by Barbara Berkeley, MD
OK. So you have to be as old as I am to get the title of this post.
It comes from the incredibly silly 60s comedy "F Troop", a show about the misadventures of a remote US Army outpost somewhere in the Wild West around the end of the Civil War. It featured dumb jokes, broad slapstick and politically incorrect Indians. If you grew up in the New York area, you were only too familiar with the series promo, which featured this scene which shows the unforgettable reaction of a really unconvincing Native American chieftain to the latest technology.
Technological advances are moving a bit more rapidly these days....in case you hadn't noticed. In the world of obesity treatment, innovators have been working on devices that can promote significant weight loss without resorting to surgery. In the past several months, two forms of intragastric balloon have been approved by the FDA and have reached the market. The balloon seems destined to become a hot topic.
NBC Evening News ran a story on balloon options last night. The news about the balloon is coming out of Obesity Week, a meeting of bariatric physicians, surgeons and allied health professionals currently being held in L.A..
The concept of filling the stomach with something to create fullness is not a new one. Back in the "F Troop" days (and before the AIDS epidemic), our movie magazines were filled with ads for AYDS candies. I remember eating them!! Taken with a hot drink they were supposed to "blow up" in your stomach so that you couldn't eat anything else. Needless to say, they turned out to be just candy and nothing blew up except the size of your thighs.
In the 1980s, a stomach filling device called the Garren Balloon had a brief period of popularity. The balloon was placed via an endoscope (what your gastroenterologist uses to look into your stomach) and removed after a period of several months. My husband, who was training as a GI fellow at the time, quickly discovered that when the time came for retrieval, the balloon was often gone. It had apparently popped and gone south, winding up being flushed into oblivion. A more serious problem came from balloons that migrated out of the stomach and wound up obstructing the intestines further down. Thus, the Garren Balloon rode off into the sunset.
Fast forward 30 years and technological advancements have given a re-do to the balloon concept. After a period of clinical study, the FDA has just approved two versions of the gastric balloon, one which is a single inflatable bubble and one which features two balloons hooked together that conform to the shape of the stomach. Both of these devices are placed under a brief period of sedation and are removed the same way after six months. Placement can be done in an endoscopy unit and does not require hospitalization. Another design which will not require endoscopy but which cannot stay in the stomach as long is currently seeking FDA approval.
The balloon is intended for use by patients with BMI between 30 and 40, which is the main territory for overweight and obese Americans. Weight losses are variable, but are obviously best in those who follow a strict diet plan while the device is in place. The ReShape balloon (the dual bubble version) includes a 12 month counseling and follow up program so that behavioral changes are reinforced.
Our practice is currently considering partnering with a gastroenterology practice to offer the balloon in combination with a year of intensive dietary counseling. The reason? Weight loss is particularly difficult and elusive for a subset of our patients. The current weight loss medications are not particularly effective and surgery is invasive, makes permanent changes to the anatomy and is only available to those who are morbidly obese. We recognize that patients often need more help than dietary changes can give and we welcome the world of new, non-invasive technologies that may soon come along to help. But we remain cautious....and so should you.
If you are thinking about the balloon, what should you consider?
- Be aware of the potential side effects. Nausea and vomiting in the early going and the possibility of a problem when the balloon is placed or removed. There is also an incidence of stomach irritation and ulcer, although low. The new balloons have been designed to resist popping and migrating, but these complications are still possible.
- Be aware that balloons are not yet covered by insurance. Most programs will offer a payment option but the costs will probably be in the $7-8,000 range.
- Be aware that you may need to have an additional medical insurance policy to cover any complications. The cost of this small policy may be included in the total price you are quoted, but do ask.
- Make sure that your balloon is placed by a highly qualified gastroenterologist or bariatric surgeon who has experience doing endoscopy. In the short term, the number of centers that offer the balloon will be limited and experienced, but if the use of the balloon expands markedly, you will want to check about the experience of the center.
- Make sure that your program includes a year of counseling and weight management and that the persons providing that counseling are good at it.
- Recognize that the balloon may stop you from eating too much while in place, but that you must use that time to seriously work on changing the way you eat going forward. (Of course I would recommend that you institute a primarian diet at the time of balloon placement and continue it after removal).
- Continue to read about the device and follow the stories of those who have had it placed. Make your own decisions based on the best available evidence for safety and effectiveness.