Upgraded balloons for weight loss

THIS isn't an easy diet method to swallow, but the gastric balloon is a proven physical procedure to help patients shed that stubborn 10kg of weight - if they're desperate and determined enough.

The gastric balloon is a technique that's been around for about a decade in Singapore now, as a saline-filled silicone balloon that is inserted into the stomach from the mouth by a simple procedure using a gastroscope. It was designed to help weight loss for people with moderate obesity without surgery.

The balloon is kept in the stomach for up to six months and then removed by puncturing, deflating and extracting the device with the gastroscope. The idea is that the balloon, filling up space in the stomach, would help one feel full faster when they eat, thus restricting calories.

Now, a newer balloon will further improve on this weight-loss method, says Melvin Look of PanAsia Surgery Group.

Dr Look says he's had many success stories among his patients with the older gastric balloon, with most patients losing between five and 15 kg within six months.

However, the outcomes can also be quite variable, as some patients do not lose any significant amount of weight at all, he notes. "This may be related to the filling volume of the balloon, as this can range from anything between 400 and 700 ml. It is not easy to predict for a particular individual the optimal size that will give the best satiety effect. The stomach is a very stretchable hollow organ and it is the stimulation of the stretch receptors in the stomach that makes us feel full after a meal," he explains.

A balloon that is too big, on the other hand, can cause side-effects such as vomiting and cramps. Most patients' weight loss also plateaus after two to three months when they get used to the space-occupying effect of the balloon.

Since last year, however, Dr Look has introduced the new adjustable device called the Spatz balloon which allows it to be accessed with the gastroscope and inflated (or deflated) to get the exact desired effect. "This balloon is also safe for a longer period, of up to 12 months instead of just six months. This longer period of treatment, along with a few upward adjustments in size along the way, can lead to a higher success rate in terms of weight loss. Some clinical studies show about 50 per cent loss in excess weight for patients," says Dr Look.

He points out that the longer the balloon stays in the stomach, the higher the chance that the body gets used to a lower food intake. "The Spatz balloon also allows for repeated treatments."

The insertion procedure is the same. The Spatz adjustable gastric balloon is performed under sedation in a simple 15-minute gastroscopy procedure. Most patients are discharged after a few hours rest and then reviewed at the clinic a week later.

Dr Look points out that the gastric balloon is a medical device and a tool that helps change eating habits. "Close follow-up with our team of doctors and dietitian is required to effect that change."

Although this is a very safe procedure, most patients will have a variable amount of cramps and vomiting for the first few days. "This usually subsides with time and with medication, but we always warn our patients to be mentally prepared for a difficult initial period. Some patients cannot tolerate this, however, and we may have to consider removing the balloon if the body constantly rejects the device. An advantage of the adjustable balloon, however, is that we can also downsize the balloon quickly for patients who have excessive vomiting, instead of removing it completely like we had to in the past," Dr Look explains.

Having done several hundred gastric balloon procedures over the years, Dr Look says his initial experience with the adjustable balloon has been very positive. "I think with the improvements in product design this can play a bigger role in helping patients achieve sustainable weight loss. It will probably work best in people with moderate obesity, with a Body Mass Index between 27 and 37, who do not require weight loss surgery but needs some medical help in losing weight if conservative measures with diet, exercise and behaviour modification do not work."

In his years of working with overweight patients, Dr Look's own view is that too many people who are trying to lose weight focus on dieting alone. "A sensible balanced diet is one of the cornerstones of any weight-loss programme but this only addresses reduction in calorie intake alone. We mustn't forget that we need to increase energy output as well, through an active lifestyle and regular exercise," he points out.

His advice is that to lose weight at an ideal rate of 0.5 to one kg a week, one should aim for a moderate calorie deficit of about 20 per cent below maintenance levels. That means eating about 500 fewer calories a day for the average person.

"Don't forget that we want to lose fat and not muscle weight. That's why proteins should be an important part of the diet plan and weight training to maintain muscle mass should be added to the exercise prescription," he adds.