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Promises on the obesity front

New hope for the millions of obese Americans who are unable to maintain prescribed programs of diet, exercise and pills and also fear the possible side-effects of invasive bariatric surgeries could be available by early next year.

As a bariatric surgeon, I’ve have seen first-hand that many patients wish that there were more surgical options than those available today — options that were less invasive and with fewer side effects and that offer a hands-on chance to control their own appetite.

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One major challenge in treating the obese has been the failure to lower the totally unrealistic expectations the public has formed from years of watching TV ads and television shows touting the quick transformative effects of a wide variety of nutrition plans and exercise regimens.

The impossibility of achieving a body that looks like a young Arnold Schwarzenegger or a bikini-clad model on a Sports Illustrated cover almost certainly has deterred many overweight Americans from adopting a more sensible approach. The result has been an over focus on the unrealistic end result and nowhere near enough on achieving a sensible health effect.

Despite these culture-fed desires, by far the best reason for losing weight always has been to improve health rather than looks. I discuss this with all of the patients who come to my office.

If an average build 250-pound female loses just 22 pounds, or about 24 percent of her excess body weight, it may not sound like much, but from a health perspective it can be profoundly important.

In fact, even shedding a little as 10 percent of excess bodyweight can improve health, the quality of life, and extend life span for most obesity individuals.

Presently, a number of small bio-medical firms across the country are working on solutions that would allow Americans to control their own appetites without having to undergo more complicated bariatric surgery.

A clinically tested procedure developed by EnteroMedics, a small Minneapolis biomedical firm where I am the consulting chief medical officer, would allow patients to control their own appetites with a small “pacemaker-like” device. After promising clinical trials, it is slated to go before the Food and Drug Administration for an approval panel review later this year.

The procedure — dubbed VBLOC therapy — sends low-energy electrical impulses over two electronic wires to block the vagal nerve signals controlling hunger sensations. If it receives a federal green light, it could be available to patients sometime in 2014.

The prospect of being able to control one’s appetite yet still be free from a strict diet-control regimen should be appealing to millions of severely obese Americans who haven’t responded to the plethora of weight-loss remedies offered them during the nation’s four decades-old “war on obesity” and those that are fearful of bariatric surgery.

This is a real breakthrough in the stepped-up war on obesity. This device has very low risk, allows patients to eat most all of the food they normally eat, and can even be turned off for brief respites (such as a pregnancy). It is designed to be reversible, programmable and adjustable from outside the body.

ReShape Medical, a San Clemente California based company has also created a new medical device in which two balloons are inserted in the stomach to create a feeling of fullness in patients. It comfortably occupies existing space in the stomach for six months, serving as a built-in portion control system, to help patients feel fuller and satisfied with less food. This non-surgical option is designed for those who have exhausted their efforts with diet alone and wish to avoid or do not qualify for conventional bariatric surgery.

Jaime Ponce, president of the American Society for Metabolic and Bariatric Surgery stated, “We’re very enthusiastic about its potential to help patients lose significant weight, without surgery.”

Both of these new devices are good news for the estimated 99 percent of morbidly obese Americans who qualify for, but shy away from today’s procedures each year. And for whom recommendations of diet and exercise have been minimally effective.

The American Medical Association’s decision earlier this year to officially label obesity a disease instead of a behavioral condition was an important step forward in the war against obesity. This designation is symbolic but does express the concern that obesity treatment needs to be undertaken as seriously as the treatment of diabetes or cancer.

A 2012 study by researchers at Duke University predicted that 42 percent of Americans will be obese by 2030 — a nearly 20 percent increase from the 36 percent considered obese in 2010. The 36 percent figure had remained pretty much steady for the first decade of this century.

That’s a distressing development since the United States has spent billions of dollars fighting a protracted war on obesity — one that has stretched several decades longer than one it has been fighting against terrorists in the Middle East.

Hopefully, the progress being made by companies such as EnteroMedics, ReShape Medical and other pioneering biotech firms like Boston based Rhythm and MedImmune in Gaithersburg, Maryland, will help millions of Americans whose quality of life and longevity have been seriously eroded by obesity to permanently achieve a healthy life.

Dr. Scott Shikora is director of the Center for Metabolic and Bariatric Surgery at Brigham and Women’s Hospital.
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