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Pietrabissa G, Bertuzzi V, Simpson S, Guerrini Usubini A, Cattivelli R, Bertoli S, Mozzi E, Roviaro G, Castelnuovo G, Molinari E. Psychological Aspects of Treatment with Intragastric Balloon for Management of Obesity: A Systematic Review of the Literature. Obes Facts 2022; 15:1-18. [PMID: 34818229 PMCID: PMC8820150 DOI: 10.1159/000518200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 06/24/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Optimizing maintenance of weight loss for people with obesity following intragastric balloon (IGB) therapy hinges on the degree to which health care providers can recognize both the impact of emotional problems and mood difficulties on their capacity to self-manage, and requirements for additional support. However, there is limited research on the psychological correlates of IGB therapy. This systematic review, for the first time, attempts to identify and synthesize the empirical evidence for the reciprocal influence between psychological variables and IGB outcomes. METHODS A literature search was performed in the PubMed, SCOPUS, MEDLINE, and Google Scholar databases. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed using rigorous inclusion criteria and screening by at least 2 reviewers. The selected articles were assessed for quality using the Strengthening the Reporting of Observational Studies Epidemiology (STROBE) checklist. Data were extracted to address the review aims and presented as a narrative synthesis. The review protocol was preregistered (Prospero CRD42019121291). RESULTS A total of 16,179 titles, 14,369 abstracts, and 51 full-text articles were screened, of which 16 studies were included. Findings suggest that female gender, older age, basic educational level, and single/divorced civil status, together with lower levels of depression, binge eating, higher perceived quality of life, and motivation to change were predictors of enhanced IGB treatment outcomes. Dissatisfaction with treatment was higher in those with impaired obesity-related social-life difficulties. The IGB treatment was effective in reducing weight and improving depression, anxiety, eating disorder symptoms, and the overall life quality of patients with obesity - mainly within 6 months from the device positioning and in conjunction with conventional therapies. DISCUSSION/CONCLUSION In line with the available literature on obesity and bariatric surgery interventions, poor mental health appears to be an important barrier for successful weight loss among patients with obesity undergoing IGB treatment. In order to improve the efficacy and effectiveness of the IGB therapy, more comprehensive and standardized studies are needed to provide insight into the psychological mechanisms maintaining weight management issues.
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Affiliation(s)
- Giada Pietrabissa
- Department of Psychology, Catholic University of Milan, Milan, Italy,
- Istituto Auxologico Italiano IRCCS, Psychology Research Laboratory, Milan, Italy,
| | - Vanessa Bertuzzi
- Department of Psychology, Catholic University of Milan, Milan, Italy
| | - Susan Simpson
- Department of Justice and Society, University of South Australia, Adelaide, South Australia, Australia
- Regional Eating Disorders Unit, NHS Lothian, Edinburgh, United Kingdom
| | - Anna Guerrini Usubini
- Department of Psychology, Catholic University of Milan, Milan, Italy
- Istituto Auxologico Italiano IRCCS, Psychology Research Laboratory, Milan, Italy
| | - Roberto Cattivelli
- Department of Psychology, Catholic University of Milan, Milan, Italy
- Istituto Auxologico Italiano IRCCS, Psychology Research Laboratory, Milan, Italy
| | - Simona Bertoli
- Department of Endocrine and Metabolic Diseases, Obesity Unit and Laboratory of Nutrition and Obesity Research, Istituto Auxologico Italiano IRCCS, Milan, Italy
- Department of Food, Environmental and Nutritional Sciences, International Center for the Assessment of Nutritional Status, University of Milan, Milan, Italy
| | - Enrico Mozzi
- Division of General Surgery, Istituto Auxologico Italiano IRCCS, Milan, Italy
| | - Giancarlo Roviaro
- Division of General Surgery, Istituto Auxologico Italiano IRCCS, Milan, Italy
| | - Gianluca Castelnuovo
- Department of Psychology, Catholic University of Milan, Milan, Italy
- Istituto Auxologico Italiano IRCCS, Psychology Research Laboratory, Milan, Italy
| | - Enrico Molinari
- Department of Psychology, Catholic University of Milan, Milan, Italy
- Istituto Auxologico Italiano IRCCS, Psychology Research Laboratory, Milan, Italy
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Stavrou G, Shrewsbury A, Kotzampassi K. Six intragastric balloons: Which to choose? World J Gastrointest Endosc 2021; 13:238-259. [PMID: 34512874 PMCID: PMC8394181 DOI: 10.4253/wjge.v13.i8.238] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 05/17/2021] [Accepted: 07/13/2021] [Indexed: 02/06/2023] Open
Abstract
Endoscopically placed intragastric balloons (IGBs) have played a significant role in obesity treatment over the last 30 years, successfully bridging the gap between lifestyle modification/pharmacotherapy and bariatric surgery. Since they provide a continuous sensation of satiety that helps the ingestion of smaller portions of food, facilitating maintenance of a low-calorie diet, they have generally been considered an effective and reversible, less invasive, non-surgical procedure for weight loss. However, some studies indicate that balloons have limited sustainable effectiveness for the vast majority attempting such therapy, resulting in a return to the previous weight after balloon removal. In this review we try to summarize the pros and cons of various balloon types, to guide decision making for both the physician and the obese individual looking for effective treatment. We analyzed the six most commonly used IGBs, namely the liquid-filled balloons Orbera, Spatz3, ReShape Duo and Elipse, and the gas-filled Heliosphere and Obalon - also including comments on the adjustable Spatz3, and the swallowable Obalon and Elipse - to optimize the choice for maximum efficacy and safety.
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Affiliation(s)
- George Stavrou
- Department of Colorectal Surgery, Addenbrooke’s Hospital, Cambridge CB22QQ, United Kingdom
| | - Anne Shrewsbury
- Department of Surgery, Endoscopy Unit, Aristotle University of Thessaloniki, Thessaloniki 54636, Greece
| | - Katerina Kotzampassi
- Department of Surgery, Endoscopy Unit, Aristotle University of Thessaloniki, Thessaloniki 54636, Greece
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Silva LB, Neto MG. Intragastric balloon. MINIM INVASIV THER 2021; 31:505-514. [PMID: 33571068 DOI: 10.1080/13645706.2021.1874420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The intragastric balloon is a temporary and minimally invasive therapy for weight loss, currently being the main choice for mild obesity. As a space-occupying device, it reduces stomach capacity, resulting in decreased hunger and food intake. There are different balloon models, filled with liquid or air. The most used is the non-adjustable liquid-filled balloon, due to its lower rate of complications. The mechanism of action is multifactorial, involving physiological and neurohormonal changes. The device functions as an artificial bezoar, filling the stomach and leading to early satiety. In the Brazilian Intragastric Balloon Consensus Statement, there was a mean excess weight loss of 18.4%, showing effective weight loss and good safety profile. It is a valid option for overweight and obese patients unresponsive to clinical therapy or who are either not candidates for surgery or who do not wish to undergo a definitive procedure. Besides weight loss, recent studies have shown a positive effect on metabolic parameters. New devices have been developed, such as procedureless and adjustable balloons, with promising results.
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Affiliation(s)
- Lyz Bezerra Silva
- Department of Surgery, Federal University of Pernambuco, Recife, Brazil
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Do Endoscopic Bariatric Procedures Improve Postprocedural Quality of Life and Mental Health? A Systematic Review and Meta-analysis. Obes Surg 2020; 30:4091-4100. [PMID: 32761319 DOI: 10.1007/s11695-020-04860-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 07/08/2020] [Accepted: 07/11/2020] [Indexed: 02/08/2023]
Abstract
Quality of life and mental health are important outcomes of bariatric therapy. This review aimed to determine endoscopic bariatric procedures' impact on postprocedural quality of life and mental health. Four electronic databases were systematically searched. Studies with adults > 18 years who underwent an endoscopic bariatric procedure and reported pre- and postprocedural quality of life and/or mental health using a validated tool were included. Meta-analyses were conducted using RevMan and study quality was assessed. Twenty studies evaluating five different endoscopic procedures were included (N = 876 total sample size). Intragastric balloon placement was associated with a large improvement in postprocedural quality of life and mental health. Endoscopic bariatric therapies may improve short-term quality of life and mental health alongside weight loss and comorbidity improvement.
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Spirou D, Raman J, Smith E. Psychological outcomes following surgical and endoscopic bariatric procedures: A systematic review. Obes Rev 2020; 21:e12998. [PMID: 31994311 DOI: 10.1111/obr.12998] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 11/25/2019] [Accepted: 12/12/2019] [Indexed: 12/16/2022]
Abstract
Obesity is a leading global epidemic. Bariatric surgery is the only treatment demonstrating substantial long-term weight loss and medical benefits. However, there is limited research on the psychological outcomes following surgery. Therefore, the primary aim of this study was to systematically review depression, anxiety, and binge eating outcomes at different time points following bariatric surgery and identify whether bariatric surgery significantly reduces psychological symptoms over time. These outcomes were also examined among endoscopic bariatric procedures as a secondary aim. Forty-eight studies met inclusion criteria. Findings suggested that most patients experience a short-term reduction in anxiety and depression symptoms from pre-surgery. Over time, however, these symptoms increase and may even return to pre-surgery levels. Furthermore, while binge eating was uncommon after surgery, other disordered eating patterns may emerge. Binge eating may also restart over time as the stomach enlarges again. Overall, the complex psychological difficulties faced by individuals with obesity continue after surgery and may contribute to longer-term weight recidivism. More comprehensive and standardised psychological assessment procedures, including clinical interviews and longer-term follow-up, may provide insight into the psychological mechanisms maintaining weight management issues, and may serve as a starting point for improving the long-term success of patients with obesity.
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Affiliation(s)
- Dean Spirou
- Discipline of Clinical Psychology, Graduate School of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Jayanthi Raman
- Discipline of Clinical Psychology, Graduate School of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Evelyn Smith
- School of Social Sciences and Psychology, Western Sydney University, Sydney, NSW, Australia.,Translational Health Research Institute, Western Sydney University, Sydney, NSW, Australia
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Kokkeler KJE, van den Berg KS, Comijs HC, Oude Voshaar RC, Marijnissen RM. Sarcopenic obesity predicts nonremission of late-life depression. Int J Geriatr Psychiatry 2019; 34:1226-1234. [PMID: 30990918 DOI: 10.1002/gps.5121] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 04/08/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND/OBJECTIVES Aging-related physiological changes like metabolic dysregulation and physical frailty are associated with depression and worsen its prognosis. Since central obesity is a key component of the metabolic syndrome and sarcopenia of physical frailty, we examined the association of sarcopenic obesity with depression cross-sectional and over time. METHODS Cohort study of depressed patients and a nondepressed comparison group. SETTING Primary and secondary mental health care. PARTICIPANTS Three hundred seventy-eight older (≥60 y) depressed patients of which 285 were followed up at 2 years and 132 nondepressed persons participating in the Netherlands Study of Depression in Older (NESDO) persons. MEASUREMENTS Sarcopenic obesity was based on predefined cutoffs for both maximum handgrip strength (assessed with a dynamometer) and waist circumference (dichotomous) as well as the product term of handgrip strength by waist circumference (dimensional). Depressive disorder according to DSM-IV-TR criteria was assessed with fully structured psychiatric interview at baseline and 2-year follow-up. RESULTS Sarcopenic obesity was more prevalent among depressed patients compared with nondepressed participants (18.9% versus 10.7%, P = 0.030). Neither the dichotomous nor dimensional operationalization of sarcopenic obesity was associated with baseline depressive disorder when adjusted for covariates. Nonetheless, among depressed patients, logistic regression showed that the interaction of handgrip strength by waist circumference was associated with remitted depression at 2-year follow-up (P = 0.044). Only among patients with a low handgrip strength, a higher waist circumference predicted nonremission. CONCLUSION Among depressed patients, sarcopenic obesity predicts nonremission of depression. Therefore, combined exercise and nutritional interventions might be effective for depressed patients with sarcopenic obesity.
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Affiliation(s)
- Kitty J E Kokkeler
- Department of Old Age Psychiatry, ProPersona, Wolfheze/ Ede, The Netherlands.,University Center of Psychiatry & Interdisciplinary Center for Psychopathology of Emotion Regulation, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Karen S van den Berg
- University Center of Psychiatry & Interdisciplinary Center for Psychopathology of Emotion Regulation, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Department of Psychiatry, St Antonius Hospital, Utrecht, The Netherlands
| | - Hannie C Comijs
- GGZinGeest/Department Psychiatry/Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Richard C Oude Voshaar
- University Center of Psychiatry & Interdisciplinary Center for Psychopathology of Emotion Regulation, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Radboud M Marijnissen
- Department of Old Age Psychiatry, ProPersona, Wolfheze/ Ede, The Netherlands.,University Center of Psychiatry & Interdisciplinary Center for Psychopathology of Emotion Regulation, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Marijnissen RM, Vogelzangs N, Mulder ME, van den Brink RHS, Comijs HC, Oude Voshaar RC. Metabolic dysregulation and late-life depression: a prospective study. Psychol Med 2017; 47:1041-1052. [PMID: 27938429 DOI: 10.1017/s0033291716003196] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Depression is associated with the metabolic syndrome (MS). We examined whether metabolic dysregulation predicted the 2-year course of clinical depression. METHOD A total of 285 older persons (⩾60 years) suffering from depressive disorder according to DSM-IV-TR criteria was followed up for 2 years. Severity of depression was assessed with the Inventory of Depressive Symptomatology (IDS) at 6-month intervals. Metabolic syndrome was defined according the National Cholesterol Education Programme (NCEP-ATP III). We applied logistic regression and linear mixed models adjusted for age, sex, years of education, smoking, alcohol use, physical activity, somatic co-morbidity, cognitive functioning and drug use (antidepressants, anti-inflammatory drugs) and severity of depression at baseline. RESULTS MS predicted non-remission at 2 years (odds ratioper component = 1.26, 95% confidence interval 1.00-1.58), p = 0.047), which was driven by the waist circumference and HDL cholesterol. MS was not associated with IDS sum score. Subsequent analyses on its subscales, however, identified an association with the somatic symptom subscale score over time (interaction time × somatic subscale, p = 0.005), driven by higher waist circumference and elevated fasting glucose level. CONCLUSIONS Metabolic dysregulation predicts a poor course of late-life depression. This finding supports the concept of 'metabolic depression', recently proposed on population-based findings of a protracted course of depressive symptoms in the presence of metabolic dysregulation. Our findings seem to be driven by abdominal obesity (as indicated by the waist circumference) and HDL cholesterol dysregulation.
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Affiliation(s)
- R M Marijnissen
- Department of Old Age Psychiatry,ProPersona,Arnhem/Wolfheze,The Netherlands
| | - N Vogelzangs
- Department of Epidemiology,Cardiovascular Research Institute Maastricht (CARIM) & Maastricht Centre for Systems Biology (MaCSBio),Maastricht University,Maastricht,The Netherlands
| | - M E Mulder
- Department of Old Age Psychiatry,ProPersona,Arnhem/Wolfheze,The Netherlands
| | - R H S van den Brink
- University Center of Psychiatry & Interdisciplinary Center for Psychopathology of Emotion Regulation,University Medical Center Groningen,University of Groningen,Groningen,The Netherlands
| | - H C Comijs
- Department Psychiatry,EMGO Institute for Health and Care Research VU University Medical Center/GGZinGeest,Amsterdam,The Netherlands
| | - R C Oude Voshaar
- University Center of Psychiatry & Interdisciplinary Center for Psychopathology of Emotion Regulation,University Medical Center Groningen,University of Groningen,Groningen,The Netherlands
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Kumar N, Sullivan S, Thompson CC. The role of endoscopic therapy in obesity management: intragastric balloons and aspiration therapy. Diabetes Metab Syndr Obes 2017; 10:311-316. [PMID: 28740414 PMCID: PMC5505535 DOI: 10.2147/dmso.s95118] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Weight management is increasingly incorporating endoscopic bariatric therapy (EBT). As the global burden of obesity and its comorbidities has increased, it is evident that novel therapeutic approaches will be necessary to address the obesity epidemic. EBTs offer greater efficacy than diet and lifestyle modification and lower invasiveness than bariatric surgery. The US Food and Drug Administration has approved two intragastric balloons and aspiration therapy for the treatment of obesity: Apollo Orbera is indicated for the treatment of Class I and Class II obesity, Re Shape Integrated Dual Balloon system is indicated for the same range with a comorbidity, and Aspire Bariatrics AspireAssist is approved for patients with a body mass index of 35-55 kg/m2. These devices have proven safe and effective in clinical trials and are gaining commercial acceptance in the USA; the Orbera has been used extensively outside the USA for over 20 years. These devices will need to be delivered in the context of a multidisciplinary weight loss program, integrating comprehensive care of obesity. Patient selection is important, and ensuring appropriate patient expectations and understanding of alternatives such as pharmacologic therapy and surgery is essential. With several EBTs on the horizon, patients with obesity will have an even broader array of safe and effective options for weight management in the future.
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Affiliation(s)
- Nitin Kumar
- Bariatric Endoscopy Institute, Addison, IL
- Correspondence: Nitin Kumar, Gastroenterology and Weight Management, Bariatric Endoscopy Institute, 1450 West Lake Street, Suite 101, Addison, IL 60101, USA, Tel +1 630 387 9362, Email
| | - Shelby Sullivan
- Gastroenterology Bariatric and Metabolic Program, University of Colorado School of Medicine, Denver, CO
| | - Christopher C Thompson
- Gastroenterology and Therapeutic Endoscopy, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
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Neylan CJ, Dempsey DT, Tewksbury CM, Williams NN, Dumon KR. Endoscopic treatments of obesity: a comprehensive review. Surg Obes Relat Dis 2016; 12:1108-1115. [DOI: 10.1016/j.soard.2016.02.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Revised: 01/30/2016] [Accepted: 02/07/2016] [Indexed: 12/23/2022]
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Madeira E, Madeira M, Guedes EP, Mafort TT, Neto LV, de Oliveira Moreira R, de Pinho PRA, Lopes AJ, Farias MLF. Assessment of Predictive Response Factors to Intragastric Balloon Therapy for the Treatment of Obesity. J Laparoendosc Adv Surg Tech A 2016; 26:168-73. [PMID: 26844373 DOI: 10.1089/lap.2015.0305] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Obesity is a worldwide epidemic that is difficult to control with non-invasive treatments, which usually present poor results. In this context, the intragastric balloon (IGB) is an important tool that presents a mean body weight loss (BWL) estimated at approximately 12%, although individual responses are highly variable. OBJECTIVES This study assesses whether there are factors that can predict responses to IGB therapy either before or early after placement of the device. MATERIALS AND METHODS A total of 50 obese patients underwent insertion of IGB placed endoscopically, and patients were monitored for 6 months. The evaluated predictive factors involved general characteristics and psychological, social, and dyspeptic aspects, and the preliminary results obtained in the first month after balloon placement. RESULTS The mean weight loss was 11.5%, and 48% of the participants presented BWL >10%. Among the factors analyzed before IGB placement, only advanced age (P = .04) and higher scores obtained in the social relationships domain of a shorter version of the World Health Organization's Quality of Life questionnaire (P = .02) were significant. Analysis of the factors evaluated after IGB placement revealed that the BWL amounts observed in week 2 (P = .001) and week 4 (P < .001) and the intensity of dyspeptic symptoms in week 2 (P < .001) were positive predictive factors. CONCLUSIONS The assessment of predictive factors may help to manage patients with IGB.
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Affiliation(s)
- Eduardo Madeira
- 1 Postgraduate Programme in Endocrinology, Federal University of Rio de Janeiro , Rio de Janeiro, Brazil
| | - Miguel Madeira
- 1 Postgraduate Programme in Endocrinology, Federal University of Rio de Janeiro , Rio de Janeiro, Brazil
| | - Erika Paniago Guedes
- 1 Postgraduate Programme in Endocrinology, Federal University of Rio de Janeiro , Rio de Janeiro, Brazil
| | - Thiago Thomaz Mafort
- 2 Postgraduate Programme in Medical Sciences, State University of Rio de Janeiro , Rio de Janeiro, Brazil
| | - Leonardo Vieira Neto
- 1 Postgraduate Programme in Endocrinology, Federal University of Rio de Janeiro , Rio de Janeiro, Brazil
| | - Rodrigo de Oliveira Moreira
- 3 Endocrinology Department, The Capriglione Luiz State Institute of Diabetes and Endocrinology , Rio de Janeiro, Brazil
| | | | - Agnaldo José Lopes
- 2 Postgraduate Programme in Medical Sciences, State University of Rio de Janeiro , Rio de Janeiro, Brazil
| | - Maria Lucia Fleiuss Farias
- 1 Postgraduate Programme in Endocrinology, Federal University of Rio de Janeiro , Rio de Janeiro, Brazil
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Guedes EP, Madeira E, Mafort TT, Madeira M, Moreira RO, Mendonça LMC, Godoy-Matos AF, Lopes AJ, Farias MLF. Impact of a 6-month treatment with intragastric balloon on body composition and psychopathological profile in obese individuals with metabolic syndrome. Diabetol Metab Syndr 2016; 8:81. [PMID: 28031749 PMCID: PMC5168847 DOI: 10.1186/s13098-016-0197-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 12/04/2016] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The aim of this study was to investigate the effects of a 6-month treatment with intragastric balloon (IGB) on body composition and depressive/anxiety symptoms in obese individuals with metabolic syndrome (MS). METHODS Fifty patients (aged 18-50 years) with obesity and MS were selected for treatment with IGB for 6 months. Body composition was verified with dual-energy X-ray absorptiometry (DXA) at baseline and right after IGB removal. Anxiety/depressive symptoms were assessed with the Beck Depression Inventory (BDI) and the hospital anxiety and depression scale (HADS) at baseline and after 6 months of treatment. RESULTS In total, 39 patients completed the study. After 6 months, there were significant decreases in weight (11.7 ± 9.6 kg, p < 0.0001) and waist circumference (9.3 ± 8.2 cm, p < 0.0001). Weight loss was also demonstrated by DXA and corresponded to decreases of 3.0 ± 3.4% in body fat percentage, 7.53 ± 7.62 kg in total body fat, and 3.70 ± 4.89 kg in lean body mass (p < 0.001 for all comparisons). Depressive symptoms scores decreased by a mean of 4.57 ± 10.6 points when assessed with the BDI (p = 0.002) and 1.82 ± 5.16 points when assessed with the HADS-Depression (p = 0.0345). Anxiety symptoms scores decreased by a mean of 1.84 ± 4.04 points when determined with the HADS-anxiety (p = 0.0066). The decrease in body fat percentage was the parameter that best correlated with improvements in depressive (p = 0.008) and anxiety symptoms (p = 0.014). CONCLUSIONS In obese individuals with MS, fat mass reduction was associated with short-term improvements in depressive and anxiety symptoms. Trial Registration Registered at ClinicalTrials.gov, NCT01598233.
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Affiliation(s)
- Erika P. Guedes
- Division of Metabology, State Institute of Diabetes and Endocrinology (IEDE), Rua Moncorvo Filho 90-Centro, Rio de Janeiro, RJ CEP 20211-340 Brazil
- Division of Endocrinology, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Eduardo Madeira
- Division of Endocrinology, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- Division of Gastroenterology, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Thiago T. Mafort
- Division of Pulmonology, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Miguel Madeira
- Division of Endocrinology, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Rodrigo O. Moreira
- Division of Metabology, State Institute of Diabetes and Endocrinology (IEDE), Rua Moncorvo Filho 90-Centro, Rio de Janeiro, RJ CEP 20211-340 Brazil
- Division of Endocrinology, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Amélio F. Godoy-Matos
- Division of Metabology, State Institute of Diabetes and Endocrinology (IEDE), Rua Moncorvo Filho 90-Centro, Rio de Janeiro, RJ CEP 20211-340 Brazil
| | - Agnaldo J. Lopes
- Division of Pulmonology, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Maria Lucia F. Farias
- Division of Endocrinology, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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ASGE Bariatric Endoscopy Task Force systematic review and meta-analysis assessing the ASGE PIVI thresholds for adopting endoscopic bariatric therapies. Gastrointest Endosc 2015; 82:425-38.e5. [PMID: 26232362 DOI: 10.1016/j.gie.2015.03.1964] [Citation(s) in RCA: 281] [Impact Index Per Article: 31.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 03/17/2015] [Indexed: 02/08/2023]
Abstract
The increasing global burden of obesity and its associated comorbidities has created an urgent need for additional treatment options to fight this pandemic. Endoscopic bariatric therapies (EBTs) provide an effective and minimally invasive treatment approach to obesity that would increase treatment options beyond surgery, medications, and lifestyle measures. This systematic review and meta-analysis were performed by the American Society for Gastrointestinal Endoscopy (ASGE) Bariatric Endoscopy Task Force comprising experts in the subject area and the ASGE Technology Committee Chair to specifically assess whether acceptable performance thresholds outlined by an ASGE Preservation and Incorporation of Valuable endoscopic Innovations (PIVI) document for clinical adoption of available EBTs have been met. After conducting a comprehensive search of several English-language databases, we performed direct meta-analyses by using random-effects models to assess whether the Orbera intragastric balloon (IGB) (Apollo Endosurgery, Austin, Tex) and the EndoBarrier duodenal-jejunal bypass sleeve (DJBS) (GI Dynamics, Lexington, Mass) have met the PIVI thresholds. The meta-analyses results indicate that the Orbera IGB meets the PIVI thresholds for both primary and nonprimary bridge obesity therapy. Based on a meta-analysis of 17 studies including 1683 patients, the percentage of excess weight loss (%EWL) with the Orbera IGB at 12 months was 25.44% (95% confidence interval [CI], 21.47%-29.41%) (random model) with a mean difference in %EWL over controls of 26.9% (95% CI, 15.66%-38.24%; P ≤ .01) in 3 randomized, controlled trials. Furthermore, the pooled percentage of total body weight loss (% TBWL) after Orbera IGB implantation was 12.3% (95% CI, 7.9%–16.73%), 13.16% (95% CI, 12.37%–13.95%), and 11.27% (95% CI, 8.17%–14.36%) at 3, 6, and 12 months after implantation, respectively, thus exceeding the PIVI threshold of 5% TBWL for nonprimary (bridge) obesity therapy. With the data available, the DJBS liner does appear to meet the %EWL PIVI threshold at 12 months, resulting in 35% EWL (95% CI, 24%-46%) but does not meet the 15% EWL over control required by the PIVI. We await review of the pivotal trial data on the efficacy and safety of this device. Data are insufficient to evaluate PIVI thresholds for any other EBT at this time. Both evaluated EBTs had ≤5% incidence of serious adverse events as set by the PIVI document to indicate acceptable safety profiles. Our task force consequently recognizes the Orbera IGB for meeting the PIVI criteria for the management of obesity. As additional data from the other EBTs become available, we will update our recommendations accordingly.
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Zheng Y, Wang M, He S, Ji G. Short-term effects of intragastric balloon in association with conservative therapy on weight loss: a meta-analysis. J Transl Med 2015; 13:246. [PMID: 26219459 PMCID: PMC4517653 DOI: 10.1186/s12967-015-0607-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2015] [Accepted: 07/16/2015] [Indexed: 01/17/2023] Open
Abstract
Obesity is an epidemic chronic disease which is a risk factor for a number of serious medical conditions. Intragastric balloon, as an alternative, non-surgical treatment approach for the management of obesity, was rejected in previous evidence-based reviews. The object of this review is updating the data and confirming the safety and efficacy of the procedure. In this review, systematic literature retrieve of MEDLINE, EMBASE, CENTRAL and other information sources was performed from inception to December 2014. The quality of selected studies was assessed and meta-analyses of weighted mean differences were made using the inverse variance method. Meta-analyses presented significant effect sizes of -8.9 kg, -3.1 kg/m(2) and -21.0% for SMG as well as of -1.5 kg and -1.2 kg/m(2) for LSG, favoring the intervention group. Safety analysis showed that minor complications occurred at a high rate in intervention group, however, no serious or fatal complication was reported in these studies. In conclusion, the current review presents that short-term efficacy for 6 months treatment of intragastric balloon in association with conservative therapy is clinically significant.
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Affiliation(s)
- Yiyuan Zheng
- Department of Internal Medicine of Traditional Chinese Medicine, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, China.
| | - Miao Wang
- Institute of Digestive Diseases, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, China.
| | - Songhua He
- Department of Internal Medicine of Traditional Chinese Medicine, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, China.
| | - Guang Ji
- Institute of Digestive Diseases, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, China.
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Kumar N. Endoscopic therapy for weight loss: Gastroplasty, duodenal sleeves, intragastric balloons, and aspiration. World J Gastrointest Endosc 2015; 7:847-859. [PMID: 26240686 PMCID: PMC4515419 DOI: 10.4253/wjge.v7.i9.847] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Revised: 01/06/2015] [Accepted: 06/11/2015] [Indexed: 02/05/2023] Open
Abstract
A new paradigm in the treatment of obesity and metabolic disease is developing. The global obesity epidemic continues to expand despite the availability of diet and lifestyle counseling, pharmacologic therapy, and weight loss surgery. Endoscopic procedures have the potential to bridge the gap between medical therapy and surgery. Current primary endoscopic bariatric therapies can be classified as restrictive, bypass, space-occupying, or aspiration therapy. Restrictive procedures include the USGI Primary Obesity Surgery Endolumenal procedure, endoscopic sleeve gastroplasty using Apollo OverStitch, TransOral GAstroplasty, gastric volume reduction using the ACE stapler, and insertion of the TERIS restrictive device. Intestinal bypass has been reported using the EndoBarrier duodenal-jejunal bypass liner. A number of space-occupying devices have been studied or are in use, including intragastric balloons (Orbera, Reshape Duo, Heliosphere BAG, Obalon), Transpyloric Shuttle, and SatiSphere. The AspireAssist aspiration system has demonstrated efficacy. Finally, endoscopic revision of gastric bypass to address weight regain has been studied using Apollo OverStitch, the USGI Incisionless Operating Platform Revision Obesity Surgery Endolumenal procedure, Stomaphyx, and endoscopic sclerotherapy. Endoscopic therapies for weight loss are potentially reversible, repeatable, less invasive, and lower cost than various medical and surgical alternatives. Given the variety of devices under development, in clinical trials, and currently in use, patients will have multiple endoscopic options with greater efficacy than medical therapy, and with lower invasiveness and greater accessibility than surgery.
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Kotzampassi K, Shrewsbury AD, Papakostas P, Penna S, Tsaousi GG, Grosomanidis V. Looking into the profile of those who succeed in losing weight with an intragastric balloon. J Laparoendosc Adv Surg Tech A 2014; 24:295-301. [PMID: 24438221 DOI: 10.1089/lap.2013.0439] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Weight loss by means of an intragastric balloon is an advantageous procedure, as usage of such a balloon is minimally invasive and of minimal operational risk. Nevertheless, despite the encouraging results referred in to large population studies, its success rate as a treatment option is still questionable. The aim of this study was to classify and analyze all parameters recorded in a database of a treatment protocol concerning obese individuals handled by an intragastric balloon, in an attempt to delineate the comparable profile of those who succeeded to lose weight and those who failed. SUBJECTS AND METHODS Retrospective data collection, including demographic and anthropometric data, social and psychological factors, educational status, and attendance at sessions and the exercise program, was conducted. Using as a criterion for grouping the percentage of excess weight loss (%EWL), the successful (%EWL ≥50%) and the poor (%EWL ≤20%) responders were identified. RESULTS In total, 583 patients were assessed. Initial and ideal body weight (BW), initial body mass index (BMI), and excess weight were significantly lower in the %EWL ≥50% group (P<.001). Upon balloon removal, both groups exhibited a significant difference regarding BW, BW lost, BMI, and %EWL (P<.001). Advanced age (odds ratio [OR]=1.06; P<.001), female gender (OR=3.31; P<.001), basic educational level (OR=3.12; P<.001), and single or divorced marital status (OR=6.00; P<.001) were identified as the most powerful determinants of %EWL ≥50%. Moreover, attendance at more than four monthly interviews and strict exercise program commitment contributed significantly to a favorable outcome. CONCLUSIONS Our findings could serve as an initial step for further research into factors possibly contributing to the early identification of those individuals who will notably benefit from usage of an intragastric balloon regarding BW loss.
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Affiliation(s)
- Katerina Kotzampassi
- 1 Department of Surgery, Aristotle's University of Thessaloniki , Thessaloniki, Greece
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Lopresti AL, Drummond PD. Obesity and psychiatric disorders: commonalities in dysregulated biological pathways and their implications for treatment. Prog Neuropsychopharmacol Biol Psychiatry 2013; 45:92-9. [PMID: 23685202 DOI: 10.1016/j.pnpbp.2013.05.005] [Citation(s) in RCA: 152] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Revised: 04/28/2013] [Accepted: 05/07/2013] [Indexed: 11/25/2022]
Abstract
Rates of obesity are higher than normal across a range of psychiatric disorders, including major depressive disorder, bipolar disorder, schizophrenia and anxiety disorders. While the problem of obesity is generally acknowledged in mental health research and treatment, an understanding of their bi-directional relationship is still developing. In this review the association between obesity and psychiatric disorders is summarised, with a specific emphasis on similarities in their disturbed biological pathways; namely neurotransmitter imbalances, hypothalamus-pituitary-adrenal axis disturbances, dysregulated inflammatory pathways, increased oxidative and nitrosative stress, mitochondrial disturbances, and neuroprogression. The applicability and effectiveness of weight-loss interventions in psychiatric populations are reviewed along with their potential efficacy in ameliorating disturbed biological pathways, particularly those mediating inflammation and oxidative stress. It is proposed that weight loss may not only be an effective intervention to enhance physical health but may also improve mental health outcomes and slow the rate of neuroprogressive disturbances in psychiatric disorders. Areas of future research to help expand our understanding of the relationship between obesity and psychiatric disorders are also outlined.
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Affiliation(s)
- Adrian L Lopresti
- School of Psychology, Murdoch University, Perth, Western Australia 6150, Australia.
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