A peer-reviewed, evidence-based journal that promotes clinical development and metabolic insights in total bariatric patient care for the healthcare professional
Issue link: https://bariatrictimes.epubxp.com/i/651228
Editorial Message 3 Bariatric Times • March 2016 Dear Readers: Welcome to the March 2016 issue of Bariatric Times. It is an honor to provide a summary of the articles being featured this month and also to discuss some important, timely topics in our field. In "Anesthetic Aspects of Bariatric Surgery," authors Ingrid Moreno-Duarte, MD, and Roman Schumann, MD, report results of a study aimed to document and quantify the research on anesthesia in patients with obesity. They found that, despite a prevalence of perioperative obesity of approximately 30 percent, an average of just above two percent of scientific abstracts at two leading anesthesiology society meetings were obesity related in the last 14 years. They concluded that future research should focus more on the patient population with obesity. Authors 2nd LT Solomon Tong, MS; LCDR Jesse Bandle, MD; and CDR Gordon G. Wisbach, MD, MBA, present an interesting case report on late onset abdominal pain after gastric bypass due to a rare diagnosis—jejuno-jejunostomy volvulus. They state that such a complication can be difficult to diagnose nonoperatively and challenging to differentiate from other gastrointestinal disorders since abdominal pain with or without nausea and vomiting, are typically vague symptoms. This month's "Emerging Technologies" column features an article titled, "Intragastric Balloons: Closing the Gap on Weight Loss Treatment Options," which I contributed. In this article, I discuss the clinical trials evaluating the safety and effectiveness of the intragastric balloons (IGB [ReShape ® Integrated Dual Balloon System, ReShape Medical, Inc., San Clemente, California, and Orbera ™ Intragastric Balloon System, Apollo Endosurgery Inc, Austin, Texas]). I provide an overview of how IGB systems work and discuss their role among current obesity treatments. When discussing IGB systems and other endoscopic therapies, it is important to emphasize that these therapies are not in competition with bariatric surgery (e.g., Roux-en-Y gastric bypass, sleeve gastrectomy). The balloon isn't a therapy that offers a long- term, permanent weight loss solution, however, it allows a good, strong diet and weight loss program to work for a patient much better than without the balloon intervention. Patients who are either not candidates for or do not want to undergo surgery may try multiple diet/lifestyle modification plans, lose some weight, experience regain, and then feel frustrated. The balloon provides an intervention for these patients, allowing them to achieve up to 2 to 3 times the weight loss achieved with just diet/lifestyle modification. The period of time in which the patient has the balloon (6 months) is a great opportunity for us to teach them how to make dietary and lifestyle changes. So, coupled with a multidisciplinary weight loss program, the balloon has a role in treating obesity at a certain stage—body mass index (BMI) 30–40kg/m 2 . As with other weight loss therapies, some patients may Dear Colleagues, Since the United States FDA Approval of two intragastricballoon (IGB) systems (ReShape ® Integrated Dual Balloon System, ReShape Medical, Inc., San Clemente, California, and Orbera ™ Intragastric Balloon System, Apollo Endosurgery Inc, Austin, Texas) last summer, we have been learning more about this and other endoscopic therapies and how they may assist patients with lower BMIs. This month, Dr. Jaime Ponce discusses IGB research both in and outside of the United States; details of the procedure and programs; benefits, limitations, and adverse events, as well as a brief description of his personal experience. I believe that the IGB and other endoscopic therapies help bridge the gap between pharmacotherapy and surgery. In turn, they provide effective treatment to patients afflicted by the disease of obesity that may otherwise not seek treatment. Although such therapies may not result in as much weight loss as bariatric surgery, the modest weight loss is nonetheless significant. Results from US clinical trials show that patients who have the IGB experience superior excess weight loss at six months compared to patients who diet and exercise alone. It goes back to the message I've touted before: modest weight loss is an important and an achievable goal in controlling obesity related medical problems. Recent research agrees. In an article published last month in Cell Biology, Magkos et al 1 demonstrated once again that a "moderate five percent weight loss improves metabolic function in multiple organs simultaneously, and progressive weight loss causes dose-dependent alterations in key adipose tissue biological pathways." Weight loss produced by IGB and other therapies indicated for patients of lower BMI (30–40kg/m 2 ) may also have a significant impact on improving type 2 diabetes mellitus (T2DM), hypertension, obstructive sleep apnea, and nonalcoholic fatty liver disease (NAFLD). NAFLD, one of the less talked about comorbidities of obesity, encompasses steatosis, nonalcoholic steatohepatitis (NASH), fibrosis, and cirrhosis. Currently NASH is the second most common indication for liver transplantation in the country today. 2 Weight loss is the most beneficial treatment for there are unfortunately no pharmacologic treatments available. The good news is, however, that even modest weight loss has been proven to be beneficial in patients with NASH. In addition to helping patients achieve their weight loss goals, the IGB may help with patient adherence since it is an implanted device. Unlike pharmacotherapy, the patient does not have to remember to take medications every day. Like all other adjective treatments, patients should be adherent to a comprehensive program for the IGB to be most effective. Currently, the IGB is approved for six months of implantation. This, and other short-term devices, may also benefit patients that need to lose weight and improve their health conditions before undergoing elective surgical procedure, such as a knee or hip THE LANDSCAPE OF BARIATRICS: A Discussion on the Role of Intragastric Balloons, Evaluating Case Growth, and Determining Realistic Needs for the Future Intragastric Balloons May Help Individuals with Obesity Reach the Important Goal of Modest Weight Loss, Improve Obesity- Related Comorbidities A Message from Dr. Jaime Ponce A Message from Dr. Christopher Still Christopher Still, DO, FACN, FACP, Co-Clinical Editor, Bariatric Times; Medical Director for the Center for Nutrition and Weight Management, and Director for Geisinger Obesity Research I nstitute, Geisinger Medical Center, Danville, Pennsylvania. Dr. Still is also a board member of the Obesity Action Coalition, Tampa, Florida. Jaime Ponce, MD, FACS, FASMBS, is from Chattanooga Bariatrics, Chattanooga, Tennessee. He is a past president of t he American Society for Metabolic and Bariatric Surgery. Continued on following page... Continued on following page...