Adjustable gastric balloons for weight loss – a higher yield of responders compared to non-adjustable gastric balloons

Introduction: The degree of efficacy and duration of effect of the intragastric balloon (IGB) can be variable and unpredictable. The Spatz Adjustable Intragastric balloon (AIGB) was developed to extend implantation to 1 year, decrease the balloon volume for intolerance and increase the volume for a diminishing effect. The utility/efficacy and responder rate with the Spatz3 AIGB were the subjects of this study. Methods: The results of 227 consecutive patients, without exclusions, in 3 centres implanted with the Spatz3 AIGB were reviewed retrospectively. Mean BMI 35.9; mean weight 99.6 kg; mean Excess Body Weight Loss (EBWL) 30.6%; mean balloon volume 464ml (400–500 ml). Balloon volume adjustments were offered: downward adjustments for intolerance and upward adjustments for weight loss plateau. Results: 227 patients were implanted (mean 10.3 months) yielding a mean weight loss of 15.8 kg; mean 15.7% Total Body Weight Loss (TBWL) and 57.6% Excess Body Weight Loss (EBWL). Response (> 25% EBWL) was achieved in 83.3% of the patients. Downward adjustments in 15 patients (mean 2.3 weeks; mean –120 ml) allowed 12/15 (80%) to continue IGB therapy for a mean of 8.8 months. Upward adjustments in 107 patients (mean of 4.7 months; mean +284ml) yielded an additional mean weight loss of 8.5 kg. The upward-adjusted group at extraction had a mean weight loss of 17.8 kg; 17.2% TBWL and 59.2% EBWL. Two gastric ulcers: one due to NSAIDs and one healed with downward adjustment. Conclusions: In this retrospective review of 227 consecutive Spatz3 AIGB patients, upward adjustments yielded a mean 8.5 kg extra weight loss for those with a weight loss plateau, and downward adjustments alleviated early intolerance in 80% of the patients. These two adjustment functions may be instrumental in yielding a response rate of 83.3%

The diagnostic criteria of "weight loss plateau" phenomenon in the treatment of obesity

Background. The phenomenon of "weight loss plateau" is not fully understood, and because of this practitioners may reasonably have difficulties in determining its truth or falsity; there is no clear boarders to identify this condition. Aims. To generate diagnostic criteria of "weight loss plateau" phenomenon useful for estimating the rate of weight gain dynamics in the treatment of obesity. Materials and methods. Statistical analysis of basal metabolism (BM) calculated level (the sample mean and sample standard deviation) on the basis of potential mathematically matched anthropometric data with subsequent determination of the proportion of these BM values difference in overweight and obesity patients, and numbers of the desired weight. Results. Formation of a numeric array on theoretically inherent output, obtained the average proportion of the difference between present BM values and recommended indicators that are proposed to be guided to determine the phenomenon of "weight loss plateau" in the process of diet therapy of obesity. Conclusions. Authors offer available for using algorithm, which allows establish the potential availability of "weight loss plateau" phenomenon and its truth or falsity on different stages of weight loss process in obesity. These arguments need further scientific dialogue and research.

One year adjustable intragastric balloon: safety and efficacy of the Spatz3 adjustable balloons

Background: The Spatz3 Adjustable balloon system is approved for 1 year implantation and allows multiple changes in the balloon volume during the course of implantation.Other intragastric balloons are currently approved for 6 months and their balloon volumes cannot be adjusted after implantation.Aim: To determine the efficacy and safety of the Spatz3 adjustable balloon system.Methods: Seventy seven consecutive patients (66 females and 11 males) in two medical centers were implanted with the Spatz3 adjustable balloon device and were followed prospectively. The patients’ mean BMI was 37.2; the mean weight was 108.7 kg; the mean age was 41 (16-68); the mean balloon volume was 469 ml (450-500 ml). Adjustments were made for intolerance or weight loss plateau.Results: The mean weight loss at 1 year was 17.2 kg with 15.9 % weight loss and 42.9 % Excess Weight Loss (%EWL). Eighteen patients underwent balloon volume adjustments: three downward adjustments of 100 -150 cc which alleviated early intolerance; 15 upward adjustments (mean 320 ml; range 200-500) at a mean 4.1 months (range 2-5 months) yielded additional mean wt loss of 8.2 kg (range 0-25 kg) after the adjustment. Three balloons were removed before the 1 year completion date due to intolerance and three others were removed for other reasons (pregnancy, gall bladder surgery, and alcoholism). There was one episode of gastric ulceration which required endoscopic therapy and balloon removal. There were no deflations or perforations. Conclusions: The Spatz3 adjustable balloon is a safe and effective treatment for weight loss. The adjustability function can yield greater weight loss for those who show weight loss plateau and can mitigate intolerance.

Increase in depression symptoms with weight loss: association with glucose homeostasis and thyroid function

The purpose of this study was to assess the potential impact of weight loss up to a state of plateau on symptoms of depression. Eleven obese men (mean body mass index (BMI) = 33.4 kg·m–2, mean age = 38 y) participated in this repeated-measures, within-subjects, clinical intervention. They were subjected to a weight-loss program that consisted of a supervised diet and exercise clinical intervention. The phases investigated were (i) baseline; (ii) after 5 ± 1 kg loss of body mass (phase 1); (iii) after 10 ± 1 kg weight loss (phase 2); and (iv) at resistance to further weight loss (plateau). At each phase of the weight-reducing program, glucose homeostasis markers were determined using an oral glucose tolerance test (OGTT). Serum thyroid-stimulating hormone (TSH), total triiodothyronine (T3), and free thyroxine (fT4) concentrations were also measured and the Beck Depression Inventory (BDI) was administered. The weight loss plateau occurred after 7.4 ± 1.9 months of intervention and corresponded to a loss of 11.2% of initial body weight (93.9% of which was from fat stores). This amount of weight loss induced a significant decrease in resting metabolic rate (RMR) (p < 0.05) and a significant increase in desire to eat (p < 0.05) and in depression symptoms (p < 0.01) compared with baseline. Intriguingly, the glucose area below fasting values (GABF) at plateau was significantly higher as compared with other phases of the program (p < 0.01). We found a strong negative correlation (r = –0.77, p < 0.01) between the change in glucose concentrations at 180 min of the OGTT and the change in BDI scores between plateau and baseline values. Similarly, highly significant relationships were found between the change in T3 or fT4 concentrations and the change in BDI scores (r = –0.71 and r = –0.68, respectively; p < 0.01). Weight loss until plateauing is associated with a trend toward hypoglycemia at the end of the oral glucose challenge and with a decrease in T3 and fT4 levels. These physiological changes are shown to be highly linked with the increase in depression symptoms observed at plateau. Taken together, these data emphasize the relevance of caution and reasonable objectives when prescribing a weight reduction program to obese individuals.