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Health Matters 7/17: Minimally Invasive Procedure Promotes Weight Loss

By Monica Saumoy, M.D.

Obesity is a common and serious disease in the United States, affecting more than 40% of adults and putting them at greater risk for a wide range of other health complications, including heart disease, stroke and diabetes.

And while diet and exercise are critical to achieving and maintaining a healthy weight, people with obesity may need additional interventions to help them in their weight loss journey.

The Center for Bariatric Surgery & Metabolic Medicine at Princeton Medical Center offers a comprehensive and multidisciplinary approach to treating obesity, including a safe and effective procedure called endoscopic sleeve gastroplasty.

This procedure, together with diet and exercise, can help patients regain their health and feel more confident in their appearance.

Serious Health Impacts

Obesity rates in the United States have been climbing for decades, according to the Centers for Disease Control and Prevention (CDC).

From 1999 through 2018, the prevalence of obesity increased from 30.5% to 42.4%, the CDC reports.

Defined as having a body mass index (BMI) of 30 or above, obesity is classified as a disease because it has adverse medical effects on your body.

In addition to increasing the risk for heart disease, stroke and diabetes, obesity has been associated with acid reflux, joint problems, sleep apnea, certain cancers, infertility and many other medical problems as well as premature death.

Treating obesity has been shown to decrease the risk for many of these conditions.

For those who have tried to lose weight and failed, procedures are available to promote weight loss. The most commonly known is bariatric surgery, where the stomach is surgically altered to reduce its size or the way food is digested.
Candidates for bariatric surgery typically must:

• Have a BMI of 40 or greater or be more than 100 pounds overweight, or
• Have a BMI of 35 or greater and at least one more obesity-related conditions

Candidates for endoscopic sleeve gastroplasty include patients with obesity who have a BMI greater than 30, those who have not had success with weight loss through diet and exercise, and those who, for one reason or another, do not feel that surgery is an option.

A Minimally Invasive Outpatient Procedure

With endoscopic sleeve gastroplasty, doctors insert an endoscope equipped with a suturing device into your throat and down to your stomach.

The doctor then sutures the stomach to create a smaller, tube-shaped pouch, which effectively restricts the amount of food you can eat.

A good way to picture the result is to imagine a balloon. When you eat, your stomach stretches like a balloon. If you reduce the size of the balloon, you reduce the amount of food it takes to feel full.

The procedure takes about an hour to 90 minutes to perform and does not require any incisions. Most patients go home the same day.

Following endoscopic sleeve gastroplasty, a liquid diet is temporarily prescribed in order to allow for healing and to jumpstart the weight-loss process. There generally are no other restrictions beyond diet following the procedure. Patients usually return to work within a day or two after the procedure and begin to integrate a diet and exercise routine to help lose weight and keep it off.

Studies show that over a period of five years, people who underwent endoscopic sleeve gastroplasty were able to achieve and sustain a weight loss of 15-20% of their total body weight. In other words, if you weighed 225 pounds prior to the procedure, your result could be a sustainable weight of 180 pounds. Typically, people lose the weight in the first three to six months after the procedure, with the goal of maintaining it over time.

Lifelong Journey

While endoscopic sleeve gastroplasty and other procedures have proven to be effective in helping people lose weight, weight loss is a lifelong journey.

A healthy diet and daily physical activity are just as important to achieving and maintaining a healthy body weight.

No matter where you are in your weight loss journey, here are some helpful tips for eating healthy and managing your weight.

• Eat a healthy diet that emphasizes fruits, vegetables, and low-fat or fat-free dairy, and is low in saturated fat and added sugars. Most fruits and vegetables are low in calories and high fiber, which will leave you feeling fuller longer.

• Pay attention to portion sizes. You can still eat your favorite foods but eat smaller portions less often.

• Think about what you drink. Calories aren’t just on your plate; they’re in your glass too. Try substituting water for high-calorie beverages like soda and juice, and if you drink alcohol, limit how much you consume.

• Slow down. It takes your brain at least 20 minutes to catch up to your stomach. Eating slowly can help you eat less.

• Get moving. Exercise can help you maintain a healthy weight, and it can help further reduce your risk for cardiovascular disease, diabetes, and a host of other health problems. If you haven’t been physically active for a while, talk with your doctor before beginning an exercise plan and start slowly.

• Monitor your weight. Checking in with your scale regularly can help you keep track of your weight and alert you to any adjustments that need to be made in your diet and exercise routine to stay within a healthy range.

Patients at Penn Medicine Princeton Medical Center (PMC) who undergo endoscopic sleeve gastroplasty have access to the same pre- and post-procedure services that are offered to patients who undergo bariatric surgery at PMC, including nutrition counseling, cognitive behavioral therapy, and social worker support. Coverage for the procedure varies by insurance plan. Check with your plan to see if it is covered.

To find a bariatric surgeon with Penn Medicine Princeton Health or for more information about the Center for Bariatric Surgery & Metabolic Medicine at Princeton Medical Center, call 1-888-742-7496 or visit www.princetonhcs.org.

Monica Saumoy, M.D., is board certified in gastroenterology and internal medicine. She is a member of the medical staff at Penn Medicine Princeton Health.

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