Expert Q&A: New, Available Treatment in the Weight Loss Journey

HCA Healthcare-affiliated Drs. Michael Snyder and Matthew Brengman are two of only a select few bariatric surgeons trained on the newly approved ORBERA Intragastric Balloon weight loss procedure. The procedure was approved by the U.S. Food and Drug Administration (FDA) in August. Both doctors were involved in the FDA trial of the gastric balloon. We followed up with them to learn more about obesity, the new procedure and how it differs from other weight loss surgeries.

Dr. Michael Snyder

Q:  Why are we or should we be concerned about obesity?

A: There are nearly two billion adults who are overweight or obese across the globe. The United States ranks number one in both adult – 78.6 million affected – and child obesity. In the last 35 years, the obesity rate has more than doubled in all age groups. Obesity also increases the risk of health problems such as heart disease, diabetes, high blood pressure, and sleep apnea, to name a few potentially fatal conditions. However, these are not just statistics we’re talking about, they are lives. Lives that we, as bariatric surgeons, want to help people live to the fullest.  Your weight affects what you do, how you do it and what you want to do.  My goal is to educate, support and care for people struggling with obesity and help them to live life on their own terms.

Dr. Matthew Brengman 

Q: What are the options available to patients who want to lose weight?

A: We realize that weight loss can be a struggle – and, for some, a constant one. The good news is there are options to help people in their weight loss journey. There’s diet and exercise, prescription dietary medications, and if the first two options haven’t worked? …there are weight loss procedures.

That’s where I come in. To help patients go over the options, benefits and risks of weight loss procedures. First, there are the “traditional” surgical weight loss surgeries, specifically:

• Laparoscopic Gastric bypass, known as “The Gold Standard”. It’s been around since the 1960s and is the most commonly performed weight loss procedure due to its name recognition and its potential for the greatest weight loss. It’s highly effective and specifically indicated in patients with more severe and long-standing diabetes and those with severe reflux and large hiatal hernias – when the stomach bulges through the diaphragm.
• Laparoscopic Gastric Sleeve or the “sleeve” is a newer procedure commonly performed for the last 10 years.  It represents over 50 percent of all weight loss surgeries over the past couple of years in the United States.  Typical patients are at least 75 pounds overweight, and their weight and quality of life are affected by their weight.
• Lap bands probably are best for those individuals who have a body mass index (BMI) of 30-42.  It is the only surgical procedure with a FDA approved indication for a weight as low as BMI 30 (about 50 pounds overweight). There is no removal or rearrangement of the intestines or stomach.  Patients use specific food types to control their hunger. The weight loss will be at a slower pace, but patients should expect to lose 40 to 50 percent excess weight.

And, just recently, the U.S. Food and Drug Administration (FDA) approved a non-surgical procedure to help those patients who don’t have notable weight issues, yet want to get control of their weight. It’s called the ORBERA Intragastric Balloon.

Dr. Michael Snyder

Q: How does the intragastric balloon differ from the other procedures?

A: It’s the new kid on the block – in the United States, at least.  But, it’s already experienced around 20 years of success with more than 220,000 balloons distributed in over 80 countries. The number one difference between this procedure compared to the “traditionals” is that it’s a non-surgical procedure. It is truly intended for patients with a Body Mass Index (BMI) of 30 to 40 who have attempted more conservative weight reduction alternatives.

It’s performed under a mild sedative, where the deflated ORBERA balloon is placed into the stomach and filled with saline until it reaches the size of a grapefruit. The balloon remains in the stomach for six months and helps curb the patients’ appetite. After six months, the balloon is deflated and removed through a nearly identical outpatient procedure.

On the other hand, the gastric bypass and gastric sleeve are both inpatient procedures that can be performed through open surgery or laparoscopically. The gastric bypass restricts the amount of food you can eat and reduces the amount of calories absorbed by the body by creating a pouch from the stomach and rerouting food to that pouch, while the gastric sleeve procedure (which is irreversible) removes nearly 70 percent of your stomach. The remaining portion is a tube about the size of a banana.

Lastly, the lap band is an outpatient procedure where the stomach is neither opened nor stapled. A silicone band is placed around the stomach, creating a small pouch that restricts the amount of food that can enter the stomach.

Dr. Matthew Brengman 

Q: What’s unique about the intragastric balloon procedure?

A:   This procedure is for those patients who are moderately obese (BMI 30-40), weren’t successful with diet and exercise and who don’t desire a permanent surgical procedure. It fills the gap and provides a bridge therapy for people who didn’t previously have a medical weight loss option. This solution is also unique in that it teams each individual with experts – a dietician, psychologist or exercise physiologist, for example – for one year to help them make better food choices and sustain their weight loss over time.

Dr. Snyder/Dr. Brengman

Q: Have either of you performed the intragastric balloon procedure yet?  Tell us about it.

A: Dr. Snyder:  I have performed the balloon procedure before. I participated in the FDA trial last year and we have already started doing some of the procedures here in Denver since FDA approval came in August.  The procedures have gone well.  Our team has learned how to do them efficiently, so the patients can get home quickly and back to work.  It’s a big lifestyle adjustment, but as more people become aware of this option, we think it’s going to be a really useful and effective procedure for some of our patients.

A: Dr. Brengman: We performed the first intragastric balloon procedure in the Mid-Atlantic regions of the United States in September of 2015.  During the 15-minute procedure, the patient underwent sedation, screening endoscopy and balloon placement.  The patient was discharged home within an hour of the procedure.

The patient did experience typical nausea for the first two days following the procedure.  By the third day she was feeling well but “full”. This patient was really excited.  Her BMI was in the low 30’s and she had pre-diabetes and mild hypertension.  She really had tried hard with multiple medical regimens, including prescription medications.

Over the next six months she will work with our team to lose weight, establish that weight loss and then we will remove the balloon at six months.

Dr. Snyder is the medical director of the Bariatric Surgery Center at Rose Medical Center in Denver, Colo. He appeared on the Dr. Oz show to discuss the intragastric balloon. Dr. Brengman is with Advanced Surgical Partners of Virginia and is the medical director for Parham Doctors Hospital Bariatric Program in Richmond, Va.