Rx for Readers: Optimal loss

Readers get answers for their medical and health queries.

Woman standing on bathroom scale measuring her weight  (photo credit: INGIMAGE)
Woman standing on bathroom scale measuring her weight
(photo credit: INGIMAGE)
I am an overweight, 48-year-old man. My body mass index is 30. I am afraid of undergoing bariatric surgery. I heard that there is a procedure from the US and approved by the FDA that is called Spatz that is now available in Israel (but not included in the basket of health services) in which a baloon is inserted into the stomach via the mouth and inflated, making it difficult to overeat. By the time it’s removed, the person has lost a lot of weight. Do experts in weight loss and bariatric surgery recommend this? How much does it cost and where is it available? As it does not involve surgery, it must be much cheaper, so why isn’t it paid for by the health funds? -A.R., Givatayim
Judy Siegel-Itzkovich comments: The Spatz balloon was developed by Spatz FGIA Inc., a USbased medical device company that maintains it has succeeded in creating “a non-surgical, less invasive and safe device for the treatment of obesity.”
Advertisements for the treatment have appeared in Israel under the name of Optimal, which performs aesthetic and other treatments. The specialist who is known for performing it here is Dr. Jeffrey Brooks, who founded the company in 2005 and describes himself as a “US board-certified gastroenterologist with 25 years of clinical experience who has held an academic position at Columbia University.” The company website maintains that the Spatz Adjustable Balloon System has been designed and manufactured under good manufacturing practice conditions.
However, when I asked two leading experts on the subject of gastroenterology and treating obesity, both were opposed to the use of the balloon.
Prof. Max Maislos, a veteran specialist in diabetes and metabolism at Ben-Gurion University of the Negev’s Faculty of Health Sciences in Beersheba, commented: This treatment is approved for temporary insertion in the stomach, about one year. It is much less invasive than bariatric surgery, but the effect is much more limited.
After the removal of the device, there is no barrier or impediment for the patient to overeat again and regain the lost weight. I don’t see it as an effective means of losing weight over the long run. It is not included in the basket of health services, so one must pay privately. There are always people willing to pay, looking for an easy answer to a complex problem.
Prof. Yaron Niv, deputy director-general of Petah Tikva’s Rabin Medical Center-Beilinson Campus, director of its gastroenterology department and its risk management and quality assurance department, replies: The story of the temporary gastric balloon has been running for the last 25 years, and there have been different versions.
The previous versions were unsafe, killing patients due to intestinal obstruction (the balloon sometimes left the stomach). The modern versions are safer, still having no effect in the long run. Sometimes it is used for bridging before bariatric surgery, in people that are too obese to stand general anesthesia and major surgery.
Personally, even though I have studied the procedure – which is simple – I do not believe in this approach, and I do not recommend it to my patients.
There are very few medical articles that have studied the new, safer version that has only some short-duration success.
I came across a question/answer article in your Friday, January 8 edition of The Jerusalem Post regarding benign prostate hyperplasia that I can relate to. I am 71 years old and have all the classic symptoms enumerated by Prof. Ofer Shenfeld, including an elevated PSA level. It started at around four points on the scale when I was in my early 50s, and it is now seven points. The urologist who has examined me has found nothing suspicious in the digital rectal examination. I wanted to know if I can or should rule out prostate cancer by undergoing a biopsy or whether there is a less-invasive procedure. -A.L., Rishon Lezion
Prof. Ofer Shenfeld, chief of urology at Jerusalem’s Shaare Zedek Medical Center, replies: Not having a suspicious lesion on a rectal examination does not rule out prostate cancer. Actually most patients diagnosed by biopsy have no suspicious palpable nodule in the prostate. However, one may argue that by age 71, it may not matter if the patient has prostate cancer because there have been studies showing that in general, patients with localized prostate cancer treated after 68 did not do better than those not treated at all. Having a biopsy would be a judgment call based on the specific patient’s general health (projected longevity) and his desires after a discussion with a urologist.
Rx for Readers welcomes queries from readers about medical problems. Experts will answer those we find most interesting. Write Rx for Readers, The Jerusalem Post, POB 81, Jerusalem 9100002, fax your question to Judy Siegel-Itzkovich at (02) 538-9527, or email it to [email protected], giving your initials, age and place of residence.