Europeans Find Extra Options for Staying Slim writePost();
By ELISABETH ROSENTHAL
Published: January 3, 2006
After years of failed dieting, Sabrina Spalliera, 33, underwent a minor procedure to have a fluid-filled balloon inserted into her stomach, where it sat for six months last year and simply took up space.
Feeling full after just a few bites of food, Ms. Spalliera, an office worker, quickly lost 77 pounds, dropping from 242 to about 165 pounds. She had read about the balloon on the Internet.
Now, wearing a denim miniskirt and high black boots, she hardly looks like a candidate for weight-loss surgery. But here she is, at Rome's Policlinico Umberto I, asking for another balloon. Her goal: to lose another 22 pounds. ''This has radically changed my life; I can walk,'' Ms. Spalliera said. ''I can climb stairs. I have a love life.'' Surgical procedures to lose weight have gained popularity in Europe as methods have become simpler and obesity rates have climbed.
Though still largely the province of people with dangerous obesity, the procedures are now regarded as so simple and safe by many European surgeons that they are being offered to people like Ms. Spalliera, who, after her initial weight loss, was merely overweight.
In Italy, as in most of Europe, the number of procedures carried out has doubled in the last three years, according to medical studies. A vast majority use a simple, minimally invasive technique in which an adjustable band is slipped around the stomach to reduce its size.
More recently, doctors have been using balloons like Ms. Spalliera's, which can be inserted through a tube in the mouth and inflated in 15 minutes.
''We can afford to offer it to more people since it is relatively complication-free,'' Dr. Nicola Basso, a leading Italian researcher on surgery for obesity, said of the so-called Lap Band technique. ''This has become the most common surgical procedure in Western Europe for weight loss. It has the pole position.''
But even as Europeans rave about their bands and their balloons, many American doctors have remained suspicious, regarding the techniques as not terribly effective and even dangerous.
Bands, used for more than a decade in Europe, are just catching on in the United States; balloons are not in the pipeline for approval from the Food and Drug Administration yet.
''There are really profound differences in how we think about weight-loss surgery,'' said Dr. Sayeed Ikramuddin, a fellow of the American College of Surgeons and the chief of bariatric surgery at the University of Minnesota.
Eighty percent of weight-loss surgery in the United States involves a far more arduous and technically demanding bypass operation in which the stomach is cut and made smaller with staples, then reconnected far down in the intestine.
While the initial weight loss is often more rapid, complications are more common and many patients are loath to undergo the larger procedure.
It is a striking example of the way that patients' options are governed by doctors' habits in even the most sophisticated medical systems.
''It's really just a question of who got used to what first, and what has insurance approval,'' Dr. Ikramuddin said.
In some early trials in the United States, he added, the less invasive techniques produced mixed results, and this lastingly tarnished their reputation among American medical professionals.
Because the new procedures are widely accepted in Italy, both the band and the balloon are virtually free for patients, paid for by the national health insurance plan. In France, the banding procedure is covered, but the balloon option is not; it costs about 5,000 euros or a little more than $5,900.
European surgeons extol the spread of simple weight-loss surgery to the masses, noting that obesity is not just a cosmetic problem.
Most obese people have serious medical problems, like breathing difficulty and diabetes, which shorten their life expectancies; weight loss improves the condition of a majority of them.
''This is a lifesaving procedure which is very difficult for some people to understand,'' Dr. Basso said.
Obesity rates are rising sharply in countries across Europe, according to the health directorate of the European Commission. Some are catching up with the United States, where obesity rates are 28 percent for men and 34 percent for women.
European Union figures show the highest rates for European men in Cyprus (nearly 27 percent) and for women in Greece (38 percent).
Dr. Basso said that 1.5 million Italians could potentially benefit from weight-loss surgery, and that many were demanding it, especially now that simpler procedures are available.
Davide Rubbio, 48, an ambulance worker in Rome, had missed nine months of work over a three-year period before having the stomach band procedure in February. At about 320 pounds, life was a struggle: he was depressed, could not tie his shoes, had diabetes and was chronically short of breath.
He heard about the band surgery on television; it appealed to him, he said, because it did not require a big operation and ''nothing was taken out.'' Nine months later, he has lost 77 pounds and is losing more. ''Now I'm advising everyone I know to have it,'' he said.
On both sides of the Atlantic, patients who are contemplating weight-loss surgery generally undergo intensive medical and psychological screening.
A patient's body mass index, a measure of obesity, must be above 40, or above 35 if the patient has a related medical disorder like diabetes. (To calculate body mass index, divide your weight in pounds by your height in inches squared. Then multiply the result by 703.)
But in Europe, those criteria are being eroded by the presence of the balloons, and by patient demand.
''You have patients who don't quite meet indications for surgery, but they've failed lots of diets, and they are gaining weight,'' said Dr. Alfredo Genco of the Policlinico. ''So we should do nothing and wait until they get morbidly obese? This is a very safe procedure and can prevent it, so why not give them the option?''
He recently returned from Kentucky, where he inserted the balloon in 10 patients to initiate a trial for F.D.A. approval, which is still years away. His American colleagues, Dr. Genco said, ''continue to think of it as dangerous, but it's just not true.''
''They don't have experience with the current device,'' he continued.
To Dr. Genco, the balloon is a tool to help motivated patients lose weight, allowing them in the meantime to acquire healthier eating habits. He said his own wife, who has been struggling to lose 25 or so pounds for years, is now demanding a balloon. If she fails one more round of dieting, she will try it, he said.
In a recently completed clinical trial involving more than 2,500 patients in Italy, serious complications occurred in 5 patients when pressure from the balloon eroded the stomach wall and caused it to burst. Two of the five patients died.
On the other hand, almost 90 percent of people with obesity-related illnesses like diabetes and high blood pressure were cured or showed improvement after six months of the balloon.
Weight-loss experts on both sides of the Atlantic are somewhat mystified about why early trials of banding and balloons were not as successful in the United States as in Europe. Eating habits may be partly to blame, however, as patients must be capable of cutting down on food to benefit fully from the simpler European procedures.
Although the procedures reduce the stomach to the size of a coffee cup, they will ''not be effective if it is filled hundreds of times a day,'' Dr. Basso said.
The lap band procedure involves the placement of a ring around the stomach through a scope inserted through the abdominal wall. Intended to remain for life, it can be adjusted from outside to regulate the flow of food and can be reversed if there are problems.
The balloon is kept in place for six months and is then removed because of concerns that the material might wear out.
Massimo Chiovelli was at the clinic last week for balloon removal after losing a little over 68 pounds. Convinced that he can lose weight and still enjoy life while eating smaller meals, he said he could not eat a steak and that he felt full after a small amount of yogurt. He will soon undergo the longer-term banding procedure.
Mr. Chiovelli, who is a dental technician and who, like many here, wears clothes that now hang loosely on his frame, said: ''I was just so fat I couldn't take a walk or climb stairs, and at work I just sit all day.''
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