloon for Obesity Treatment: Safety, Tolerance, and Efficacy
Article
Full-text available
  • Dec 2017
Background: Obesity is an increasing worldwide problem associated with a vast number of comorbidities. Decreasing body weight by only 5-10% has been shown to slow and even prevent the onset of obesity-related comorbidities. Between pharmacological therapy and bariatric surgery a great variety of endoscopic techniques are available, the most common being intragastric balloon (IGB). The purpose of this study was to assess the safety, tolerance, and kinetics of IGBs in weight loss. The kinetics of weight loss were evaluated in 2 different contexts and phases: after the IGB's removal and after follow-up that varied between 6 and 12 months. Successful weight loss was defined as ≥10% weight loss after 6-12 months. Methods: The study included 51 patients who had undergone Orbera® IGB placement between September 2014 and February 2016. Inclusion criteria were age between 18 and 65 years; body mass index (BMI) 28-35 with severe obesity-related disorders; or BMI 35-40. The IGB was removed 6 months later. All patients were followed for a minimum period of 6-12 months. Results: Of 51 patients, 16 were excluded (7 due to intolerance) and 35 patients entered the study, of which 83% were followed for more than 6-12 months. The average weight loss (WL) and % excess WL (%EWL) after 6 months of treatment were 11.94 kg and 42.16%, respectively. At 6-12 months, after removal of the IGB, the mean WL was 8.25 kg and %EWL was 30.27%. Nineteen patients attained a WL of ≥10% the baseline value at IGB removal and 12 maintained their weight below this threshold during the 6-12 following months. Conclusions: After temporary IGB implantation in overweight or obese individuals, a WL that was ≥10% of weight at baseline was achieved in 54.3% and sustained at 6-12 months in 41.4% of participants. IGBs are an attractive intermediate option between diet and exercise programs and bariatric surgery. In general, IGB placement is a safe and well-tolerated procedure.
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Impact of 6 months of treatment with intragastric balloon on body fat and quality of life in obese individuals with metabolic syndrome
Article
Full-text available
  • Oct 2017
  • HEALTH QUAL LIFE OUT
Background Obesity is a worldwide public health issue with a negative impact on quality of life. Different weight loss interventions have demonstrated improvements in quality of life. The aim of this study was to investigate the effect of 6 months of treatment with an intragastric balloon (IGB) on health-related quality of life (HRQOL) and its relation to changes in body fat in obese individuals with metabolic syndrome (MS). Methods Fifty obese patients with MS aged 18–50 were selected for treatment with IGB for 6 months. Body fat was assessed with anthropometric measures and dual-energy X-ray absorptiometry (DXA) at baseline and after removal of the IGB. HRQOL was evaluated with the short form of the World Health Organization Quality of Life (WHOQOL-BREF) at baseline and soon after removal of the IGB. ResultsThirty-nine patients completed the study. After 6 months, there was a significant improvement in quality of life (p = 0.0009) and health (p < 0.0001) perceptions, and in the Physical (p = 0.001), Psychological (p = 0.031), and Environmental domains (p = 0.0071). Anthropometric measures and total fat determined by DXA were directly and significantly related to an improvement in general aspects of quality of life. The decrease in the percentage of total fat was the parameter that better correlated with improvements in quality of life perception after regression (p = 0.032). Conclusions In obese individuals with MS, weight loss parameters were associated with short-term improvements in HRQOL after 6 months of treatment with IGB. However, only total fat was independently related to HRQOL perception. Trial registrationClinicalTrials.gov NCT01598233.
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Brazilian Intragastric Balloon Consensus Statement (BIBC): practical recommendations based on experience of over 40,000 cases
Article
Full-text available
  • Sep 2017
  • SURG OBES RELAT DIS
Background Intragastric balloons (IGBs) are a minimally invasive option for obesity treatment, acting as a space-occupying device and leading to weight loss through increased satiety. This device has been growing in popularity owing to its safety profile and good weight loss results. However, there are no published guidelines that standardize the technical aspects of the procedure. Objectives To create a practical guideline for intragastric balloon usage. Setting Private and Academic Settings, Brazil. Methods A consensus meeting was held in São Paulo, Brazil, in June 2016, bringing together 39 Brazilian endoscopists with extensive experience in IGBs from all regions of the country. Topics on patient selection, indications, contraindications, multidisciplinary follow-up, technique, and adverse events were discussed in the form of questions. After electronic voting, a consensus was defined when there was ≥70% agreement. Experts were also requested to provide data on their experience with IGBs. Results The selected experts discussed and reached a consensus on 76 questions, mainly concerning specific indications and contraindications for the procedure; technical details, such as patient preparation, minimum balloon-filling volume, techniques for implant and explant; patient follow-up and recommended medication for the adaptation period; and adverse event management. The overall Brazilian expert data encompassed 41,863 IGBs, with a mean percentage total weight loss of 18.4% ± 2.9%. The adverse event rate after the adaptation period was 2.5%, the most common being hyperinflation (.9%) and spontaneous deflation (.8%) of the device. The early removal rate due to intolerance was 2.2%. Conclusions The present consensus represents practical recommendations for performing IGB procedures and reflects Brazil’s significant experience with this device. The experience of over 40,000 cases shows that the device leads to satisfactory weight loss with a low rate of adverse events.
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Health Effects of Overweight and Obesity in 195 Countries over 25 Years
Article
Full-text available
  • Jul 2017
BACKGROUND: Although the rising pandemic of obesity has received major attention in many countries, the effects of this attention on trends and the disease burden of obesity remain uncertain. METHODS: We analyzed data from 68.5 million persons to assess the trends in the prevalence of overweight and obesity among children and adults between 1980 and 2015. Using the Global Burden of Disease study data and methods, we also quantified the burden of disease related to high body-mass index (BMI), according to age, sex, cause, and BMI in 195 countries between 1990 and 2015. RESULTS: In 2015, a total of 107.7 million children and 603.7 million adults were obese. Since 1980, the prevalence of obesity has doubled in more than 70 countries and has continuously increased in most other countries. Although the prevalence of obesity among children has been lower than that among adults, the rate of increase in childhood obesity in many countries has been greater than the rate of increase in adult obesity. High BMI accounted for 4.0 million deaths globally, nearly 40% of which occurred in persons who were not obese. More than two thirds of deaths related to high BMI were due to cardiovascular disease. The disease burden related to high BMI has increased since 1990; however, the rate of this increase has been attenuated owing to decreases in underlying rates of death from cardiovascular disease. CONCLUSIONS: The rapid increase in the prevalence and disease burden of elevated BMI highlights the need for continued focus on surveillance of BMI and identification, implementation, and evaluation of evidence-based interventions to address this problem. (Funded by the Bill and Melinda Gates Foundation.)
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Assessment of Weight Loss With the Intragastric Balloon in Patients With Different Degrees of Obesity
Article
Full-text available
  • Jul 2017
  • SURG LAPARO ENDO PER
Introduction: The intragastric balloon (IGB) is an endoscopic device for the treatment of obesity. Best results are observed in patients who follow a dietary program but few studies have assessed the results of this treatment in patients with different degrees of obesity. Aim: The aim of this study is to compare the efficacy of IGB in patients with different degrees of obesity. Method: A total of 2002 patients with IGB were retrospectively evaluated and were divided into groups according to initial body mass index (BMI) range, as follows: group 1, 27 to 29.9 kg/m; group 2, 30 to 34.9 kg/m; group 3, 35 to 39.9 kg/m; group 4, 40 to 44.9 kg/m; group 5, ≥45 kg/m. Weight was assessed in 3 different times: before (T0), 1 month (T1), 6 months (T2), and 6 months after removal of the IGB (T3). Results: A total of 946 patients lost follow-up. Overall, 40 (3.78%) removed the device before programmed by intolerance, and 1016 patients completed the 6-month treatment. The mean weight loss was 18.9%, excess weight loss 60.1% and an BMI reduction of 6.76 points. 6 months after removal of the balloon 842 patients had continued follow-up (82.8%). At this time, weight loss was 19.84%, excess weight loss was 59.49%, and BMI reduction of 7.06 points. In all groups there was statistical difference between the times T0 and T1 and between T1 and T2 (P<0.001). There was no statistical difference between T2 and T3, in any group. Conclusion: IGB provided sustained weight loss in patients who remained in dietary follow-up for 1 year.
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Improvement of Body Composition and Quality of Life Following Intragastric Balloon
Article
  • Apr 2018
  • OBES SURG
Background: The aim is to evaluate the effects of IGB in overweight or class I obese patients, by analyzing body composition and quality of life (QOL). Methods: Prospective study including patients with BMI 27-34.9 kg/m2.body composition analysis (BCA) was performed before IGB implantation and its removal, after 6 months of treatment. QOL was assessed by the Short Form 36 (SF-36) Health Survey at baseline and after treatment. Results: Forty patients were included in this study, but four were excluded. The total weight decreased by 12.29 kg after 6 months of use of IGB, which corresponds to loss of 13.69% of the total weight. There was a significant reduction in body fat mass and fat area. QOL improved in all eight sections analyzed (p < 0.001 to 0.041): functional capacity, physical aspects, pain, general health status, vitality, social aspects, emotional aspects, and mental health. Conclusions: IGB induces not only weight loss but changes in body composition through the reduction of body fat mass and fat area. Furthermore, it improves QOL.
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A short questionnaire for the measurement of habitual physical activity in epidemiological studies
Article
  • Nov 1982
The construct validity and the test-retest reliability of a self-administered questionnaire about habitual physical activity were investigated in young males (n = 139) and females (n = 167) in three age groups (20 to 22, 25 to 27, and 30 to 32 yr) in a Dutch population. By principal components analysis three conceptually meaningful factors were distinguished. They were interpreted as: 1) physical activity at work; 2) sport during leisure time; and 3) physical activity during leisure time excluding sport. Test-retest showed that the reliability of the three indices constructed from these factors was adequate. Further, it was found that level of education was inversely related to the work index, and positively related to the leisure-time index in both sexes. The subjective experience of work load was not related to the work index, but was inversely related to the sport index, and the leisure-time index in both sexes. The lean body mass was positively related to the work index, and the sport index in males, but was not related to the leisure-time index in either sex. These differences in the relationships support the subdivision of habitual physical activity into the three components mentioned above.
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Maintenance of Lost Weight and Long-Term Management of Obesity
Article
  • Jan 2018
Weight loss can be achieved through a variety of modalities, but long-term maintenance of lost weight is much more challenging. Obesity interventions typically result in early weight loss followed by a weight plateau and progressive regain. This review describes current understanding of the biological, behavioral, and environmental factors driving this near-ubiquitous body weight trajectory and the implications for long-term weight management. Treatment of obesity requires ongoing clinical attention and weight maintenance-specific counseling to support sustainable healthful behaviors and positive weight regulation.
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Obesity as a Disease
Article
  • Oct 2017
  • MED CLIN N AM
Obesity is a complex disease with many causal factors, associated with multiple comorbidities that contribute to significant morbidity and mortality. It is a highly prevalent disease that poses an enormous health and economic burden to society. This article reviews the mechanisms of obesity and its related comorbidities.
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