Interviews

1 - Álvaro Augusto Freire

Endoscopist at the Gastroendo Clinic, Barra da Tijuca (RJ).

“I have been using the SILIMED intragastric balloon for six months, since September. So far I have treated about 40 patients. The technique of placing the balloon is very successful. Up to now I have only had one case of spontaneous deflation of the balloon. When this happens we remove it, which is also very simple with this new technique”.

“There is a minimum weight for using the balloon. The classical indication for use of the balloon is for patients with grade II obesity, but this often makes bariatric surgery impractical. So the patient uses the balloon to reduce weight and then he/she can undergo surgery. This is a classical situation. The new technique brings a new indication - grade I obesity - when the patients have already tried other alternatives without any satisfactory results. The weight goes and then comes back or else the patient already has some co-morbidities. With the balloon there is no co-morbidity. In fact, a short time ago a survey was conducted that showed Brazil as the first country to treat patients with the balloon in these circumstances, with excellent results”.

“Patients lose from 12 to 15 kilos in weight. The period for using the balloon is between four and six months. After that, with the wear of the material caused by the gastric juice, the balloon tends to deflate. However, there are cases where the balloon remains even longer. But after six months the patient’s weight-loss curve becomes insignificant”.

“Theoretically there is no age limit. We only place the balloon in patients over 18, but there is no problem whatsoever in using it in older patients. As long as there are no co-morbidities, you can use the device without any problem”.

“There is a difference between men and women. Women tend to accept it better, because of the fact that women get pregnant and know the sensations of the balloon better, such as nausea, feeling sick and even colic pains. So women, even through the circumstances of pregnancy and menstruation, get more used to the balloon. As with any other procedure, it is not advisable to place the balloon if the patient is pregnant. Now, if she gets pregnant later on, the doctor can remove the balloon. I don’t think that pregnant patients should use the balloon, because during this period she is going to have to feed herself properly”.

“There are no activities that the patient should avoid. In fact there are activities that the patient should do. The balloon is not a panacea that resolves weight loss. The balloon is an adjuvant to help the patient recover his/her self-esteem and help in the treatment. As a matter of fact, the balloon helps the patient to adjust to a diet so that he/she tries to change his/her eating habits, that is, lead a healthier life. The balloon serves this purpose”.

“One formal counter-indication for the use of the balloon is hernia of the hiatus, or patients with duodenal or gastric ulcer, or else patients who have some other gastrointestinal disease. Prior evaluation must be made to find out if the patient is free of such conditions”.

“People can use another balloon after removing the first. Sequential balloons have been used with grade-II obese patients. Instead of going straight to bariatric surgery, doctors prefer to use the balloon first. In other words, the balloon can be used for four to six months, then it is removed and a period of two months passes for the patient to erase the memory of that balloon sensation. After two months, the balloon is placed again for the patient to try to lose weight. Except that normally the second weight loss is not the same as the first. Where the first is between 12 and 15 kilos, the second is only half that amount”.

<< Back

2 - Carlos Eduardo Moraes

Gastroenterologist and endoscopist at the Gastroendo and Gastrocor Clinics, both in Barra da Tijuca (RJ).

“I have already followed up 76 patients with an intragastric balloon. Follow-up is done by a multidisciplinary team made up of a gastroenterologist, an endoscopist, an endocrinologist, a nutritionist and under the orientation of a personal trainer. We have achieved more than 95% success, with the patient losing between 13 and 30 kilos in a period of six months”.

“We base our work on the body mass index (BMI) to define whether the patient can use the balloon. For a BMI of above 27, with some health complications such as hypertension, diabetes or pains in the back or joints, we recommend having the balloon placed. For above 30 BMI, we recommend having the balloon placed, even without any associated pathology”.

“We have had no complications with the use of the balloon, because it is a very safe and very simple procedure. The literature reports complications such as intestinal obstruction and irritation of the wall of the stomach causing gastritis, but we have had none of those cases”.

“The life of persons who use a balloon is quite normal. In fact, I myself am using a balloon. I had one placed in me to show my patients how safe it is. I have lost 16 kilos in four months. Life is normal. The balloon does not limit the quality of food. It limits the quantity, because it serves those people who eat a lot. It is a stomach reducer, but without surgery. The gastric chamber becomes much smaller when you have a balloon inserted. I weighed 100 kilos four months ago, now I weigh 84. I should have the balloon removed in two months’ time, but I’m going to keep it in longer because I am undergoing a treatment to try to increase the life of the balloon. The test is on me. I’m going to keep it in for eight months”.

“Physical activity is fundamental. The sooner the patient starts physical activity, the better his/her adaptation to the balloon. There is a period of three days to adapt to the balloon, when the patient feels sick, has nauseas and colic pains. And when he/she is doing some exercise, these symptoms are greatly reduced. Physical activity is essential for losing weight. In principle, in the first month the patient should do no frontal abdominal exercises. Otherwise the patient is free to do everything. Aerobic activities and body-building are the most recommended exercises”.

“Patients can implement another balloon after the first. For patients who want to lose more than 25 kilos, we recommend having another balloon placed two months after the first balloon has been removed.”

“In my opinion, the balloon is a safe opportunity with few counter-indications. Compared with other methods used for slimming, this is without doubt the least aggressive, with no side effects, and with quick results. The balloon is being used for those who are overweight, not for the very obese. We obtain better results with those patients who are 10 or 15 kilos overweight and cannot manage to lose weight. These are the patients who are having the balloon inserted”.

<< Back

3 - Denise de Farias Batista

Quality-control assistant, 28 years old (patient).

“Before having the intragastric balloon inserted, I had only undergone treatment to slim with an endocrinologist, using medicaments”.

“The balloon is a new method that is not aggressive and yields excellent results. The proposal to use it appeared and I accepted. I am very satisfied. At first everything has a period of adaptation, but it all worked out well and I am satisfied. At first you find it strange because it is a foreign body inside you, but as I said, this is a process of pre-adaptation, and already on the third day you feel quite normal”.

“I was not afraid of having the product placed, because no surgical process was required to tear something. It’s like endoscopy. As I had already had an endoscopy done, I knew the process was the same, so I was quite calm”.

“There is some discomfort and malaise on the first day, but that is normal. After that, you feel nothing at all. At first I had a weekly follow-up with the doctor, then it was every two weeks, and now it’s every month. I have had follow-up from the very first day up to now”.

“The balloon has restricted none of my everyday activities. Quite the contrary, it has helped a lot, and now I feel very well. Just having my pressure come down already has made me feel more disposed, prettier and with my self-esteem way up there. I’m not hypertense, but I put on a lot of weight in a short space of time, and that’s fatal for your pressure. Sometimes it rose a little, but after I lost weight it returned to normal”

“Actually I had already lost 20 kilos before having the balloon placed, and with the balloon I have lost almost 8 kilos. I was weighing nearly 100 kilos and now I am down to 70. This weight loss took just over a year and it was quite a sacrifice following diets. After a year of dieting, the proposal of the balloon appeared. That’s when I had it placed and lost more weight”.

“Today I can eat a little of everything. You eat well and you eat healthier food. In fact, with the balloon I have learned to re-educate myself”.

“I recommend other people to use the balloon because it’s an effective product with a high standard of quality and gives perfect results. I would recommend it to others, and if I had to, I would have another one placed.”

<< Back

4 - Fabiane Duque Estrada de Almeida

Cardiologist of the Guanabara Center of Nuclear Medicine, in the Center of Rio de Janeiro.

“Fat is a facilitator of hypertension. So if there is a tendency in your family and you put on weight, you could become hypertense. Hypertension is one of the risk factors that are closely linked to coronary disease. Accumulated fat in the abdomen, the increase in cholesterol and triglycerides, and automatically the increased resistance to insulin, which raises the quantity of glucose in the blood: all these factors are linked to obesity and make up the metabolic syndrome, which is closely tied to coronary disease. So it is absolutely essential for anyone who suffers from hypertension or has a coronary problem to lose weight”.

“People who are decompensed, with arrhythmia, for example, chest pains or breathlessness, need to have prior evaluation. Not that there is an absolute counter-indication, because to have the balloon placed, the patient undergoes an endoscopy, not a surgical procedure. You don’t receive a heavy sedation during the procedure, which does not take long. There is no need to take a surgical risk. However, patients who are really decompensated, without any treatment, and feeling bad, should not have the device placed. But if you are hypertense, diabetic or coronariopathic, any of these, with regular and controlled treatment, there is no problem at all in having the balloon placed. Quite the contrary: it is recommended that such patients have it placed”.

“I have not followed up on many hypertense patients, but with the few I have treated, the tendency is to lower the dose of medication. If a patient has become hypertense just through weight increase, he/she may not require medication. Now, if a patient has a family tendency, the dose of medication can be reduced, and benefits can be gained by taking a smaller amount of medicine and controlling the pressure”.

“While the balloon is being used, the patient maintains normal medication and should do some accompanied physical activity if permitted by the cardiologist. Physical activity is more than recommended”.

“The balloon must not be considered as a first option. For patients whose BMI is over 28 or 29, with accumulated fat especially in the abdominal region - women above 80cm, generally 88cm - we should recommend losing weight, especially those with high triglyceride count, family history, cardiac disease. There are clinical treatments for such cases. Now, when a person spends three more years trying to lose weight without any success, and in fact puts on more weight and is not stimulated, we use the balloon for him/her to lose weight, because there is no counter-indication. The balloon impels patients to feel stimulated to follow a diet and make some changes in their life-style”.

<< Back

5 - Gustavo Carvalho

Surgeon, specialized in Surgery of the Digestive Apparatus, the Oswaldo Cruz Hospital of Clinics (PE). Professor at the University of Pernambuco (UPE).

“I have used the intragastric balloon since 2000. I have been using the SILIMED balloon since 2005. We have performed 98 procedures with the SILIMED balloon, for a total of 91 patients. Seven patients are already using their second balloon. From 2005 to present, we implement between 40 and 50 balloons a year”.

“Data from world literature on different types of balloons indicate an 80% success rate with this procedure. Success is when the patient loses more than 50% of his/her excess weight. Total loss of excess weight is something that bariatric surgery, which is far more radical, guarantees you. But with the balloon we consider any loss above 50% a success. Today the average weight loss stands at 70%. Excess weight is what we have to lose in order to become a normal person. Let me give an example of someone whose ideal weight is 65 kilos. If they weigh 80 kilos, their excess weight is 15 kilos. The balloon makes you lose weight proportional to your initial weight. So, a loss of 60% of the excess weight. If a person should ideally weigh 60 kilos, but they weigh 90 kilos, that is, 30 kilos more than they should, they will lose from 16 to 20 kilos. In other words, a little bit more of this 60% loss of excess weight would be very good for that person. Now, if a person weighs 10 or 12 kilos more than the ideal, they will lose between 8 and 10 kilos”.

“There are many different complications. The most frequent complication, which may happen in up to 20% of people, is not losing the weight they would like to lose. This is a complication that I consider very serious, because the person invests time, the desire to lose weight, anxiety and even money on a technique, and ends up not losing any weight. This is a serious complication that the balloon can have. In our case here in Pernambuco, this happens in 15% of cases. In the world literature, the figure stands at 20%. Less frequent complications, occurring in less than 1% of cases, are rupture of the balloon, with migration to the intestine; intestinal obstruction; and hemorrhagic gastritis. These complications are very infrequent, but they can happen with this technique. All of them have far less probability of something more serious happening – even death - than the traditional techniques of bariatric surgery”.

“After the balloon is placed, there are two phases. Right after implementation you have the phase of adapting to the use of the balloon. In the first few days you go through this experience. You may even vomit, and for three days you may not be able to go back to work. After a week using the balloon, your life returns to normal. In fact, patients are encouraged to do physical exercises after the first week using the balloon. Doing physical exercise is something fundamental. There is no restriction of any kind. Patients are stimulated to do some kind of exercise”.

“Nor is there any restriction as to food. When the balloon is first placed, patients are restricted because they don’t manage to eat anything other than clear liquids. But after 30 to 40 days they can eat practically anything, as long as in small quantities. However, if you really want to lose more than 60% of the excess weight that the balloon recommends, it is important to follow a balanced nutritional diet, normally under the guidance of a nutritionist. This makes a person lose more weight than just the 60% excess, and they can even reach 90% or 100% of their overweight”.

“The balloon is a reversible technique. When it is placed in position, it already has a date to be removed. Inside a period of six months, the patient has the balloon removed. If in this period the patient has not managed to re-educate his/her eating habits, they may put on the same weight they had lost, just as happens with a good diet. Therefore, if the patient does not feel confident about staying with the recommended re-education in eating habits, he/she can have the second balloon placed and even lose 50% of the volume of weight lost with the first balloon. For example: if the patient lost 10 kilos with the first balloon, with the second he can lose about 5 kilos, which would help to complement the weight loss. In fact, I have two patients who are interested in having a third balloon inserted. It is necessary for the patient to wait at least two months between having a balloon removed and another implanted, so that the brain can forget that the balloon was stimulating the production of hormones in the stomach. Then the second balloon will be far more effective”.

“I have a very good piece of advice for those who want to lose weight using the balloon. This is that the balloon is a very good technique as an adjuvant in carrying out any diet. People who have a balloon in their stomach and start to follow a diet are just like a football player about to take a penalty kick without a goalkeeper in front of him. If he just aims at the middle of the goal, the ball will go in smoothly. But if he wants to waste the penalty kick, he can. So the balloon is an adjuvant, it helps people to follow a diet, to re-educate their eating habits. Whether this is going to be long-lasting will really depend on the person who is having the balloon placed. The balloon does not make you lose weight. What makes you lose weight is the capacity and facility that you have to comply with the diet, but it is very difficult for an obese person to follow the rigor of a diet. Patients who have the balloon don’t lose weight, if that’s what they want. Today we have 15% of patients who did not lose the weight that they wanted to lose and not even the 60% excess weight and had a loss of under 5 kilos. They managed to waste a penalty kick without a goalkeeper in the goal in front of them. And they are aware of this. The patient who is going to have a balloon placed needs to realize that it is a fundamental part of the process. We who place the balloon will help the patient to lose weight, but the patient’s collaboration is essential”.

<< Back

6 - Odaiza França de Souza

Nutritionist.

“I began to follow up patients with the balloon in September 2007. I do all the follow-up on the patient for the six months that they have the balloon inside them. In this period the patient comes to the office three times. The first time, so that I can explain the diet they will have to follow, with the estimated caloric value. Two months later, they come so that I can see how the diet is coming along and if they are losing weight. The last month, when they are close to having the balloon removed, a new evaluation is made to see the level of mineral salts, vitamins, proteins, and if everything is all right”.

“What happens is that I have to re-educate them in their eating habits. It is only logical that they will reduce the quantity, but they have to opt for the quality, so that they can have a better quality of life, a healthier life. They have to eat healthier food. If you diminish the quantity but increase the caloric value, the benefit is nil. For example: if you eat two spoonfuls of rice but decide to eat two forkfuls of French fries, the caloric value is much higher. If you drink condensed milk, that increases your caloric value tremendously. So, the quantity may be less, but if you don’t have the proper eating habits, it’s not going to do you any good”.

“The first 2 weeks, you cut completely all fried food, fats in general, and fibrous foods - leaves and salads. The first 2 weeks, the patient cannot consume any food of this type. Since the patients are not going to complete their digestive process, they will vomit a lot and these foods will emerge intact. When this period is over, there is nothing that they cannot eat. From that day on they have to be aware of the caloric value of their food. I prescribe a balanced diet and stipulate a value. This is generally between 800 and one thousand calories, or 1,200 at the most. So, if the patient goes beyond this caloric value, he is not going to lose weight - that will depend on his metabolism. If he manages, within this value of one thousand calories, to eat French fries, fried food in general, fast-food, there is no problem”.

“The problem is that the patient has to restrict his intake of food. There are patients whose aim is to really slim, so they accept this quite well. When that is not the aim, when it is something imposed on them, sometimes parents who want their adolescent child to lose weight, to control his consumption of food, that bothers patients and they don’t manage to follow the diet”.

<< Back

7 - Sonia Raquel Andrade Silva

Sales promoter, 31 years old (patient).

“I wear a balloon. Before this, I underwent several other treatments. I tried all the diets imaginable. I came upon the balloon through my sister’s recommendation. I got into the Internet to see about the process and decided to try it. But I was afraid of going through the whole process because I was scared of becoming ill”.

“After I had the balloon implanted, the first few days were complicated, but nothing unbearable. I felt very sick, with vomiting and colic pains, and with the diet just on the basis of liquids, which was very hard. But I had the full support of the team that implanted the balloon. The two doctors who placed the balloon always gave me lots of support. When I went for consultation, they were always concerned. They prescribed medicine for sickness and showed me how to get over this difficult initial period”.

“The balloon has not affected any of my everyday activities in the least. I have had no problems at all. Only in the first three days was I unable to do anything because I stayed at home. I have had the balloon for six months now and soon I will have it removed”.

“The last time I weighed myself, I had lost ten kilos. Before I weighed 87 kilos. Today I am about 77. My eating habits have changed, because I have learned to eat better. I still eat the same things, nothing has changed. The only thing that has changed is that I have reduced the quantity and regulated the times for eating. I used not to have any fixed times for eating, it was all off balance”.

“I certainly recommend anyone who wants to use a balloon to do so, because it helps you psychologically and also helps you not to feel so hungry”.

<< Back