Intragastric balloons (IGB) are a safe and effective treatment for obesity. However, limited knowledge exists on the underlying biological changes with IGB placement.
This single-institution study was part of an adjustable IGB randomized controlled trial. Subjects with obesity were randomized in a 2 to 1 ratio to 32 weeks of IGB with diet/exercise counseling (n=8) versus counseling alone (controls, n=4). Diet/exercise counseling was continued for 24 weeks post-IGB removal to assess weight maintenance. We used mass spectrometry for non-targeted plasma lipidomics analysis and 16S rRNA sequencing to profile the fecal microbiome.
IGB subjects lost 15.5% of their body weight at 32 weeks versus 2.59% for controls (P<0.05). Maintenance of a 10.5% weight loss occurred post-IGB explant. IGB placement followed by weight maintenance led to a -378.9 uM/L reduction in serum free fatty acids compared to pre-IGB (95% CI: -612.9, -145.0). This reduction was mainly in saturated, mono, and omega-6 fatty acids when compared to pre-IGB. Polyunsaturated phosphatidylcholines also increased after IGB (difference of 27 uM/L; 95% CI: 1.1, 52.8). Compared to controls, saturated and omega-6 free fatty acids (linoleic and arachidonic acids) were reduced after IGB. The fecal microbiota changed post-IGB placement and weight maintenance versus pre-IGB (P<0.05). Further analysis showed a possible trend toward reduced Firmicutes and increased Bacteroidetes post-IGB and counseling, a change that was not conclusively different from counseling alone.
IGB treatment is associated with an altered fecal microbiome profile and may have a better effect on the obesity-related lipidome than counseling alone.