WASHINGTON — Both online and in-person support given after placement of intragastric balloon produced similar clinically significant weight loss outcomes, according to research presented here.
“The foundation of obesity management relies on a good foundation of lifestyle and behavioral interventions. Comprehensive obesity management involving health coaches, registered dietitians and psychologists are key to successful weight loss and weight maintenance. In the community, many practicing gastroenterologists have limited access to these comprehensive resources, presenting a major barrier for them to safely and effectively implement these into their practice,” Eric J. Vargas, MD, of Mayo Clinic Rochester, said during his presentation. “In response to this need, many commercial programs have been offering online services that try to mimic traditional follow up programs with registered dietitians, health coaches that provide advice and instruction for nutrition, fitness and management of patients’ overall weight-related health.”
These programs give patients access to instruction in the convenience of their home and offer greater options to physicians in smaller practices, but Vargas questioned if they are an acceptable alternative. He and his colleagues analyzed two prospectively maintained databases from a mix of academic and private centers across the U.S. The patients included were adults who received the Orbera (Apollo Endosurgery) intragastric balloon for weight loss.
The researchers compared the online Orbera coach, which entailed monthly one-on-one sessions with a registered dietitian who acts as a health coach and monthly group sessions, with the face-to-face program, which also met monthly one-on-one with dietitians and other health care practitioners.
Primary outcomes were: percent total body weight loss (TBWL) at 3 months, at 6 months when the balloon was removed and after balloon removal; and the proportion of patients achieving 5%, 10% and 15% TBWL at 6 months and after balloon removal. Vargas and his team also monitored adherence by number of follow-up encounters at 3 months, 6 months and after balloon removal.
The study included 758 unique patients from 78 different centers: 437 in the online cohort and 321 in the traditional care cohort. Weight loss data were available for 689 of the original 758. Overall, at baseline, the online group was slightly younger and weighed slightly less than the traditional care group.
Looking at the groups together, patients reported TBWL of 6.2% (n = 275) at 3 months, 11% (n = 257) at 6 months and 12.2% (n = 157) about 3 months after balloon removal, which Vargas said showed that lifestyle interventions did have a long-term effect in both groups.
When analyzing the groups separately, the online cohort showed 5.8% TBWL at 3 months, 10.3% TBWL at 6 months and 11.9% TBWL after balloon removal. The traditional care group showed 8.2% TBWL at 3 months (P < .002 difference), 11.5% TBWL at 6 months and 12.8% TBWL after balloon removal.
“At 3 months, the traditional registry did have statistically significantly higher TBWL ... and while they had higher total mean weight loss at balloon removal at 6 months and post balloon removal, these differences were not statistically significant,” Vargas said.
Adherence rates were very similar between groups, Vargas showed. Both groups were at 0.7 visits at 3 months. At 6 months, the online group was at 1.9 visits while the traditional group was at 1.2 (P = .03). Post balloon removal visits were 2.6 in the online group and 2.74 in the traditional group.
“They were pretty much the same except for the 6-month follow-ups,” Vargas said.
Vargas presented the clinically significant milestones of 5%, 10% and 15% TBWL at 6 months, showing that the study as a whole saw 84% of patients reach 5% TBWL, 54% reach 10% TBWL and 25% reach 15% TBWL. The traditional cohort mirrored those at 83%, 55% and 29%, respectively, and the online group was similar at 86%, 53% and 20%, respectively.
These rates were similar 3 months after balloon removal. Overall, the study showed 81% reached 5% TBWL, 58% reached 10% TBWL and 32% reached 15% TBWL. In the traditional cohort, they saw 81%, 57% and 34%, respectively. In the online group, it was 80%, 59% and 32%, respectively.
In a secondary analysis, Vargas showed there was no significant difference between experience, with TBWL in practices having performed less than 10 balloon procedures and those having performed more.
“The single fluid filled balloon tends to produce reproducible weight loss regardless of the setting or modality of the aftercare program. Commercially available aftercare programs may be acceptable alternatives for those centers who don’t have a robust interdisciplinary practice who are looking to add balloons to their practice,” Vargas said. “We need randomized data to make a definitive answer whether online is better than traditional or equivalent. We need weight loss beyond 1 year to determine if these are viable alternatives.” – by Katrina Altersitz
Vargas EJ, et al. Abstract 321. Presented at: Digestive Disease Week; June 2-5, 2018; Washington, D.C.
Disclosures: Vargas reports no relevant financial disclosures. Please see the DDW faculty disclosure index for a list of all other authors’ relevant financial disclosures.