Changing the narrative around obesity in the UK: a survey of people with obesity and healthcare professionals from the ACTION-IO study

ObjectivesTo investigate the perceptions, attitudes, behaviours and potential barriers to effective obesity care in the UK using data collected from people with obesity (PwO) and healthcare professionals (HCPs) in the Awareness, Care, and Treatment In Obesity maNagement–International Observation (ACTION-IO) study.DesignUK’s PwO (body mass index of ≥30 kg/m2 based on self-reported height and weight) and HCPs who manage patients with obesity completed an online survey.ResultsIn the UK, 1500 PwO and 306 HCPs completed the survey. Among the 47% of PwO who discussed weight with an HCP in the past 5 years, it took a mean of 9 years from the start of their struggles with weight until a discussion occurred. HCPs reported that PwO initiated 35% of weight-related discussions; PwO reported that they initiated 47% of discussions. Most PwO (85%) assumed full responsibility for their own weight loss. The presence of obesity-related comorbidities was cited by 76% of HCPs as a top criterion for initiating weight management conversations. The perception of lack of interest (72%) and motivation (61%) in losing weight was reported as top reasons by HCPs for not discussing weight with a patient. Sixty-five per cent of PwO liked their HCP bringing up weight during appointments. PwO reported complex and varied emotions following a weight loss conversation with an HCP, including supported (36%), hopeful (31%), motivated (23%) and embarrassed (17%). Follow-up appointments were scheduled for 19% of PwO after a weight discussion despite 62% wanting follow-up.ConclusionsThe current narrative around obesity requires a paradigm shift in the UK to address the delay between PwO struggling with their weight and discussing weight with their HCP. Perceptions of lack of patient interest and motivation in weight management must be challenged along with the blame culture of individual responsibility that is prevalent throughout society. While PwO may welcome weight-related conversations with an HCP, they evoke complex feelings, demonstrating the need for sensitivity and respect in these conversations.Trial registration numberNCT03584191.

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Attitudes and Approaches to Use of Meal Replacement Products among Healthcare Professionals in Management of Excess Weight

Behavioral Sciences ◽

10.3390/bs10090136 ◽

2020 ◽

Vol 10 (9) ◽

pp. 136

Author(s):

Gabrielle Maston ◽

Janet Franklin ◽

Alice A. Gibson ◽

Elisa Manson ◽

Samantha Hocking ◽

...

Keyword(s):

Weight Loss ◽

Weight Management ◽

Online Survey ◽

Healthcare Professionals ◽

Overweight And Obesity ◽

Prescribing Patterns ◽

Formal Training ◽

Meal Replacement ◽

Potential Barriers ◽

Safety Concerns

Meal replacement product-based diets are an effective weight loss intervention used in the management of obesity. Historically, these diets have been underutilised by HealthCare Professionals (HCPs). An online survey of mixed methods design was distributed to HCPs to capture current perceptions and prescribing patterns of meal replacement products (MRPs) in the management of overweight and obesity. A total of 303 HCPs working in weight management across Australia began the survey and 197 (65%) completed it. While over 70% of HCPs have prescribed MRP currently or in the past, MRPs are only prescribed to a median 7% of patients seeking weight management treatment. Qualitative analysis identified potential barriers to MRP prescription, which include experience with patient non-compliance, perceived poor long-term weight loss durability and safety concerns regarding the product and its use as a total meal replacement program. Safety concerns are centred on the perceived risk of weight cycling and its potential negative psychological impact. MRP prescription is 66% more likely to occur if HCPs had formal training in the use of MRPs relative to those who did not, with a relative risk (RR) of 1.7 (95% CI 1.4, 2.0). This study highlights the potential barriers to the prescription of MRPs, which are centred around safety concerns. This also indicates that formal training may enhance the likelihood of prescribing MRPs, suggesting that once HCPs have a comprehensive understanding of the products and the evidence behind their use, their prescription is likely to be increased.

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ACTION-IO as a platform to understand differences in perceptions, attitudes, and behaviors of people with obesity and physicians across countries – the Israeli experience

Israel Journal of Health Policy Research ◽

10.1186/s13584-020-00404-2 ◽

2020 ◽

Vol 9 (1) ◽

Author(s):

Dror Dicker ◽

Batya Kornboim ◽

Rakefet Bachrach ◽

Naim Shehadeh ◽

Shani Potesman-Yona ◽

...

Keyword(s):

Weight Loss ◽

Weight Management ◽

Online Survey ◽

International Study ◽

Direct Patient Care ◽

Link Type ◽

Full Responsibility ◽

Medical Need ◽

Treatment Of Obesity ◽

Israeli Experience

Abstract Background Obesity is a highly prevalent, complex, and chronic relapsing disease with a considerable unmet medical need. We aimed to identify perceptions, attitudes, behaviors, and barriers to effective obesity treatment among people with obesity (PwO) and physicians in Israel. Methods The ACTION-IO study was an online survey conducted in 11 countries, including Israel. Findings from the Israeli cohort are reported here. Israeli respondents were PwO (body mass index of ≥30 kg/m2 based on self-reported height and weight) and physicians primarily in direct patient care. Results In total, 750 PwO and 169 physicians completed the survey in Israel. Although most PwO (70%) and physicians (95%) perceived obesity as a chronic disease, the majority of PwO assumed full responsibility for their own weight loss (88%) compared with only 19% of physicians who placed the responsibility for weight loss on their patients with obesity. Many PwO (62%) and physicians (73%) agreed that a complete change in lifestyle would be required for PwO to lose weight and felt that treatment of obesity should be a team effort between different healthcare professionals (HCPs; 80 and 90%, respectively). Dietitians were considered by 82% of physicians to be the most effective professionals in helping PwO achieve their weight loss goals. Many PwO (69%) liked that their HCP initiated weight management discussions and 68% of those who had not previously discussed their weight would like their HCP to initiate the conversation. However, among PwO who had discussed their weight with an HCP, 59% considered the discussions to be a little helpful or not at all helpful. The beliefs that patients have little interest in or motivation for losing weight were identified by physicians as the main reasons (71 and 70%, respectively) for not initiating weight management discussions. Conclusions In line with the ACTION-IO international study, our Israeli dataset reveals a need to improve awareness, primarily among physicians, on the physiologic basis and clinical management of obesity, including how to approach weight and weight management discussions during patient consultations. Trial registration Registered at ClinicalTrials.gov, NCT03584191. Data first posted on ClinicalTrials.gov: 12 July 2018 - ‘Retrospectively registered’.

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Healthy Dads, Healthy Kids UK, a weight management programme for fathers: feasibility RCT

BMJ Open ◽

10.1136/bmjopen-2019-033534 ◽

2019 ◽

Vol 9 (12) ◽

pp. e033534 ◽

Cited By ~ 2

Author(s):

Tania Griffin ◽

Yongzhong Sun ◽

Manbinder Sidhu ◽

Peymane Adab ◽

Adrienne Burgess ◽

...

Keyword(s):

Weight Loss ◽

Weight Management ◽

Controlled Trial ◽

Intervention Group ◽

Management Programme ◽

Feasibility Trial ◽

Minority Ethnic Group ◽

Weight Management Programme ◽

Overweight Or Obesity

ObjectiveTo assess (1) the feasibility of delivering a culturally adapted weight management programme, Healthy Dads, Healthy Kids United Kingdom (HDHK-UK), for fathers with overweight or obesity and their primary school-aged children, and (2) the feasibility of conducting a definitive randomised controlled trial (RCT).DesignA two-arm, randomised feasibility trial with a mixed-methods process evaluation.SettingSocioeconomically disadvantaged, ethnically diverse localities in West Midlands, UK.ParticipantsFathers with overweight or obesity and their children aged 4–11 years.InterventionParticipants were randomised in a 1:2 ratio to control (family voucher for a leisure centre) or intervention comprising 9 weekly healthy lifestyle group sessions.OutcomesFeasibility of the intervention and RCT was assessed according to prespecified progression criteria: study recruitment, consent and follow-up, ability to deliver intervention, intervention fidelity, adherence and acceptability, weight loss, using questionnaires and measurements at baseline, 3 and 6 months, and through qualitative interviews.ResultsThe study recruited 43 men, 48% of the target sample size; the mean body mass index was 30.2 kg/m2 (SD 5.1); 61% were from a minority ethnic group; and 54% were from communities in the most disadvantaged quintile for socioeconomic deprivation. Recruitment was challenging. Retention at follow-up of 3 and 6 months was 63%. Identifying delivery sites and appropriately skilled and trained programme facilitators proved difficult. Four programmes were delivered in leisure centres and community venues. Of the 29 intervention participants, 20 (69%) attended the intervention at least once, of whom 75% attended ≥5 sessions. Sessions were delivered with high fidelity. Participants rated sessions as ‘good/very good’ and reported lifestyle behavioural change. Weight loss at 6 months in the intervention group (n=17) was 2.9 kg (95% CI −5.1 to −0.6).ConclusionsThe intervention was well received, but there were significant challenges in recruitment, programme delivery and follow-up. The HDHK-UK study was not considered feasible for progression to a full RCT based on prespecified stop–go criteria.Trial registration numberISRCTN16724454.

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Walk the Doc Talk

Clinical Lactation ◽

10.1891/2158-0782.7.2.49 ◽

2016 ◽

Vol 7 (2) ◽

pp. 49-56

Author(s):

Tristan Kiraly ◽

Shelagh Quinn ◽

Janice Fyfe ◽

Edith Kernerman

Keyword(s):

Online Survey ◽

Healthcare Professionals ◽

Interdisciplinary Communication ◽

Negative Experiences ◽

Lactation Consultant ◽

Breastfeeding Knowledge ◽

Contact Information ◽

Lactation Consultants ◽

Positive Experiences

There is limited research on interdisciplinary communication between lactation consultants (International Board Certified Lactation Consultant [IBCLC]) and other healthcare professionals. An online survey assessed how healthcare professionals (physicians, surgeons, and alternative practitioners) perceive lactation consultants and what language, forms of communication, and practices are helpful. Participants (N = 75) indicated mostly positive experiences. Negative experiences included lack of communication or dissatisfaction with experience or outcome. Breastfeeding terms were, on average, “somewhat clear,” and several were correlated with perceived adequacy of breastfeeding knowledge. Participants indicated that communications from lactation consultants should include a plan for follow-up, an outline of the safety and rationale for use of potentially unfamiliar treatments, and contact information. The preferred form of communication varied. Improving interdisciplinary communication and collaboration will likely result in better support for breastfeeding dyads.

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Concordance among Swedish, German, Danish, and UK EQ-5D-3L Value Sets: Analyses of Patient-Reported Outcomes in the Swedish Hip Arthroplasty Register

Journal of Clinical Medicine ◽

10.3390/jcm10184205 ◽

2021 ◽

Vol 10 (18) ◽

pp. 4205

Author(s):

Fitsum Sebsibe Teni ◽

Ola Rolfson ◽

Jenny Berg ◽

Reiner Leidl ◽

Kristina Burström

Keyword(s):

Hip Arthroplasty ◽

Arthroplasty Register ◽

Patient Reported ◽

Before And After ◽

Value Sets ◽

Using Data ◽

Mean Differences ◽

The Uk ◽

Eq Vas

Background: Application of different value sets to health-related quality of life (HRQoL) measured with the EQ-5D-3L may lead to different results due to differences in methods, perspectives, and countries used. Focusing on concordance, this study aimed at understanding the implications of applying EQ-5D-3L value sets from Sweden, Germany, Denmark, and the UK to evaluate HRQoL of patients undergoing total hip replacement (THR) in Sweden before and after surgery. Methods: We performed a longitudinal study of patients in the Swedish Hip Arthroplasty Register from preoperative stage to 1-year follow-up (n = 73,523) using data collected from 2008 to 2016. Eight EQ-5D-3L value sets from the four countries were compared based on a valuation method (visual analogue scale (VAS) or time trade-off (TTO)), perspective (experience-based or hypothetical), and country. Concordance among the value sets with patient-reported EQ VAS score was also assessed. Longitudinal changes in EQ-5D-3L index over the 1-year follow-up were compared across value sets by method, perspective, and country. Results: Value sets based on the same method and perspective showed higher concordance in EQ-5D-3L index at both measurement time points than other comparisons. In the comparisons by perspective, VAS value sets showed higher concordance than TTO value sets. The Swedish VAS and the Danish TTO value sets showed the highest levels of concordance with patient-reported EQ VAS scores. Generally, value sets based on the same method and perspective had the smallest mean differences between changes in EQ-5D-3L indices from preoperative to 1-year postoperative follow-up. Conclusion: Among THR patients value sets based on the same method and perspective, a direct transfer of results across countries could be meaningful. In cases of differences in methods and perspectives among value sets, transfer of value sets across settings would have to consider conversion through crosswalk.

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Diagnostic value of cutaneous manifestation of SARS-CoV-2 infection

10.1101/2020.07.10.20150656 ◽

2020 ◽

Cited By ~ 4

Author(s):

Alessia Visconti ◽

Veronique Bataille ◽

Niccolò Rossi ◽

Justine Kluk ◽

Ruth Murphy ◽

...

Keyword(s):

Online Survey ◽

Healthcare Professionals ◽

Diagnostic Value ◽

Cutaneous Manifestation ◽

Community Based ◽

Positive Skin ◽

Key Points ◽

Test Result ◽

New Skin

AbstractImportanceSARS-CoV-2 causes multiple immune-related reactions at various stages of the disease, and the wide variety of cutaneous presentations has delayed linking these to the virus. Previous studies had attempted to look at the prevalence and timing of COVID-19 rashes but were mostly based on hospitalized severe cases with limited follow up.ObjectiveTo assess the diagnostic value of new skin rashes in SARS-CoV-2 infection.DesignObservational study including data collected longitudinally via the COVID Symptom Study app between May 7th and June 22nd, 2020, as well as data from an independent online survey on skin-related symptoms.SettingCommunity-basedParticipantsVolunteer sample of 336,847 UK users of the COVID Symptom Study app and 11,546 surveyees, aged 1 to 90 years old.ExposureUsers self-reporting a positive or negative SARS-CoV-2 swab test result, untested symptomatic users, and survey respondents.Main Outcome(s) and Measure(s)the diagnostic value of new skin rashes in SARS-CoV-2 infection, and observation on their duration and timing in relation to other COVID-19 symptomsResultsIn the app data, 8.8% of the swab positive cases (N=2,021) reported either a body rash or an acral rash, compared to 5.4% of those with a negative swab test (N=25,136). Together, these two cutaneous presentations showed an odds ratio (OR) of 1.67 (95% confidence interval [CI]: 1.42-1.97) for being swab positive. Skin rashes were also predictive in the larger untested group of symptomatic app users (N=54,652), as 8.2% of those who had reported at least one classic COVID-19 symptom, i.e., fever, persistent cough, and/or anosmia, also reported a rash. Data from the independent online survey showed that in 17% of swab positive cases, the rash was the initial presentation. Furthermore, in 21%, the rash was the only clinical sign.Conclusions and RelevanceSkin rashes cluster with other COVID-19 symptoms, are predictive of a positive swab test and occur in a significant number of cases, either alone or before other symptoms. Recognising rashes is important for the early detection of COVID-19 cases. To help healthcare professionals in this task we have established a large library of high-quality manually curated photos, available at: https://covidskinsigns.comKey pointsQuestionWhat is the diagnostiv value of the cutaneous manifestation of SARS-CoV-2 infection?FindingsWe confirmed, in a community-based setting, that the presence of a rash is predictive of SARS-CoV-2 infection, and provided a large library of cutaneous manifestation photos to help healthcare professionals in diagnosing COVID-19.MeaningSkin rashes should be considered as part of the clinical presentation of COVID-19 to aid earlier diagnosis and curb the spread of the infection.

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Results of a referral-based weight management program targeted toward children aged 2 to 6 years with obesity or severe obesity

BMC Pediatrics ◽

10.1186/s12887-019-1886-8 ◽

2019 ◽

Vol 19 (1) ◽

Author(s):

Eric E. Wickel ◽

Lamiaa Ali ◽

Hollie Hawkins ◽

Eden Hemming

Keyword(s):

Body Size ◽

Weight Management ◽

Intervention Program ◽

Severe Obesity ◽

Management Program ◽

Weight Management Program ◽

Hispanic Children ◽

Study Child ◽

Using Data

Abstract Background Relatively little is known about weight management programs targeted toward young children with obesity. Using data from the Early Lifestyles Intervention program, we report outcomes from a referral-based, multi-disciplinary weight management program targeted toward children aged 2 to 6 years with obesity or severe obesity. Methods Data from 55 children (4.5 ± 1.3 years) medically referred to the ELI program were examined in this non-randomized investigation. At baseline, a nurse collected demographic, anthropometric and clinical measures from the study child, while parents/guardians completed questionnaires regarding their child’s nutrition and activity behavior. Follow-up sessions were conducted to discuss healthy behavior strategies and collect anthropometrics from the study child. Body mass index (BMI) values were reported relative to the 95th BMI percentile (%BMIp95) and children were classified as obese (≥ 100% of 95th BMI percentile) or severely obese (≥ 120% of 95th BMI). Questionnaire data were analyzed to report group-level differences and to determine whether individual items predicted changes in %BMIp95 from baseline to follow-up. Regression models were used to examine the change in %BMIp95 by sex, ethnicity, and baseline body size. Results Certain behaviors were more frequent among non-Hispanic children compared to Hispanic children (demanding certain foods), whereas other behaviors were more frequent among children with severe obesity compared to children with obesity (requesting a second helping, getting own snack and sneaking food). Greater reductions in the study child’s %BMIp95 were found among parents indicating their child requests a second helping, is a faster eater, or complains of being hungry. Among the combined sample, %BMIp95 significantly decreased from baseline to final follow-up. On average, the decrease in %BMIp95 did not differ by sex, ethnicity, or baseline body size. Conclusions Modest improvements in body size were observed. Additional studies are needed to identify best practices for pediatric interventions seeking weight management.

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P106 Psychological and self-management support for people with systemic vasculitis or CTDs: a mixed methods study of health professionals’ perception of provision in Rheumatology and Nephrology departments in the UK

Rheumatology ◽

10.1093/rheumatology/keaa111.104 ◽

2020 ◽

Vol 59 (Supplement_2) ◽

Author(s):

Joanna C Robson ◽

Michael Shepherd ◽

Mwidimi Ndosi ◽

Lorraine Harper ◽

Caroline Flurey ◽

...

Keyword(s):

Health Professional ◽

Health Professionals ◽

Online Survey ◽

Psychological Support ◽

Self Management ◽

Free Text ◽

Management Support ◽

The Uk

Abstract Background People with a connective tissue disease (CTD) or systemic vasculititis have diseases which can be life and organ threatening, require complicated medication regimens and impact on all aspects of health-related quality of life. People are routinely managed across multiple medical specialities and have to navigate their way through complex health care systems. The aim of this study was to investigate current psychological and self-management support available for people with CTDs and vasculitis in rheumatology and nephrology departments in the UK. Methods An online survey of health professionals in rheumatology and nephrology departments was conducted with follow-up interviews. The survey comprised 45 multiple-choice and free-text questions. Quantitative material was analysed descriptively. Follow-up interviews were recorded, transcribed and analysed thematically, together with free-text survey responses, to identify health professionals’ perceptions on unmet needs and key improvements required. Results The online survey included 120 health professional respondents (34 % specialist nurses, 51% doctors and 12 % allied health professionals and pharmacists). Respondents worked primarily in rheumatology (52.9%) and nephrology (21.5%). Access to self-management programmes or clinics for people with CTD and vasculitis was available in 23% of rheumatology and 8% of nephrology departments. In response to the question “How well is your team providing self-management support to people with CTD and vasculitis?”, 38% of respondents reported not very well, or not well at all. Direct access to psychological support (either within their department or within the hospital) was available for patients in 76.9% of nephrology and 32.8% of rheumatology departments. Where psychological referrals were direct, the assessment of the quality of the service by health professionals was higher than when the referrals were indirect (i.e when patients were either referred to primary care or asked to self-refer) (X2=13.83, p < 0.001). Over 80% of health-professional respondents reported they would like additional training in providing self-management support. Key themes from the qualitative data included the need for dedicated psychological support within departments, self-management programmes (specifically for people with CTD and vasculitis or opening up established programmes for people with other conditions), the benefits of a whole team approach (specialist teams not individual clinicians working to empower patients to take a lead in managing their own care), individual staff training needs ( training in brief psychological interventions and support for health professionals to set up self-management programmes) and signposting to additional resources for patients and their families ( disease-specific written and online information and support from patient charities). Conclusion People with CTD and vasculitis have complex needs and systemic improvements in support are required. Patients in nephrology departments are more likely to have access to psychological support than those in rheumatology. There is inadequate access to structured self-management programmes in both nephrology and rheumatology. Disclosures J.C. Robson None. M. Shepherd None. M. Ndosi None. L. Harper None. C. Flurey None. S. Logan None. K. Austin None. E. Dures None.

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Understanding rider:horse bodyweight ratio trends, weight management practices and rider weight perceptions within leisure and amateur riders in the UK

Comparative Exercise Physiology ◽

10.3920/cep200082 ◽

2021 ◽

pp. 1-16

Author(s):

C.L. Challinor ◽

H. Randle ◽

J.M. Williams

Keyword(s):

Weight Management ◽

Online Survey ◽

Management Practices ◽

Management Strategies ◽

Legal Responsibility ◽

Estimation Methods ◽

Social Licence To Operate ◽

The Uk ◽

Post Hoc ◽

The Impact

Horse riders in the UK have a legal responsibility for the welfare of the horses in their care, outlined by the Animal Welfare Act (2006). Understanding weight management factors that influence rider: horse bodyweight (RHBW) ratio is key to safeguarding horse welfare as human obesity rates increase. Recent high-profile incidents have seen riders being asked to dismount for being too heavy, demonstrating an awareness of the possible impact of excessive rider weight, threatening the equestrian industry’s social licence to operate. This study investigated RHBW trends within the UK leisure and amateur rider population to understand rider perception of ‘ideal’ RHBW and factors influencing rider and horse weight management. An online survey (SurveyMonkey®) was distributed via UK equine-related Facebook™ groups and collected information on horse and rider demographics, rider weight management strategies and respondents’ views on the importance of rider weight on horse welfare. Kruskal-Wallis analyses with Mann Whitney U post-hoc tests identified whether differences in respondent views differed between RHBW groups. A total of 971 riders completed the survey; respondents were aged between 18-65+ years old and 88% (n=953) were experienced riders. RHBWs were calculated for 764 (79%) of respondents as 21.2% (n=206) did not know either their own and/or their horses’ weight. Weight tapes (44.5%; n=432) and weigh bridges (29.5%; n=286) were common horse weight estimation methods. RHBWs ranged from 4.9% to 21.88%, mean: 12.5%±2.7%. Riders with lower RHBW thought about their own weight less and measured their horses’ weight less often than those with higher ratios (P<0.005, P<0.0004, respectively). The majority of riders who participated were weight conscious and recognised potential detrimental impacts associated with increased rider weight. Development of RHBW guidelines supported by equestrian governing bodies would highlight the need for riders to consider the impact of weight and support them in choosing suitable horses.

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TP6.2.20 UK- single centre experience with the ElipseTM intragastric balloon; Early safety and effectiveness

British Journal of Surgery ◽

10.1093/bjs/znab362.047 ◽

2021 ◽

Vol 108 (Supplement_7) ◽

Author(s):

Bankole Oyewole ◽

Irena Stefanova ◽

Anu Sandhya ◽

Shannon Mangat ◽

Simon Monkhouse

Keyword(s):

Weight Loss ◽

Final Analysis ◽

Total Body Weight ◽

Acid Reflux ◽

Abdominal Radiograph ◽

Balloon Expulsion ◽

Total Body ◽

The Uk ◽

Lost To Follow Up

Abstract Introduction The ElipseTM gastric balloon (EIGB) is an established outpatient, non-invasive, non-surgical device for weight-loss not requiring endoscopy nor sedation. This study reports the early safety and effectiveness from the largest and only reported UK cohort treated with the EIGB. Methods A retrospective study of 224 consecutive patients undergoing EIGB insertion between May 2018 and December 2020 was performed. EIGB placement involved swallowing of the ElipseTM capsule followed by a pre-inflation abdominal radiograph to confirm position. Inflation was performed with 550mls of sterile water followed by a post-inflation radiograph. Patients had weekly follow-up to assess symptoms, weight-loss, time and route of balloon expulsion. Results 224 patients underwent EIGB insertion during the study period; 39 patients were lost to follow-up. 185 patients (28 male and 157 female) were included in the final analysis with a mean age of 38.1 years. Mean study follow-up was 10 weeks, mean weight at insertion was 97.7 kg. Mean %Total Body Weight (TBW) loss was 6.5% at 4 weeks and 9% at last follow-up. 32 patients had 15.3 %TBW loss at 16 weeks follow-up. Frequently experienced symptoms during the first week were acid reflux, abdominal pain and bloating, nausea and vomiting. One patient had early expulsion at 8 weeks. Seven patients required early deflation due to severe symptoms (5), pancreatitis (1) and hyperinflation (1). Conclusion EIGB is a safe and effective method of weight loss. Longer follow-up studies in the UK population are required to assess overall patient outcomes and associated factors for weight loss.

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