Pilot Study: Use of intragastric balloons and a lifestyle support program to promote weight loss in severely obese adolescents: The 'BOB' study 

Project team: Lindsey Reece, Pooja Sachdev, Rob Copeland, Jerry Wales, Mike Thompson and Neil Wright 

Reluctance to commission permanent bariatric surgery in obese adolescent's means alternative options must be considered. One such approach, which is proposed here, is the use of intra gastric balloons as a potential, reversible, intervention for obese adolescents for which other available treatments have been exhausted. 

This pilot study aims to assess the use of an intragastric balloon, alongside a lifestyle support program, to promote weight loss in severely obese adolescents at six months and maintain weight loss 18 months post-intervention. 12 obese adolescents (7 females 5 males; average age 15yrs; BMI >3.5SD; puberty stage 4 or more) were recruited. An intragastric balloon (ORBERA®), inflated with 500ml saline, was endoscopically placed in situ under general anaesthesia, and remained in the stomach for 6 months, whilst families engaged in an evidence based lifestyle program. 

The lifestyle support program sees families weekly, incorporating advice on diet and physical activity as well as exploring behavioural skills to help implement and maintain lifestyle changes back in their own environments. A range of behaviour change technqiues, aligned to Abraham and Mitchie (2002), were delivered to ensure consistency. Results are presented on 9 patients (due to the timing of this publication). Total average percentage weight loss (n=9) at 1 month was 6.09kg, 2 month 9.34kg, 3 month 8.77kg and 6 month 11.37kg. Improved insulin resistance and hypertension resolved in 50% of patients. Average hospital stay has been 24 hours with the balloon well tolerated with limited side effects. Encouraging trends have also been observed for increased physical activity and physical fitness, with overall positive engagement from families. 

In summary, interim data suggests the intra-gastric balloons have been well tolerated and further research is needed to explore its effectiveness as a treatment option in this complex population group. The long-term weight loss maintenance results will be available in March 2016. 

Implications and Contribution 
Severe obesity is the fastest growing sub category of obesity in adolescents yet despite the associated serious immediate and long term health complications, current treatments are of limited effectiveness. To our knowledge, this innovative piece of research is the first to offer an alternative treatment solution for severely obese adolescents, bridging the gap between lifestyle interventions, which we know in the majority of cases, are ineffective for this population, and bariatric surgery, which is met with significant reluctance by professionals and policy makers. It is therefore, hoped that findings from both studies will contribute to the transformation of obesity treatment, improving patient outcomes and informing policy. 

Key messages for providers and commissioners 
This innovative pilot assesses the feasibility of a non-invasive treatment option for severely obese adolescents bridging the current treatment gap. 
  • Confirms further research is needed. 
  • Contributes to the treatment fidelity of lifestyle interventions designed to change behaviour of severely obese adolescents. 
  • It is hoped that findings from this study will improve the effectiveness of obesity treatment, improve patient outcomes and inform policy.