VHA Program Combines Bariatric Endoscopy, Pharmacology to Improve BMI

To better address the many health threats posed by obesity, physicians at NY VA Harbor Healthcare System in New York City launched the first Veterans Health Administration (VHA) bariatric endoscopy program. They recently described their approach to helping veterans lower problematic body mass index (BMI) in The American Journal of Gastroenterology.

“[B]ariatric surgery is usually approved for patients with BMI ≥ 40 kg/m², or ≥35 kg/m² with excess weight comorbidities, missing the opportunity to intervene earlier in patients with lower BMIs, before significant metabolic disease is established,” wrote Violeta Popov, MD, PhD, Ayse Aytaman, MD, FACG, and José O. Alemán, MD, PhD. “Within the VHA, 78% of veterans have BMI as overweight or obesity, but there are only 21 VHA bariatric surgery programs.”

Endoscopic bariatric and metabolic therapies, such as gastric balloons, aspiration therapy, and endoscopic gastroplasty, are approved for patients with weights as low as BMI >30 kg/m². Weight loss can range from about 10% with gastric balloons to 16% with endoscopic gastroplasty, which, the authors pointed out, are losses significant enough to reverse liver fibrosis and reduce myocardial infarction risk.

The VHA bariatric endoscopy program combines endoscopic bariatric and metabolic therapies, obesity pharmacotherapy, and lifestyle interventions in collaboration with the VA MOVE! weight management program. Patients receive assessments from a registered dietitian and psychologist, and participate in discussions with the primary care provider, bariatric endoscopist, and endocrinologist, before settling on a treatment plan. Afterward, patients are reassessed every 3 to 6 months, and strategies can be changed as necessary to include different weight loss medications, procedures, or surgery. The program is designed to be long-term, with patients actively participating in healthy lifestyle changes throughout the process.

“The multidisciplinary stepped-care approach and ongoing conversation between providers and patients allow us to create an environment in which our patients feel supported and eager to participate,” the team wrote. “Our versatile approach gives the practitioner more options to respond to the patient’s progress or lack thereof.”

Short-term evidence supports the strategy, according to the authors. Going forward, they plan to continue to collect data to see if effects are sustained over the long-term.

—Jolynn Tumolo

Reference:

Popov VB, Aytaman A, Alemán JO. Obesity: the forgotten pandemic. Am J Gastroenterol. 2022;117(1):7-10.