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Non-Surgical Treatment of Obesity

Non-Surgical Treatment of Obesity. Dr David Orr Gastroenterologist MacMurray Centre Auckland. Non-surgical management of Obesity. Background Diet, exercise and behavioural modification Pharmacological treatments Endoscopic treatments: - Overview

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Non-Surgical Treatment of Obesity

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  1. Non-Surgical Treatment of Obesity Dr David Orr Gastroenterologist MacMurray Centre Auckland

  2. Non-surgical management of Obesity • Background • Diet, exercise and behavioural modification • Pharmacological treatments • Endoscopic treatments: - Overview - Intra-gastric Balloons - Endoscopic sleeve gastroplasty • Conclusion

  3. Obesity • NZ third highest obesity rate in OECD • Adult obesity rate increased from 27% in 2006/07 to 32% in 2015/16 • 35% adults are overweight but not obese Obesity: Adults by Ethnic Group (BMI >30Kg/m2), age >15 yrs Percentage (%) MOH statistics 2016

  4. Diet • Low energy, VLCD, low glycaemic index diets all achieve similar weight loss ~4kg at 1yr • Low carbohydrate vs low fat diets, no significant difference in weight loss. (7.25Kg vs 7.27Kg, p=ns). Exercise results in improved weight loss maintenance at 1 yr. • Meta-analysis; no specific diet identified for healthy obese patients Vink et al. Obesity. 2016 Feb;24(2):321-7. Johnston et al. JAMA. 2014; 312(9):923-33 Stelmach-Mardas et al. Nutrients. 2016; 28; 8(8). 

  5. Exercise • 150-250 mins/week moderate intensity exercise will only produce modest weight loss • >250mins/week associated with clinically significant weight loss • BUT: health status is improved even in the absence of weight loss (improved BP, lipids, insulin resistance).

  6. Medical Therapies Mean Weight Loss Dropout Rates

  7. Endoscopic Management of Obesity

  8. Title Type procedure Product

  9. Intragastric Balloons

  10. Intragastric Balloons • First generation IGBs were air-filled, associated severe complications, spontaneous deflation • Fluid filled IGBs have resolved concerns

  11. Intragastric Balloon(IGB) History • 350,000 IGBs since 1980s • 10,000 IGBs reported in over 50 studies • Variable results • Effective 2-4 months 80% of weight lost in first 3 months • 10% early extraction; 14% -18.8% in FDA studies • Low Success rates (> 10% TBL or > 25% EWL) < 50% success rate Orbera 46.4%, Reshape 48%, Obalon 26.5%

  12. IGB RCT: Meta-analysis • 16 Studies; 3068 patients (Imaz et al) - Overall Weight loss: 14.7Kg, reduction BMI 5.7Kg/m2 and 32.1 %EWL at 6-months Adverse Symptoms and Safety • Nausea: 63-80%, Vomiting 50-75% GER 30% Discomfort Balloon intolerance 5-15% Constipation 20% • n=6771. 57 complications (0.84%) Imaz et al. ObesSurg 2008; 18 (7): 841-6 Espinet-Coll et al. RevEspEnferm Dig 2017; 109 (5). 350-56 FDA

  13. Intra-Gastric Balloons Orbera Spatz3 Placed under sedation 6-month duration Median weight loss: 14-15Kg Placed under deep sedation Adjustable 12-month duration Median weight loss: 23-24Kg

  14. Clinical Results: Spatz3 • 708 patients • Mean BMI 35.3 (29-54) • Age 41 (20-63) • Mean Weight 97.9 kg • Balloon Volume: insertion 484 ml (400 – 500) Down Adjustment 143 ml (100-150) Up Adjustment 297 ml (200-300 ml)

  15. Clinical Results: Spatz3 • Weight Loss at 1yr: 50.1 % EWL; 12.6 %TBL • Down Adjustments 90.5% > 60 days 55% > 180 days Mean implant time 219 days • Up Adjustments (mean 5.7 months) Additional 4.6 kg weight loss • Success Rate (> 25% EWL); 71.7% • Complications: 6x GU (2 NSAID/ETOH) 3x grade C-D esophagitis

  16. Weight Loss ResultsAdjustable vs Non-adjustable IGB’s Successful weight loss: defined as > 10%TBL or > 25% EWL

  17. Endoscopic Sleeve Gastroplasty (ESG)

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