Short-term intragastric balloon treatment improves quality of life

Six-month treatment with intragastric balloon (IGB) was associated with significant weight loss and improvements in obese individuals with metabolic syndrome in their health-related quality of life (HRQoL), according to researchers from Federal University of Rio de Janeiro, Rio de Janeiro, Brazil. They reported that weight loss parameters were associated with short-term improvements in HRQoL, although only total fat was independently related to HRQOL perception. The paper, ‘Impact of 6 months of treatment with intragastric balloon on body fat and quality of life in obese individuals with metabolic syndrome’, published online in the journal - Health and Quality of Life Outcomes.

The aim of their study was to investigate the effect of six months of treatment with an IGB on HRQOL (including specific domains) in obese individuals with metabolic syndrome and its relationship with changes in body composition, including fat content measured by dual-energy X-ray densitometry (DXA).

The researchers recruited 50 patients from July 2011 to April 2012 and were implanted with a silicone IGB (Silimed Silicone Instrumental Médico Cirúrgico Hospitalar Ltda). The patients were subsequently followed for up to six months when the IGB was then removed.

The follow-up visits were performed at weeks 0 (baseline), eight, 16 and 24. During each visit, body weight (kg) and height (m) for calculation of their BMI was taken, as well as waist circumference (WC, cm). The body fat content (%) was evaluated at weeks 0 and 24 by DXA using a Prodigy-GE densitometer (GE Healthcare).

The authors utilised the World Health Organization Quality of Life (WHOQOL), an internationally widely used questionnaire to evaluate quality of life, translated and validated for the Brazilian population. This questionnaire evaluates and individual’s overall quality of life (question 1), general health (question 2), Physical Domain (pain, fatigue, energy, sleep, and rest), Psychological Domain (self-esteem, memory, positive and negative feelings, perceptions of body image, and appearance), Social Domain (assessment of personal relationships), and Environmental Domain (safety, financial resources, leisure time, home environment, transportation, convenience of getting information, and medical service). The WHOQOL-BREF questionnaire was applied to the study group at baseline and soon after removal of the IGB. WHOQOL-BREF was used with permission from WHO, even though the permission was obtained after the completion of the trial.

Of the 50 patients included in the protocol, 11 did not complete the study due to gastric intolerance in four, balloon rupture in five, uterus cancer in one and loss of follow-up in another one. Therefore, prospective data were analysed for 39 patients who completed the study.

Outcomes

The mean age of the cohort was 34.6±7.1 years and the mean BMI40.0±6.3. After six months of treatment with IGB, the mean reduction in weight, BMI, WC, fat free mass and total body fat analysed with DXA was 11.7±9.6kg (p<0.0001), 4.4±3.5kg/m2 (p<0.0001), 9.3±8.2 cm (p<0.0001), 3.7±4.8kg and 7.53±7.62kg (p<0.0001), respectively.

Patients who completed the study also displayed a significant improvement in almost all aspects of HRQOL measured by the WHOQOL-BREF, except the Social Domain, which presented only a trend toward significance.

The researchers then performed a correlation analysis to investigate whether the amount of weight loss would correlate with the improvement in different aspects of quality of life . The reduction in all markers of excess weight (BMI, WC, weight, and total fat [%]) was directly related to the improvement in general aspects of HRQOL (questions 1 and 2 of the WHOQOL-BREF).

These results were not observed for the specific domain of the questionnaires. For the Physical Domain, only the reduction in WC was associated with the improvement. For the Environmental Domain, only the reduction in body fat measured by DXA correlated with the improvement in the scores. Among all domains of the WHOQOL-BREF, Physicological did not meet the requirements.

Therefore, the authors stress that the results of their study are not applicable to patients with psychiatric syndromes and they state additional studies are necessary to clarify the impact of IGB in this specific population.

Multiple linear regression was used to identify which variables (anthropometric and DXA) independently correlated with the improvements in quality of life. ‘Question 1’ and ‘Question 2’ were used as the dependent variable and three different factors indicative of weight excess as independent variables (i.e., BMI, WC, fat free mass and total fat [%]).

Both models were also adjusted for age and gender. After regression, only total fat (%) remained independently related to question 1 (p=0.047). On the other hand, no variable (i.e. BMI, WC, and total fat [%]) reached statistical significance after regression for Question 2.

“Our study demonstrated that weight loss, particularly the reduction in body fat, was associated with improvement in general HRQOL,” the authors write. “These results strongly suggest that, although several different mechanisms may be proposed to explain the improvement in specific aspects of HRQoL after rapid weight loss, the reduction in body fat seems to be one of the main determinant in this improvement.”