The end of dieting: how doctors are “zapping” hunger centers now for patients who want to lose weight.

 

 

I remember as a young adult hearing my mother say, “Can’t they just zap my brain or something so I won’t’ eat?” Well, mom – it looks like that time is finally here.

Zap 1. BAE. BAE stands for “bariatric artery embolization.” As it turns out, the hunger hormone is released into the blood by the stomach when it’s time to eat.  It also turns out that doctors can block the release of this hormone (called ghrelin) with a simple procedure through the blood vessels.

The procedure involves placing a small tube into the blood vessels and blocking the blood supply to that portion of the stomach. It’s an outpatient procedure that takes about an hour and you go home the same day. It’s new, but has resulted in overall weight loss for groups that have been studied.  A bit more information about BAE can be found here.

Zap 2. Cryoablation of the hunger nerve. This is also very new. Doctors use cat scan guidance to guide a needle to the nerve that carries hunger signals (also located near the stomach). The needle drops the temperature in the region and freezes the nerve, which results in less severe hunger when the stomach is empty (Figure 1). A bit more information on this procedure can be found here. The Maestro device is a similar idea. It is a small electronic device that is implanted beneath the skin and attaches to the hunger nerve to decrease its signaling. Their website is here.

 

 

Zap 3. Medications. The 21st century has revealed an entirely new axis for obesity. Brand new targets for which pharmaceutical companies can generate specific medications have been discovered. Hunger centers in the brain are now targeted specifically with medications taken by mouth. Similarly, receptors in the gut have been discovered for which medicines now exist. Even targets in the pancreas, muscles, and fat cells themselves have been successfully targeted with medications recently.

Zap 4. Stomach balloons. Balloons which are placed in the stomach either through a tube placed in the mouth and esophagus under sedation, placed through the skin into the stomach, or taken as a pill. These balloons occupy space in the stomach which may result in earlier satiety (getting full earlier) and also maintain distention of the stomach which has effects on the nerves mentioned above. They are either decompressed by the doctor in the office the way they went in, or are degradable and eventually pass on their own.

Zap 5. Surgery. Bariatric surgeries, such as gastric bypass, have evolved and changed the face of obesity medicine. In fact, it is these surgeries that unveiled the true mechanisms of obesity and led to Zaps 1-4. These techniques vary but essentially involve changing the hormones related to eating for patients, and have been shown to be crazily successful for both weight loss and disease modification (such as diabetes or heart disease) in the right patients.

The state of being overweight is complex and comparable to other chronic diseases.  Just as we don’t tell our patients to use willpower against their diabetes or cancer, so should we be moving on from the antiquated “no pain, no gain” approach to obesity. Help is available for getting over the hump so patients can lead healthy lives.

 

 

 

 

 

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Bariatric Artery Embolization (BAE)

 

Ghrelin is the hunger hormone. It is primarily produced in the stomach, specifically by cells called X/A cells that live in a portion of the stomach called the fundus. (Figure 1) Once produced, ghrelin travels through the bloodstream from the stomach to the brain and signals the brain to seek food and feel hungry.

 

Millions of dollars have been spent by drug companies trying to block ghrelin without success. We have, however, been successful in blocking ghrelin through gastric bypass surgery by excluding the portion of the stomach that produces ghrelin. (Figure 2) In fact, recent studies have confirmed that the reason gastric bypass patients lose weight – and even cure their diabetes and other obesity related conditions – is because hunger hormone profiles change after the surgery.

 

 

Bariatric artery embolization is a new way to shut down ghrelin producing cells. Interventional radiologists use X-ray guidance to steer a catheter into the artery that supplies the portion of the stomach that contains the ghrelin producing cells. Using small particles, the artery is blocked and the tiny ghrelin factories closed. (Figure 3) The entire procedure is performed through a tiny hole in the groin (the same method used for heart catheterizations, liver cancer embolizations, and other), nonsurgically.

 

In the months following the procedure patients can lose significant amounts of weight. The outcomes of BAE can be markedly improved with implementation of exercise and diet modifications during the months following the procedure – such that the effect of either interventions is accelerated by the other.

 

 

References [1-8]

  1. Weiss, C.R., et al., Bariatric Embolization of the Gastric Arteries for the Treatment of Obesity. J Vasc Interv Radiol, 2015.
  2. Borer, K.T., et al., Appetite responds to changes in meal content, whereas ghrelin, leptin, and insulin track changes in energy availability. J Clin Endocrinol Metab, 2009. 94(7): p. 2290-8.
  3. Disse, E., et al., Systemic ghrelin and reward: effect of cholinergic blockade. Physiol Behav, 2011. 102(5): p. 481-4.
  4. Karra, E., A. Yousseif, and R.L. Batterham, Mechanisms facilitating weight loss and resolution of type 2 diabetes following bariatric surgery. Trends Endocrinol Metab, 2010. 21(6): p. 337-44.
  5. Moran, T.H. and M.J. Dailey, Intestinal feedback signaling and satiety. Physiol Behav, 2011. 105(1): p. 77-81.
  6. Stensel, D., Exercise, appetite and appetite-regulating hormones: implications for food intake and weight control. Ann Nutr Metab, 2010. 57 Suppl 2: p. 36-42.
  7. Dockray, G.J., Gastrointestinal hormones and the dialogue between gut and brain. J Physiol, 2014. 592(Pt 14): p. 2927-41.
  8. Barja-Fernandez, S., et al., Peripheral signals mediate the beneficial effects of gastric surgery in obesity. Gastroenterol Res Pract, 2015. 2015: p. 560938.

 

 

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