Weight Loss and Wellness Program: Endoscopic intragastric balloon
Manpreet Mundi, M.D., Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic: When it comes to weight loss, you have many choices but if we look closely at these options, you see that many centers develop expertise in just one aspect of weight loss. Mayo Clinic has always taken a comprehensive approach to health care. So with this in mind, we've developed clinical expertise that's combined with cutting-edge research to create a team that consists of endocrinologists, dietitians, healthcare coaches, psychologists, gastroenterologists and surgeons who will guide you through your entire journey, giving you the best chance of losing weight and keeping it off.
Andres Acosta Cardenas, M.D., Ph.D., Gastroenterology & Hepatology, Mayo Clinic: We take a different approach basically by saying that we need to introduce tools to help you be successful to a diet and a physical activity program. The reason why we believe that tools are essential for weight loss is because your body usually adapts to a weight loss program if it's only based on a diet and exercise program. There are many things in your body that makes it difficult to sustain that weight loss and more importantly, it makes it difficult to fight back what your body is designed to do. Your body is designed to save energy, so if we don't introduce a tool to help us with that diet program and that exercise program, usually people tend to feel very frustrated. With not eating enough calories, they feel a lot of hungry and appetite and moody and so on, so they usually fail their diet, but it's not because the patient doesn't lack motivation or doesn't want to lose weight, it is usually because your body is fighting against us. So this is where we introduce the tools. We have three tools that are essentials. We have medications, endoscopic procedures, and we have surgery.
Advantages of an endoscopic procedure
Dr. Acosta Cardenas: So endoscopic procedures are the new kids on the block for weight loss tools to help us with a diet and exercise program. They are usually better than medications and sometimes they can be as good as bariatric surgery.
The advantages of an endoscopic procedure is that it's an outpatient procedure, so no need to stay overnight. There is no scars, like in surgery. All of this is done by endoscopy. They are usually safer with less complications. Patients tolerate this better and usually the way that they work is by helping the patient by either decreasing their hungry and appetite levels by making you feel full, by either producing and occupying a space in the stomach, like in the example with the balloons, or in the example of the sleeve, by making you feel full by reducing the size of your stomach.
Intragastric balloon procedure
Barham Abu Dayyeh, M.D., Gastroenterology & Hepatology, Mayo Clinic: Let's start by discussing the intragastric balloon procedure which is a procedure that has been recently approved by the FDA for the management of obesity. Basically, it's an endoscopic procedure. That means it's done in an endoscopy unit as an outpatient using the endoscope. The endoscope is a tube that has a camera on its tip that allow us to insert, to go from the mouth and visualize the esophagus and the stomach. Once we visualize the esophagus and the stomach, we place, we guide the balloon which becomes deflated into the stomach. Once we're happy with the position within the stomach, we then insufflate the balloon with about 650 mL of a salt solution called saline. The fully insufflated balloon is about the size of a grapefruit and sits in the stomach doing two things: one, it makes you feel full when you're fasting because there's something sitting in your stomach, and the other thing, once you eat a healthy meal, it will allow you to feel full longer with a healthy meal because it delays the rate by which food is emptying out of the stomach. So the balloon is designed to stay in the stomach for six months because we know that this is the duration where it's safe to keep this balloon in. After six months, you come back to the same endoscopy unit as the balloon was placed and with the aid of the same endoscope, we go inside the stomach again from your mouth, deflate the balloon, and then retrieve it out of your mouth.
As far as the side effects of the balloon, they're rare. In the first week, it's expected that people have some abdominal cramps and some nausea which we call accommodative symptoms that means your stomach is adjusting to the balloon. We manage these usually with anti-nausea medications and pain medication and the vast majority of these symptoms resolve within the first week. More serious side effects are very rare after the balloon but they could include ulcerations of the stomach, tears in the stomach or the esophagus, and obstruction of the small intestines but these side effects are very rare.
The balloon is a temporary tool that will allow you to lose significant amount of weight. You might be asking me how much weight do I expect to lose with the balloon and it's usually the average weight loss has been about 13% of the total body weight. The key for the balloon procedure, it enables you to adopt a healthier lifestyle. And with that tool and with the aid of our team in nutrition and psychology, we will give you a 12-month program to supplement the balloon in order to allow you to adopt a healthier lifestyle that would allow you to maintain the weight loss for the longer term after the balloon.
Post-procedure lifestyle intervention program
Karen Grothe, Ph.D., L.P., Psychiatry and Psychology, Mayo Clinic: For many people it's not a knowledge deficit that's getting in the way of them being successful with managing weight, it's often about habits or behaviors. And many of us do things that we know are not good for us but we continue to do them anyway, and we can help you try to understand a little bit better what some of the triggers are for those behaviors, some of the consequences and help you really make those behavior changes more in the long term. Also, a lot of people struggle with maintaining motivation over the long term, to eat healthy or to be more active, and so psychologists can really help you tap into what motivates you to try to stay healthy. Additionally, some people struggle with stress or depression or addiction to alcohol or tobacco that can interfere with their ability to be successful, and a psychologist can really help you address and treat those things so that you can be more successful in the long term.
Kristine Schmitz, R.D., L.D., Department of Medicine, Mayo Clinic: An endoscopic procedure causes changes in how your body handles food and nutrients which require changes on your part to. For example, initially, it's important to have a liquid diet to help with healing. Longer term, we'll want to work with you to optimize your nutrition intake. We'll also work with you to identify incorrect eating habits that can sabotage weight loss efforts and it will be important for you to increase your daily activity. We'll also provide you with information on foods and eating patterns that can help you feel full while lowering your calorie intake, and we'll be here along the way to help provide some coaching and support as you progress on your weight-loss journey.
For more information on the Weight Loss and Wellness Program visit: www.mayoclinic.org or call: 507-284-2111.