Diet? Not when a gastric balloon will get weight off faster

[Demi]

The Independent
London, UK
1 January, 2006


Radical ways to fight obesity are on the increase, as more people choose surgery instead of eating less
By Tom Anderson


For millions it is as much a part of the festive season as the mince pies and the hangovers. But for some the January diet is being shunned this year as weary revellers choose radical new cosmetic surgery techniques to battle their bulges.

So out go the Atkins and the F-Plan as those desperate to fight the flab look instead to gastric balloon insertions and lap band tightening. Keyhole surgery and non-invasive procedures have revolutionised the world of cosmetic medicine, and Britons are now abandoning the old-fashioned approach to weight-loss.

Last year, the number of overweight people choosing to slim surgically rocketed by 60 per cent, according to one leading clinic. Medics expect that this year will see an even greater number of slimmers willing to take such drastic action.

"There has been a huge increase in surgery," said Janet Edmond, of the British Obesity Surgery Patients' Association. "We expect it to double next year as well."

Obesity in Britain has quadrupled in the past 25 years. Three- quarters of the UK population is overweight and one-fifth is now classified as obese. Operations to deal with clinical obesity are on the increase within both the NHS, and the private sector. Transform Medical Group revealed that thousands were signing up for its procedures. These include the insertion of an inflatable balloon in the stomach that restricts the amount of food a person can eat.

One of those desperate for positive results is Emma Wade, a 19-year-old medical student, who has had a gastric balloon pushed down her throat to her stomach. She payed £6,000 to have the silicone bag inserted. It was then filled with a saline solution. Since the operation two months ago, her weight has dropped from 17.5 to 15.5 stone. However, the big test will come when the balloon is removed in two months' time.

Other obesity operations are for life. Gastric banding accounts for more than half of all operations for obesity and it sees a permanent adjustable band inserted under the skin and around the stomach at a cost of £6,830.

The effect is similar to that of the balloon. The more established gastric bypass, meanwhile, shortens the intestine surgically so food bypasses most of the stomach. It costs £10,400.

The non-invasive nature of the balloon is thought to appeal to those who might balk at the idea of liposuction or a gastric bypass. However, Dr David Haslam, from the National Obesity Forum warned: "The artificial balloon technique is not gentle on the stomach. The NHS doesn't use it."

Case Study: 'I'm determined this will work'

Emma Wade, 19, works as a sales adviser while studying to be a doctor. She paid £5,995 to have a gastric balloon inserted in her stomach at the Transform clinic in Harley Street, London, last October. She has lost two stone.

"I was always really chubby as a child. I'm a comfort eater. I've tried dieting but it never worked. I went to a surgery clinic and just asked 'what can you do for me?' I chatted to a consultant and agreed to have it done. It was as simple as that. When I first decided to have it done my boyfriend didn't agree with me because of the price - £5,995 is quite a lot for a balloon. When I got there I was put under general anaesthetic and afterwards the clinic told me the procedure took under seven minutes. I was able to leave that night. It was weird to have a foreign body in my stomach. The clinic gave me a dietician and she has been brilliant. The problem is that you can't eat any fat because if you do your body rejects it. You have to eat little and often. I have experienced some pain in my stomach. Part of the problem is that I work in a call centre as well as being a full-time student, so I'm quite stressed. The balloon comes out in April, and I'm really looking forward to it. I am determined that this will work."


http://news.independent.co.uk/uk/health_medical/article335965.ece

[Duparc]

£6000 or $10500 for a 7 minute job? That sure is expensive labour! So the dame mentioned in this article is obese as she is incapable of controlling her own diet and ultimately her health but plans to, presumably, gain a doctorate degree in medicine to help others? She also advocates that she needs to work to finance her studies yet pays $1500 a minute for labour? Sounds like a Groucho Marx's joke! Excellent material for a scriptwriter to make a comedy sketch out of this case-study!

[Lez]

If only.

Sounds like a Groucho Marx's joke! Excellent material for a scriptwriter to make a comedy sketch out of this case-study!

No Emma Wade, will be dispensing her advice on weight loss in a few years.


lez

[Dodger]

As Emma has not learned how to eat properly, she will gain back any weight that she has lost.

[Lisa N]

As Emma has not learned how to eat properly, she will gain back any weight that she has lost.

I was thinking the same thing, Mike. The fact that she is so looking forward to having the baloon removed is telling. She will still be a comfort eater and then able to go back to eating 'comfort foods' without discomfort. ;)

[kaypeeoh]

Someone I know from work had gastric bypass surgery. He was in the 400# range before surgery. After surgery he dropped to roughly 200#. Then he changed jobs and I didn't see him for several months. When I saw him again recently, he looked to have regained weight to be nearly 400# again. I assumed by removing much of the stomach, not only is there less space to hold food but also fewer gastric cells for secreting digestive enzymes. Not the case, apparently.

Another coworker went on a strict diet: lowfat with emphasis on fruit. Similar situation, he went from 350# to 200#. A year later he was back to 350#, possibly more. I saw him recently and now he's 400#.

Two different approaches and both failed in the long run. What they had in common was no interest in exercise.

20 years ago I was kicked in the face by a horse, shattering my jaw. The damage was too severe for surgery so the doctors wired my jaw shut. For two months I lived on liquids. My wife figured out how to liquify most anything. I remember having liquid turkey and stuffing over Thanksgiving. Sounds disgusting but it tasted fine. In the two month period I went from 205# down to 160#. I started running as soon as the wires were removed. At 205# it was a struggle to run 3 miles. At 160#, even though I hadn't exercised during the two months of jaw being wired, I did 6 miles in less time than 3 miles two months earlier. 20 years later I don't have a scale but from counting the holes in my belt I think I'm under 170# now.

People losing weight quickly can have this mindset that they can eat whatever they want because they can always go back to whatever diet they used before. I found as I aged I wasn't burning the calories as much as I used to, even though my weekly mileage has gone up steadily. In 1985 I started running 20 miles a week and now I'm running 90 miles a week. I assume I've become a more efficient animal. :-)

[potatofree]

If you don't deal with whatever is driving you to overeat, you can and WILL find a way to "eat around" any type of surgery... OR food plan, for that matter.

I still say surgery can be a lifesaving tool for some people, but I do believe it has to be coupled with counselling and followed through in order to achieve long-term success.

[judyr]

A friend of the family got a Lap Band a year ago Christmas. She was no sooner home than she started drinking malts and liquified things not on the diet. She lost about 80 pounds by summe, but had to have the band adjusted because of health reasons. She has gained back a great deal of her weight and can't understand why.

[CindySue48]

As Emma has not learned how to eat properly, she will gain back any weight that she has lost.How true! How many of us have said "if I could only get to goal" and then, once we get there?

[CindySue48]

Emma Wade, 19, works as a sales adviser while studying to be a doctor. She paid £5,995 to have a gastric balloon inserted in her stomach at the Transform clinic in Harley Street, London, last October. She has lost two stone.

"I was always really chubby as a child. I'm a comfort eater. I've tried dieting but it never worked. I went to a surgery clinic and just asked 'what can you do for me?' I chatted to a consultant and agreed to have it done. It was as simple as that. When I first decided to have it done my boyfriend didn't agree with me because of the price - £5,995 is quite a lot for a balloon. When I got there I was put under general anaesthetic and afterwards the clinic told me the procedure took under seven minutes. I was able to leave that night. It was weird to have a foreign body in my stomach. The clinic gave me a dietician and she has been brilliant. The problem is that you can't eat any fat because if you do your body rejects it. You have to eat little and often. I have experienced some pain in my stomach. Part of the problem is that I work in a call centre as well as being a full-time student, so I'm quite stressed. The balloon comes out in April, and I'm really looking forward to it. I am determined that this will work."
Lot of money for a 7 min procedure!

Why did she have general anesthesia? The assumption, with time and no mention of incision, is that they used a gastroscope to insert the balloon. Heavy sedation, but not general anesthesia is used.

What does this balloon do that it will cause you to "reject" fat? :rolleyes:

At least with banding and this procedure there's less risk because of less extensive procedures. But it's a shame that these people aren't put on LC first!

[Batipton]

Not to be dumb or anything, but isn't the only thing the balloon doing is taking up space? Couldn't someone also fill that space by eating a lot of food that is high fiber with minimal calorie content. For example, maybe eating 4-6 celery sticks every few hours. It would take up space, provide nutrients, and also have minimal impact on calories or insulin levels. Actually there are plenty of LC, high volumes vegetables out there that could do the trick.

As far as the gastric banding, why not just by a thick leather belt. Cinch that baby around the middle until it meets the hole corresponding to the waist size you'd like to be (or if that is not possible maybe an inch or two below what is currently comfortable). Would that do the same same as gastric banding?

I wonder how many belts and celery sticks one could get for $10,500? Maybe I should open my own weight loss clinic!

[dasanipure]

re: using a tight belt. that's funny, but i think it would squish some very important organs too. ouch!
re: the celery. yes, that's very true. so is the idea that "drinking" your dinner fills you up: if you have the same amount of solid meat suspended in a soupy broth, you're more likely to feel full. half of us eat with our eyes as much as we do with our stomachs. a big bowl filled with food (even if it's mostly non-caloric water) gives the illusion we like.
opening your own weight loss clinic? i think you're onto something... :)

[Dodger]

There were cases of royalty women who severed their kidneys while wearing corsets in France a few hundred years ago. They were trying to get the fashionable wasp waist that was considered to be ideal.

[eepobee]

January 3, 2006
By ELISABETH ROSENTHAL

ROME - After years of failed dieting, Sabrina Spalliera, 33, underwent a minor procedure to have a fluid-filled balloon inserted into her stomach, where it sat for six months last year and simply took up space.

Feeling full after just a few bites of food, Ms. Spalliera, an office worker, quickly lost 77 pounds, dropping from 242 to about 165 pounds. She had read about the balloon on the Internet.

Now, wearing a denim miniskirt and high black boots, she hardly looks like a candidate for weight-loss surgery. But here she is, at Rome's Policlinico Umberto I, asking for another balloon. Her goal: to lose another 22 pounds. "This has radically changed my life; I can walk," Ms. Spalliera said. "I can climb stairs. I have a love life." Surgical procedures to lose weight have gained popularity in Europe as methods have become simpler and obesity rates have climbed.

Though still largely the province of people with dangerous obesity, the procedures are now regarded as so simple and safe by many European surgeons that they are being offered to people like Ms. Spalliera, who, after her initial weight loss, was merely overweight.

In Italy, as in most of Europe, the number of procedures carried out has doubled in the last three years, according to medical studies. A vast majority use a simple, minimally invasive technique in which an adjustable band is slipped around the stomach to reduce its size.

More recently, doctors have been using balloons like Ms. Spalliera's, which can be inserted through a tube in the mouth and inflated in 15 minutes.

"We can afford to offer it to more people since it is relatively complication-free," Dr. Nicola Basso, a leading Italian researcher on surgery for obesity, said of the so-called lap-band technique. "This has become the most common surgical procedure in Western Europe for weight loss. It has the pole position."

But even as Europeans rave about their bands and their balloons, many American doctors have remained suspicious, regarding the techniques as not terribly effective and even dangerous.

Bands, used for more than a decade in Europe, are just catching on in the United States; balloons are not in the pipeline for approval from the Food and Drug Administration yet.

"There are really profound differences in how we think about weight-loss surgery," said Dr. Sayeed Ikramuddin, a fellow of the American College of Surgeons and the chief of bariatric surgery at the University of Minnesota.

Eighty percent of weight-loss surgery in the United States involves a far more arduous and technically demanding bypass operation in which the stomach is cut and made smaller with staples, then reconnected far down in the intestine.

While the initial weight loss is often more rapid, complications are more common and many patients are loath to undergo the larger procedure.

It is a striking example of the way that patients' options are governed by doctors' habits in even the most sophisticated medical systems.

"It's really just a question of who got used to what first, and what has insurance approval," Dr. Ikramuddin said.

In some early trials in the United States, he added, the less invasive techniques produced mixed results, and this lastingly tarnished their reputation among American medical professionals.

Because the new procedures are widely accepted in Italy, both the band and the balloon are virtually free for patients, paid for by the national health insurance plan. In France, the banding procedure is covered, but the balloon option is not; it costs about 5,000 euros or a little more than $5,900.

European surgeons extol the spread of simple weight-loss surgery to the masses, noting that obesity is not just a cosmetic problem.

Most obese people have serious medical problems, like breathing difficulty and diabetes, which shorten their life expectancies; weight loss improves the condition of a majority of them.

"This is a lifesaving procedure which is very difficult for some people to understand," Dr. Basso said.

Obesity rates are rising sharply in countries across Europe, according to the health directorate of the European Commission. Some are catching up with the United States, where obesity rates are 28 percent for men and 34 percent for women.

European Union figures show the highest rates for European men in Cyprus (nearly 27 percent) and for women in Greece (38 percent).

Dr. Basso said that 1.5 million Italians could potentially benefit from weight-loss surgery, and that many were demanding it, especially now that simpler procedures are available.

Davide Rubbio, 48, an ambulance worker in Rome, had missed nine months of work over a three-year period before having the stomach band procedure in February. At about 320 pounds, life was a struggle: he was depressed, could not tie his shoes, had diabetes and was chronically short of breath.

He heard about the band surgery on television; it appealed to him, he said, because it did not require a big operation and "nothing was taken out." Nine months later, he has lost 77 pounds and is losing more. "Now I'm advising everyone I know to have it," he said.

On both sides of the Atlantic, patients who are contemplating weight-loss surgery generally undergo intensive medical and psychological screening.

A patient's body mass index, a measure of obesity, must be above 40, or above 35 if the patient has a related medical disorder like diabetes. (To calculate body mass index, divide your weight in pounds by your height in inches squared. Then multiply the result by 703.)

But in Europe, those criteria are being eroded by the presence of the balloons, and by patient demand.

"You have patients who don't quite meet indications for surgery, but they've failed lots of diets, and they are gaining weight," said Dr. Alfredo Genco of the Policlinico. "So we should do nothing and wait until they get morbidly obese? This is a very safe procedure and can prevent it, so why not give them the option?"

He recently returned from Kentucky, where he inserted the balloon in 10 patients to initiate a trial for F.D.A. approval, which is still years away. His American colleagues, Dr. Genco said, "continue to think of it as dangerous, but it's just not true."

"They don't have experience with the current device," he continued.

To Dr. Genco, the balloon is a tool to help motivated patients lose weight, allowing them in the meantime to acquire healthier eating habits. He said his own wife, who has been struggling to lose 25 or so pounds for years, is now demanding a balloon. If she fails one more round of dieting, she will try it, he said.

In a recently completed clinical trial involving more than 2,500 patients in Italy, serious complications occurred in 5 patients when pressure from the balloon eroded the stomach wall and caused it to burst. Two of the five patients died.

On the other hand, almost 90 percent of people with obesity-related illnesses like diabetes and high blood pressure were cured or showed improvement after six months of the balloon.

Weight-loss experts on both sides of the Atlantic are somewhat mystified about why early trials of banding and balloons were not as successful in the United States as in Europe. Eating habits may be partly to blame, however, as patients must be capable of cutting down on food to benefit fully from the simpler European procedures.

Although the procedures reduce the stomach to the size of a coffee cup, they will "not be effective if it is filled hundreds of times a day," Dr. Basso said.

The lap band procedure involves the placement of a ring around the stomach through a scope inserted through the abdominal wall. Intended to remain for life, it can be adjusted from outside to regulate the flow of food and can be reversed if there are problems.

The balloon is kept in place for six months and is then removed because of concerns that the material might wear out.

Massimo Chiovelli was at the clinic last week for balloon removal after losing a little over 68 pounds. Convinced that he can lose weight and still enjoy life while eating smaller meals, he said he could not eat a steak and that he felt full after a small amount of yogurt. He will soon undergo the longer-term banding procedure.

Mr. Chiovelli, who is a dental technician and who, like many here, wears clothes that now hang loosely on his frame, said: "I was just so fat I couldn't take a walk or climb stairs, and at work I just sit all day."

http://www.nytimes.com/2006/01/03/health/03obes.html?adxnnl=1&adxnnlx=1136264888-zWDumijz0717LcZWQ666jQ

[gryfonclaw]

While this seems to be a successful procedure for some people, I just think losing weight that way seems unhealthy.

[SidC]

While this seems to be a successful procedure for some people, I just think losing weight that way seems unhealthy.
True that it would likely be better to lose weight by makikng permanent changes in diet and exercise, but some people have tried all their lives and failed. At some point, IMO, you do have to ask about trade-offs: is it better for someone to remain overweight, unhappy and unhealthy or to succeed with a less-than-perfect approach?

I can't see using intervention like this for losing 10 or 20 lbs, but if you've got 100 or more to lose, maybe something like this would really benefit people. It might make the journey seem a little less impossible.

[fella]

Those Europeans are being very riske.

[JL53563]

This may work to lose weight, but the person does not learn how to eat to keep the weight off. If a person is unable to lose weight through changes in diet, they are probably unlikely to keep the weight off through changes in diet.

[CindySue48]

True that it would likely be better to lose weight by makikng permanent changes in diet and exercise, but some people have tried all their lives and failed. At some point, IMO, you do have to ask about trade-offs: is it better for someone to remain overweight, unhappy and unhealthy or to succeed with a less-than-perfect approach?How is this different from Yoyo dieting?

I can't see using intervention like this for losing 10 or 20 lbs, but if you've got 100 or more to lose, maybe something like this would really benefit people. It might make the journey seem a little less impossible.Well, the doc in the article is talking about using it on his wife!
He said his own wife, who has been struggling to lose 25 or so pounds for years, is now demanding a balloon. If she fails one more round of dieting, she will try it, he said.

[LC_Dave]

The Atkins diet works. It works for me.

This diet or WOL needs to be presented as a via option. Instead of cutting people open, let's get them eating induction foods.

Even if you have an operation weight loss doesn't occurr overnight!

I know some people don't dig Atkins,

but.... let's not forget people are operating on themselves!

I believe if they can mutilate themselves, then they can stick to the Atkins diet.

[bsheets]

A friend I used to live with had her stomach stapled when she was about 19. While I was living with her (when she was about 25) the staples had come undone. She'd gained back all the weight she lost - maybe plus some - and didn't no why. She went through the procedure again and didn't lose a single kilo.

She's consulting with doctors now (a year later) to have that bowel surgery thing where they remove part of your bowel so you don't absorb as much. It means you have to have supplements for the rest of your life or you may suffer malnutrition. She's fine with that.

Personally, I don't see why you can be prepared to have supplements for the rest of your life but not have enough commitment BEFORE the procedure to do anything "natural" about it.

Also living with her, I know how she eats. I put the weight gain down to her bowls of chocolate icing, buying KFC chicken and only eating the skin, her bowl of butter and sugar mixed together, the instant potato mash she adores... etc.

Having this opinion, I'm probably the worst candidate but I'll be filling in for a girl in feb in a clinic that performs these gastric operations. Maybe I'll open my eyes more and be more sympathetic? Who knows....

e

[Batipton]

I cannot understand for the life of me how professionals miss why such operations have had mixed success in the U.S. At least they should have some idea. Look at how many people in the U.S. drink 100's if not 1000's of calories a day of straight sugar in colas, coffees, fruits juices, and other such concoctions. A can of cola does not take up much space and would quickly pass through the stomach. Maybe on the other side of the Atlantic they don't drink as much sugar, so they are simply eating less solid food.

If I can come up with a simple explanation than you really have to wonder about American doctors as a whole? Seems as if they are trained to treat symptoms, do surgery, and pedal drugs RATHER than actually thinking through and getting to the underlying cause of things.

[kyrasdad]

I know some people don't dig Atkins,but.... let's not forget people are operating on themselves! I believe if they can mutilate themselves, then they can stick to the Atkins diet.

Hell, yes. They make it like surgery is a magic bullet, but it's probably at least as hard as doing a diet, and harder than doing Atkins. If I have the choice between the hard work of a diet and the excrutiating life of being fat, I'll do the hard work. If I have the choice between doing the hard work of Atkins and taking my chance under the knife, I'll do the hard work.

I do think it's hard work. It's not as easy as eating whatever you want, but it's a lot easier than getting filleted or being fat.

[SidC]

How is this different from Yoyo dieting?
Just to be clear, I am not advocating this as an on-going method of weight control and I have no sympathy for the young woman who wanted surgery in order to lose 10 pounds.

I absolutely agree that what people ultimately need to do is to start eating right and getting exercise. Lose the junk food, lose the fast food, the sugar and empty starches and transfats that the food establishment incessantly pushes.

I am a huge fan of the Atkins diet precisely because it is designed to change your eating habits and make a healthy diet part of your lifestyle, not something you do for 3 months and then yoyo back to your previous weight.

My whole family has struggled all their lives with weight, with varying degrees of success. My father and one of my sisters in particular have had problems. My sister, at 5'8", is 400+. She has tried counselling and every diet under the sun. She has started various exercise regimes - but as some of you know, it is so very, very difficult to exercise when you've got that much weight. Ultimately, she has been discouraged and depressed by the thought of having to battle every day for five or more years to get down to something approaching normal.

So my point was that maybe - for some people - you could help them make that lifestyle change by giving them a running start at it. If something like the balloon would allow them to get down to a weight where physical exercise was not a crushing challenge, then maybe you are enabling them to make that lifestyle change.

And even if it only helps a small fraction of people, what is there to lose by giving them this chance?

[kwikdriver]

Eighty percent of weight-loss surgery in the United States involves a far more arduous and technically demanding bypass operation in which the stomach is cut and made smaller with staples, then reconnected far down in the intestine.

It's also more profitable -- I mean, expensive.


European Union figures show the highest rates for European men in Cyprus (nearly 27 percent) and for women in Greece (38 percent).

Where's the Mediterranean Diet I hear so much about?

[CindySue48]

Just to be clear, I am not advocating this as an on-going method of weight control and I have no sympathy for the young woman who wanted surgery in order to lose 10 pounds.

I absolutely agree that what people ultimately need to do is to start eating right and getting exercise. Lose the junk food, lose the fast food, the sugar and empty starches and transfats that the food establishment incessantly pushes.

I am a huge fan of the Atkins diet precisely because it is designed to change your eating habits and make a healthy diet part of your lifestyle, not something you do for 3 months and then yoyo back to your previous weight.

My whole family has struggled all their lives with weight, with varying degrees of success. My father and one of my sisters in particular have had problems. My sister, at 5'8", is 400+. She has tried counselling and every diet under the sun. She has started various exercise regimes - but as some of you know, it is so very, very difficult to exercise when you've got that much weight. Ultimately, she has been discouraged and depressed by the thought of having to battle every day for five or more years to get down to something approaching normal.

So my point was that maybe - for some people - you could help them make that lifestyle change by giving them a running start at it. If something like the balloon would allow them to get down to a weight where physical exercise was not a crushing challenge, then maybe you are enabling them to make that lifestyle change.

And even if it only helps a small fraction of people, what is there to lose by giving them this chance?
While I agree with everything you say.....and am glad that they've finally come up with a way to do this without an incision, I can just see our future!

Once approved, there will be all kinds of people getting this baloon placed....and yes, I can pretty much guarantee there will be some getting it just to loose that last few pounds....or for a special occasion.

Oh well, at least this way, there's no incision, the risk of the procedure is less, and it's readily reversable!

[potatofree]

I guess they can't come up with any surgical intervention that wouldn't also have the potential to be abused by people not medically in danger because of their weight. IMO, that doesn't mean those in NEED should be denied.

[ProfGumby]

As Ricky Ricardo said, "Ay, yai, yai, yai, yai!" :eek:

Self mutilation in lieu of will power? Ya, that's a plan! :eek:

Anyone can get the surgery done, but that is a little extreme for many people looking for an easy way out. Yet it is more and more popular, which in itself is a frightening trend.

Also, I whole heartedly agree that in some instances these types of proceedures are necesary, but someone doing a surgery to lose 10 or 20 pounds is insane, IMHO.

And, as was asked before, this is only slightly different from yo yo dieting in that to yo yo diet, one needent be cut open, and thereby expose themselves to surgical complications etc...

The whole crux of the biscuit is anyone can lose weight temporarily, either through surgery or by a diet. Sheer willpower has caused many to lose desired weight. But sheer willpower is a recipe for failure, as is believing the diet phalacy.

One can force outward change, but for lasting change one has to change the programming in the gray mush inside their head! If the weight loss program is one of a lifestyle change and the person following it continues to learn, be active and stay educated and accept this as the new way of life and the only way to eat, then they are successful. No matter what life plan, or surgical proceedure we are talking about.