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.