Struggling to shed those extra kilograms? The intragastric balloon is a non-invasive device that, along with a diet and exercise programme, can lead to substantial weight loss.

More than 1 billion people worldwide are obese and South Africans are not immune to this global pandemic – the World 2022 Obesity Atlas predicts that by 2030 more than a third of adults in this country will be affected. Dr Khalid Coovadia, a gastroenterologist at Mediclinic Panorama, sees the effects first hand in his practice. “Obesity is a significant problem as it leads to metabolic syndrome,” he warns, explaining the characteristics of the condition:

  • visceral fat (fat that wraps around the abdominal organs deep in your body)
  • hypertension (high blood pressure)
  • insulin resistance (leads to diabetes)
  • raised cholesterol.

“Metabolic syndrome also leads to significant medical complications affecting the brain, heart, lungs, liver, pancreas, and other organ systems,” he adds.

Is there a solution?

“Crash diets promote a yo-yo effect, cause nutritional deficiencies and hormone dysregulation and often fail in the long term,” Dr Coovadia says. “Many drugs on the market show promise regarding weight loss, but they’re considered a quick fix. They don’t promote healthy lifestyles and have serious side-effects. Bariatric surgery is very effective and helps patients lose weight quickly. But it’s a very invasive procedure, there’s a long recovery time and potential for surgical complications.”

The intragastric balloon is a minimally invasive device inserted directly into the stomach via an endoscope. This device, together with professional support from a multidisciplinary team, assists in significant weight reduction – resulting in improved quality of life and overall health.

Who is a good candidate for an intragastric balloon?

The ideal age range is 18-50 years old – but it’s crucial to have realistic expectations. You need to undergo initial medical investigations to identify any risk factors, as well as psychological evaluation. “We need patients to be well motivated, socially engaged and wanting to make significant and permanent changes to their eating and exercise,” Dr Coovadia explains

“If your BMI is greater than 40, the intragastric balloon can assist you to lose weight before required surgery [such as a knee replacement]” Dr Coovadia explains. “It’s also suitable if you have non-alcoholic fatty liver disease, osteoarthritis, or need to lose weight to exercise effectively. It’s also indicated for prediabetic patients.”

Who isn’t suitable?

If any of these apply, you cannot be considered for insertion of an intragastric balloon:

  • prior gastrointestinal or bariatric surgery
  • anatomical or structural abnormalities in the oesophagus or gastrointestinal tract
  • risk for bleeding (including having taken medications that put you at risk of bleeding, such as anti-inflammatory agents and anticoagulants)
  • inflammatory diseases of the gastrointestinal (GI) tract
  • psychiatric illnesses
  • drug or alcohol addictions.

“Pregnant or breastfeeding patients and those unwilling to participate in a behaviour modification programme also won’t be considered,” Dr Coovadia adds.

We need patients to be well-motivated, socially engaged and wanting to make significant and permanent changes to their eating and exercise.”

Dr Khalid Coovadia, gastroenterologist at Mediclinic Panorama.

How does it work?

A deflated gastric balloon is inserted through the oesophagus and into the stomach. A syringe is then used to fill the balloon with a sterile saline solution until it’s about the size of a grapefruit. There is no need for any incisions, stitches or scars, and the procedure is performed in a day clinic. “The balloon takes up space in the stomach, suppressing the patient’s hunger and appetite,” says Dr Coovadia. “It also results in reduced portion sizes and meal frequency.”

After 12 months, the balloon is removed.

Is that all it takes?

No. The balloon is just one component of lifestyle rehabilitation, which includes eating healthily and exercising regularly. Dr Coovadia’s multidisciplinary team comprises nurses, a fitness coach, and a team of dietitians. “We also have patient ambassadors who offer advice and counsel patients contemplating the procedure,” he says. “Our team goal is to review you for co-morbid illnesses to reduce the operative risks, to evaluate your nutrition, devise an exercise regime, and offer psychological assistance until the balloon is removed.”

Will medical aid pay?

Currently, South African medical aid funds will not pay. However, the American Society of Gastroenterology and the American Gastroenterology Society have published position statements and guidelines on intragastric balloons in the management of obesity. Local doctors are using these documents to convince medical aid funds that it is a medical device, rather than a device used to lose weight for aesthetic reasons.

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