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Dr. David Kim Kim Bariatric Institute

ReShape® Vs. ORBERA™ Vs. Obalon Gastric Balloons for Weight Loss

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Weight loss treatment is ever expanding. Gastric Balloons become another tool in the box, and though it is not meant to replace weight loss surgery, it is a tool with possible wide implications. Though, typically, weight loss surgery is intended for people who are about 100 lbs. or more overweight, there are several millions more who have difficulty losing 20-50 lbs. with just conventional diets.

For the most part, traditional weight loss surgery was meant for patients with a BMI (body mass index) of 40 or greater, and those patients with serious health issues often qualify with a lower BMI, such as 35 to 40 and greater.

But what about patients who aren’t as heavy, or those folks who absolutely want to avoid surgery at all costs?

This is where the gastric balloon fits in. It was meant to be a jumpstart. It is not a permanent change to anyone’s stomach. Though the first gastric balloons were approved earlier in 2016 (ORBERA™ and ReShape®), another balloon was just approved recently by the FDA (Obalon), and there is yet another balloon on the horizon (Elipse™). I will discuss the difference in these balloons later in the article, but I thought I would talk about the common features of these first.

All balloons are restrictive, meaning they are intended for you to eat less. This occurs because after the balloon is placed in the stomach, it is filled with saline (ReShape® and ORBERA™) to fill up the stomach and compete for the same space with food, allowing the patient to eat less food. The newest balloon Obalon, is filled with nitrogen gas.

All balloons have been FDA approved for patients with a BMI of 30-40. In my experience, gastric balloons have also been chosen by patients who want to avoid invasive procedures to lose weight. All balloons must be removed by six months. After this time, extraction may be more difficult and the rates of spontaneous deflation (the balloon popping on its own) are increased. A deflated balloon can pass into the small intestines and create a small bowel obstruction. This could necessitate surgery to remove the device. The ReShape® balloon is a double balloon attached in the middle, creating a dumbbell appearance, and may offer advantages to avoid passage from the stomach to the intestines (because spontaneous deflation of both balloons would seem unlikely), as opposed to the other balloons which are single balloons.

All balloons have been shown to be twice as effective as diets. When patient-randomized trials were performed, compared to people who didn’t have a balloon, the balloon group lost twice as much weight. No serious complications occurred and there were no fatalities with any of the balloons. The most common side effects were nausea and cramping with all the balloons, at the same rate. Premature extraction of the balloons because of intolerance to side effects was extremely rare with all the balloons.

When I speak with a patient about a balloon, I think it’s important that we have realistic expectations. Balloons are not meant to replace surgery. On the average, most balloons allow an obese patient to lose about 20-30 lbs. Though I have had a morbidly obese male lose 85 lbs, this type of weight loss is not typical. I will say that my patients hoping for a ” jump start” and those trying to avoid surgery were quite pleased with the overall experience and their results.

I think it is paramount that a patient and the doctor’s office stay engaged with each other. Not just in the first six months during the balloon phase, but also the six months after the balloon is removed. Lifestyle changes are very important because this will allow a patient to lose more weight when the balloon is in and hopefully keep most of it off after the balloon is removed. This should include monthly dietary visits to improve a patient’s dietary education and support towards healthier food choices. There are several food apps that can be used to track an individual’s food intake and the balloon may lend itself to virtual follow-ups, as we have started to deploy in our offices.

I’ve noticed with both the ReShape® and ORBERA™ balloons that the most weight loss occurred in the first three months. Approximately 75% of the weight loss occurred in these first three months and then tapered off during the last three months. For this reason, I encourage my patients to lose as much weight as possible in the first three months. This time period should involve rigorous exercise, excellent food choices, and behavioral modification techniques to try to limit food intake.

All balloons have contraindications for placement (reasons to abort the procedure)
These include:

  1. A large hiatal hernia
  2. Extreme acid reflux issues pre-op
  3. Surgeon sees something at the time of placement that concerns him, like large peptic ulcers or stomach tumors
  4. Pregnancy
  5. Severe conditions to major organ systems
  6. Alcohol or drug abuse
  7. Chronic steroid or immunosuppressive therapy

To decrease the incidence of unpleasant side effects like nausea and cramping that can occur with all balloons, the doctor’s office should provide prescriptions for acid-blocking medications, as well as an anti-spasmodic. I’ve noticed all patients will have some symptoms after the surgery, but a few can find these symptoms to be extreme. Most of these symptoms will pass in 48-72 hours, so it’s important to recognize that these symptoms won’t last forever. They should improve as the stomach accommodates and relaxes to accept this new volume.

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Endoscope is a lighted scope placed in the mouth that is advanced into the stomach. This is typically performed with the patient sedated.

Balloons are an exciting development because we can help so many more people than we have before with their weight problems. It takes minutes to insert all three. The disruption to someone’s active schedule is also minimal.

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