Obesity non-surgical treatment options
Treatment options and goals
Obesity treatment options should be individualized to patient needs for health improvement. Health care professionals dedicated to obesity management should guide best interests for each patient.
Treatment goals are not only the total weight loss at one timepoint, but also the long-term maintenance and obesity related diseases resolution or prevention, as well as quality of life gain. 5-15% of weight loss (20% or more in obesity class II or more) for a period of 6 months proved to provide health benefits.
A step-up approach should be offered, unless fast weight loss is needed to improve health:
- Behavioral/lifestyle intervention
- Nutrition
- Physical activity
- Psychologic counselling
- Pharmacotherapy (BMI ≥ 30kg/m2 or BMI ≥ 27kg/m2 if comorbidities)
- Bariatric/metabolic surgery (see below)
- Endoscopic options (bridging, contra-indication for surgery)
As a chronic disease with adaptative mechanisms, is mandatory continuous surveillance for long-term outcomes.
Non-surgical treatment
Treatment of obesity entails weight loss and weight loss maintenance. The complications of obesity are resolved or ameliorated with weight loss and maintenance.
Currently, non-surgical treatments are usually effective in inducing weight loss, but weight loss maintenance are only achieved if the treatments are continued in the long term. Weight regain and return of complications are the norm if treatments are stopped.
Endoscopic options
Endoscopic bariatric therapies emerged from the need for less invasive options when lifestyle and pharmacologic intervention fails. There are several endoscopic treatments available, however showed marginal results and mid and long-term data is lacking. Endoscopic techniques are not free of complications, and careful advice should be provided by an experienced professional.
Despite the limitations, patients may benefit from these techniques in specific clinical situations, in whom bariatric surgery is contraindicated:
- Bridging to allow unrelated interventions that are limited by the excess of weight (orthopedic surgery, organ transplantation, complex abdominal hernia surgery)
- Difficult surgical access (multiple surgical interventions with strong adhesions)
- Limits of age for bariatric surgery exceeded
- Unsuccessful lifestyle and pharmacologic interventions in lower obesity classes
Types of endoscopic therapies
Some of the most common techniques are named below.
Gastric interventions:
- Intragastric balloon: a balloon is inflated in the stomach limiting the space for food acommodation
- Endoscopic sleeve gastroplasty: endoscopic suturing that mimics a sleeve gastrectomy
- Primary obesity surgery endoluminal (POSE): endoscopic sutures/plications that reduce food accommodation and gastric emptying.
Small bowel interventions:
- Endobarrier: an impermeable material is anchored in the duodenum, covering part of the intestinal surface, hampering the contact with food, and mimicking a surgical bypass of small bowel.