The endoscopic bariatric patient: characteristics, beliefs, and fears

Background and Aims

Endoscopic bariatric therapies (EBTs) are minimally invasive tools to facilitate weight loss in adults with obesity and may appeal to those wishing to avoid traditional bariatric surgery (TBS). There are considerable knowledge gaps about patient beliefs, expectations, and concerns about these novel therapies, particularly in comparison with TBS.

Methods

We conducted a 34-question electronic survey of consecutive patients seeking endoscopic sleeve gastroplasty or intragastric balloon placement at a center with expertise in EBT before consultation with a medical provider.

Results

One hundred twenty-five patients were sent surveys, and 101 patients (80.8% response rate, 100% survey completion rate) responded. Patient characteristics were as follows: 88.1% women, mean age 43.2 ± 9.7 years, mean body mass index 38.8 ± 5.6 kg/m², 63.4% white, 32.7% black, 7.9% Hispanic/Latino, 92.1% employed, 58.4% married, and 76.2% had at least 1 obesity-associated comorbidity. In addition, 63.7% of respondents had ≥10 prior weight loss attempts, 64.4% first attempted weight loss before age 26 years, and previous efforts included commercial weight loss programs (66.3%), over-the-counter drugs (66.3%), and prescription antiobesity medications (70.3%). The most common motivations to pursue EBT included desire to lose weight (100%), improve health (98%), improve appearance (87.1%), improve confidence (85.1%), live longer (85.1%), improve mobility (78.0%), and participate in family activities (72.3%). Only 50.5% understood EBTs could have serious adverse events. Sixty-one respondents (60.4%) were eligible for TBS, 18% of whom had met with a bariatric surgeon. Of those eligible for TBS, 67.2% described themselves as either “unlikely” or “extremely unlikely” to pursue TBS; the top reasons cited for preference for EBT over TBS included safety (37.7%), side effects (16.4%), downtime (16.4%), same-day procedure (9.8%), and less preprocedural workup (9.8%).

Conclusions

In this cross-sectional survey of patients seeking EBTs at a practice that focuses solely on nonsurgical management of obesity, patients tended to overestimate efficacy and underestimate the risk of EBTs before undergoing a consultation with a medical provider. This cohort strongly preferred EBT over TBS, primarily driven by perceptions of safety, tolerance, access, and recovery time. This study helps characterize the EBT patient and underscores the importance of patient education in endoscopic treatments of obesity.