Conference Coverage

Endoscopic weight loss interventions need lifestyle component


 

EXPERT ANALYSIS FROM DDW 2018

Several endoscopic bariatric procedures for weight loss have recently entered routine U.S. practice, but the procedures are much less likely to achieve meaningful weight loss for patients unless they are paired with frequent patient contact and used in the context of a multidimensional lifestyle intervention, Shelby Sullivan, MD, said at the annual Digestive Disease Week.®

Dr. Shelby Sullivan, director of the gastroenterology metabolic and bariatric program at the University of Colorado in Aurora. Mitchel L. Zoler/MDedge News

Dr. Shelby Sullivan

Four different endoscopic weight loss devices that are variations on gastric balloons are now approved for routine U.S. use, and some clinicians who have pioneered endoscopic sutured gastroplasty, also known as endoscopic sleeve gastroplasty, have declared this method as appropriate for routine practice (Obes Surg. 2018 Jul;28[7]:1812-21).

Regardless of which endoscopic intervention a clinician uses, the chances for successful and complication-free weight loss highly depends on enlisting adjunctive care by specialists, including a dietitian, behavior coach, psychologist, exercise specialist, and an endocrine or obesity-specialist physician, said Dr. Sullivan, director of the gastroenterology metabolic and bariatric program at the University of Colorado, Aurora. Often it’s more cost effective to arrange for collaboration with these adjunctive specialists as consultants rather than having them on staff, she noted.

A weight loss program that provides at least 14 interventions with the patient over a 6-month period has led to a 5% greater increase in weight loss compared with a moderate-intensity program that includes 6-13 encounters with members of the weight-loss team, Dr. Sullivan said. These intervention episodes need not all be individual or one on one, but can include group sessions, telephone consults, and even online coaching sessions, according to 2013 recommendations from The Obesity Society, the American College of Cardiology, and the American Heart Association (Obesity. 2014 Jun 24;22[S2]:S5-S39). “Patient contact is the key to success with weight loss,” Dr. Sullivan said. She also strongly suggested that clinicians who wish to offer an obesity intervention “get training in delivering basic obesity education.”

Another tip for providers is to have protocols in place to both prevent and, when necessary, manage potential complications. This can involve administration of additional antibiotics beyond what’s used for prophylaxis, treatment with additional IV fluid, and imaging. Complication prevention and management of complications when they occur are two of the most important steps to take to make sure that an elective obesity intervention practice runs smoothly, Dr. Sullivan said. “Make sure you can manage these patients safely,” she admonished. Also, be sure to arrange in advance for institutional approval for using whatever devices the procedure requires, and make sure you have malpractice coverage for any novel devices or procedures. Approval for use of a novel device often requires documentation of specialized training or certification.

Endoscopic weight loss procedures often are not fully or even partially covered by health insurance, which means that patients will pay most or all of the costs out of pocket and, hence, the clinician should look on this practice as a “concierge service.” Therefore, the clinician should be especially attuned to ensuring that the staff is uniformly courteous, and be alert for any overt or covert obesity bias the staff may have that could mar a patient’s experience. You need a “reliable and compassionate” staff, Dr. Sullivan advised, and the staff should schedule patient appointments that minimize wait times.

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