Overweight patients who have not been successful at losing weight through diet and exercise but are hesitant to undergo weight-loss surgery now have a new treatment option. An innovative nonsurgical obesity treatment can offer greater weight loss than lifestyle modifications alone, without the risks of major surgery.

Now available at MUSC Health, ReShape™ weight-loss treatment involves two outpatient endoscopic procedures along with one year of nutrition and behavioral counseling.

While bariatric surgery has a track record of offering patients significant weight loss, MUSC gastroenterologist Gregory Cote, M.D., says many people are understandably reluctant to undergo surgery. He’s excited about ReShape’s potential to reach more people who have struggled to lose weight on their own. In partnership with the experienced interdisciplinary team of experts at MUSC Health, the ReShape intragastric balloon is one of the latest nonsurgical approaches to managing excess weight.

“Roughly two-thirds of the people in the United States are overweight or obese, and most of those people want nonsurgical treatment solutions,” Dr. Cote says. “There is a tremendous demand for treatments that fall somewhere between diet and lifestyle modification and more intense surgical interventions.”

ReShape: A New Kind of Weight-Loss Plan

Historically, most obesity treatments have fallen under one of two categories:

  • Lifestyle interventions, such as diet, exercise, behavioral, and pharmaceutical modifications, tend to be minimally effective at achieving long-term weight loss and are often insufficient for those with morbid obesity.
  • Bariatric surgery, which is an effective treatment for obesity, exposes patients to the potential for surgery-related complications. Bariatric surgery is currently indicated for those with morbid obesity who have a BMI greater than 35 with comorbid health conditions.

ReShape and other intragastric balloon procedures represent a middle-ground treatment approach: a minimally invasive nonsurgical procedure paired with an intensive behavioral program. The intragastric balloon helps jump-start patients’ weight loss while MUSC’s nutrition experts help patients learn healthy habits to sustain them into the future. Endoscopic approaches like the intragastric balloon also serve as a treatment option for those in the so-called “treatment gap”: patients with a BMI between 30 and 40.

Patients receiving this treatment undergo two outpatient procedures, both under light sedation:

  • Placing the dual balloon system: Using an endoscope through a patient’s mouth, a gastroenterologist inserts two connected balloons in the stomach, inflating them once they are in place. This 20-minute procedure helps patients feel full faster and reduces appetite.
  • Removing the dual balloon system: Six months later, a patient undergoes another short endoscopic procedure, during which specialists remove the balloons from the stomach. This procedure returns a patient’s digestive system back to its normal function, requiring them to rely on healthy habits to maintain their new weight.

To help patients ensure long-term weight-loss success, patients receive one full year of regular health coaching from MUSC’s nutrition and other medical experts:

  • First week after surgery: After balloon placement, patients receive daily phone calls from care specialists, to ensure they are tolerating the treatment well.
  • Monthly meetings: Soon after the balloon-placement procedure, patients attend monthly sessions with MUSC’s registered dietitians and medical specialists to:
    • Assess progress on behavioral changes and weight-loss.
    • Tackle individual challenges and plan for success.
    • Ensure patients have the tools and know-how to maintain eating and behavior changes long term.

“Patients keep careful track of their food intake after the initial balloon placement procedure,” explains Dr. Cote, who says the diet recommendations for ReShape are similar to the guidelines patients follow after bariatric surgery. “After the balloon removal procedure, patients continue to have monthly visits with our nutrition experts for continued close monitoring of weight and additional coaching.”

A New Approach to Obesity Treatment

Unlike bariatric surgery, ReShape does not permanently modify a patient’s digestive organs. Dr. Cote has high hopes that this procedure, though temporary, will help patients achieve significant weight-loss goals in the short term and adopt healthier habits that will benefit them for years to come.

“This procedure works under the premise that after one year, patients have achieved a durable weight-loss goal and, more importantly, have adapted to a healthier lifestyle. Our bariatric experts coach patients to help them incorporate portion control, exercise, and other healthy habits into their lives. With this guidance and support, they will hopefully minimize weight regain later,” says Dr. Cote.

MUSC Health is currently one of the few centers in South Carolina offering this nonsurgical balloon procedure. While Dr. Cote notes that MUSC’s Metabolic and Bariatric Surgery Program offers a range of surgical and nonsurgical treatment options, he says ReShape is most suitable for patients who have less severe obesity (with a BMI between 30 and 40) and obesity-related complications, such as prediabetes.

Because an endoscopic procedure has fewer risks than surgery, Dr. Cote hopes physicians will consider referring overweight and obese patients to MUSC’s Metabolic and Bariatric Surgery Program sooner.

“Determining the right type of weight-loss intervention for each patient is an individualized process. An intragastric balloon may not end up being the best fit for all patients. But by referring patients who could benefit from weight loss to our program, those patients can get connected to a comprehensive weight-loss program that offers the full spectrum of treatments for obesity,” says Dr. Cote.

For more information, contact Dr. Cote at cotea@musc.edu.