“The world will have more obese children and adolescents than underweight by 2022.”

Echoes a news release by the World Health Organisation (WHO), detailing the staggering hike in the global prevalence of obesity. Obesity has been a chronic disease battled worldwide for years – and for the last decade, the typical recommendations – as far as options go – given to obese patients were to adapt a healthier diet and exercise frequently.

Despite the prominent advice, there seems no stopping to the number of cases – related to obesity and overweight – reported annually, which continues to reflect worrying trends. Express UK recently reported a research that shows hospital doctors see obese patient every 15 seconds with a record of more than 600,00 hospital appointments consisting of obese patients just last year, as shown by the National Health Service (NHS) digital record.

The report further revealed that weight-related problems cost hospitals almost GBP2 billion every year. “Obesity and weight-related health problems are among the biggest crises of our era and will bankrupt the NHS,” expressed Professor Philip James, former president of the World Obesity Federation.

As the crises continue to rise, doctors believe that diet and exercise alone will not suffice in combating the disease.

Surgical treatment as an alternative to combat obesity

Powering it through: Patients battling with obesity need more than just exercise and a healthy diet.
Powering it through: Patients battling with obesity need more than just exercise and a healthy diet.

“It’s a common myth in the eyes of the public that obesity is a sign of mental weakness and that it can be controlled by diet and exercise. There are many other factors that can come into play, such as genetic factors, psycho-social and social economic factors,” explained Dr Tan Chun Hai, consultant of general surgery at Khoo Teck Puat Hospital, Singapore.

Assistant Professor Asim Shabbir, director and senior consultant at National University Hospital and president of the Obesity & Metabolic Surgery Society of Singapore, added that when a patient tries to lose weight, the body defends itself against dipping too far below a certain weight or “set points”.

“This regulation becomes abnormal in obese people. Even if this set point is abnormally high, the body defends itself.”

To help overcome the problem, Dr Shabbir suggests weight loss surgery or bariatric surgery, which is proven to be more effective for long-term weight loss compared to dietary modifications or exercise. Research also shows that the surgery improves or resolves conditions like diabetes, hypertension, high cholesterol, sleep apnea and other weight-related problems.

There are two common types of bariatric surgery; namely, vertical sleeve gastrectomy, which involves removing a portion of the stomach; and Roux-en-Y gastric bypass surgery, where a small pouch is created from the stomach. A connection will then be formed from the stomach to the small intestines, bypassing parts of the digestive tract.

In Singapore, however, such surgery is generally only considered for patients with a body mass index (BMI) of above 32.5, if they have obesity-related illness, or a BMI above 37.5 if they don’t.

In addition, the number of bariatric surgeries performed at National University Hospital rose from five in 2008 to 93 in 2015 – a clear indication of the surgery gaining popularity in the country.

Non-surgical alternatives

Recently, NHS has reported that in light of the high BMI index set by authorities, patients are desperately eating more to qualify for the stomach-shrinking operations.

“We are in a situation where desperate patients are so obese they want bariatric surgery, but local health authorities are running out of money and cutting back on this. (Therefore), people continue to get fatter so they can have surgery,” explained Tam Fry, chairman of the National Obesity Forum.

If not surgery, then what other alternatives?

Weight loss balloon placement: A deflated intragastric balloon is inserted into the patient’s stomach, and removed after six months. Photo credit: FDA
Weight loss balloon placement: A deflated intragastric balloon is inserted into the patient’s stomach, and removed after six months. Photo credit: FDA

Just last month, leading medical device company (mainly for bariatric and gastrointestinal procedures), Appollo Endosurgery—which officially launched gastric balloon, Orbera outside the US in 2004—announced the presentation of the largest global review of intragastric balloons at ObesityWeek 2017. Titled “Brazilian Intragastric Balloon Consensus after more than 40,000 cases”, the presentation showcased the results of a consensus meeting which was held in Sao Paulo, Brazil back in June 2016—featuring 39 endoscopists with up to 17 years of experience providing intragastric balloon therapy to patients. The group aggregated retrospective data on their experience with intragastric balloons in over 40,000 cases.

According to Dr Manoel Galvao Neto, lead author of the study and Clinical Associate Professor of Surgery at Florida International University and Coordinator of the Esophaegeal Motility Lab at Hospital Estadual Mario Covas in Sao Paulo, Brazil, “The majority of the experience is with Orbera and our conclusion was that intragastric balloons such as Orbera lead to very satisfactory weight loss and a very low rate of adverse events.”

Introducing yet another non-surgical option to help the obese and overweight to battle their weight issue – is a revolutionised swallowable balloon device, from Down Under.

“This is the world's first swallowable, non-operative weight-loss device that's designed to be permanent,” asserted Perth veteran weight-loss surgeon, Dr Tony Kierath, who joined forces with son, Tom, an engineer and materials chemist, to develop the IG Balloon.

According to Dr Kierath, the IG Balloon “stays (in the stomach) permanently… that's really what makes it different from a number of other devices out there on the market at the moment”—further asserting that this new invention will give patients more choice and a greater shot at success.

After the patient swallows the balloon, the internal foam reacts with their body heat and expands in the stomach. It stimulates the stomach lining and slows down digestion – to make the patient feel full, longer.

Previous alleged claims linking patient deaths to gastric balloons

Despite the less invasive method, the US Food and Drug administration (FDA) has reported five deaths allegedly related to the treatment using intragastric silicone balloons—with four of them using Orbera. Although the cause of deaths has yet been determined, FDA had issued a letter to caution healthcare providers of the potential risk.

As to all types of different surgeries, it is of paramount importance to ensure patients are informed about the potential risks before performing the procedure, stresses Dr Christopher Gostout, chief medical officer of Apollo Endosurgery.

“Each patient must be appropriately evaluated prior to the decision to place the balloon, especially the potential risks of anaesthesia and an endoscopic procedure,” emphasised Dr Gostout. MIMS

Read more:
Five deaths allegedly ‘linked’ to weight loss balloons; investigation on-going to determine root cause
Experts weigh in on NHS’ new foggy criteria for obese patients and smokers undergoing surgery
Anti-obesity: FDA approves new stomach-draining device