Endoscopic Treatment of Obesity: From Past to Future

Background: Conventional approaches in the management of obesity offer only a limited potential for sustained weight loss. Moreover, bariatric surgery, although momentarily being the most effective weight-loss treatment, has some serious pitfalls, such as significant morbidity rate, high substantial costs and limited patient applicability. Hence, there is a substantial need for endoscopic approaches to obesity. Summary: The aim of this article is to provide a historical overview of bariatric endoscopy in the management of obesity; moreover to selectively review and evaluate the currently available endoscopic weight-loss techniques and devices, and third to identify new directions and future prospects in this rapidly advancing field. Key Messages: Bariatric endoscopy procedures efficiently replicate some of the anatomical features and the physiological effects of the traditional weight-loss surgical approaches, while at the same time being more applicable, entirely reversible, less-invasive, safer and more cost effective. Endoscopic modalities in the treatment of obesity can be categorized into the following: restrictive procedures, malabsorptive procedures, gastric function/emptying regulation, gastric aspiration, and so on. To conclude, it is of high importance to constantly evaluate the long-term efficacy and safety of new endoscopic weight-loss techniques and devices, based on evidence-based medicine principles.

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Is Intragastric Botulinum Toxin A Injection Effective in Obesity Treatment?

Surgery Research and Practice ◽

10.1155/2020/2419491 ◽

2020 ◽

Vol 2020 ◽

pp. 1-4

Author(s):

Bulent Kaya ◽

Nuriye Esen Bulut ◽

Mahir Fersahoglu

Keyword(s):

Weight Loss ◽

Botulinum Toxin ◽

Prospective Study ◽

Botulinum Toxin A ◽

Statistical Significance ◽

Cost Effective ◽

Toxin A ◽

Upper Gi Endoscopy ◽

Treatment Of Obesity ◽

A Prospective Study

Aims. The objective of this prospective study was to evaluate the efficacy of intragastric botulinum toxin A (BTX-A) injection for the treatment of obesity. Materials and Methods. The study was performed between January and August 2019. This is a prospective study. After 6–12 hours of fasting, the patients were submitted to upper GI endoscopy under sedation for the injection of BTX-A. A total of 250 U of BTA-X was diluted with 10 ml of 0.9% saline. Injections were administered into the gastric antrum, each containing 1 ml of prepared solution (25 U BX-A + 1 ml saline). Continuous data were compared using a two-sample t-test. Statistical significance was determined as P≤0.05. All statistical analysis was performed using SPSS for Windows 22.1 software (SPSS, Chicago, IL, USA). Results. A total of 56 patients were studied. Mean weight before gastric Botox was 85.25 ± 14.02, and mean weight after gastric Botox was 76.98 ± 12.68. Mean weight loss was approximately 9 kg in studied patients. BMI decreased about 3 units. The mean time for maximum weight loss was 60.39 ± 37.43 days. A total of 49 patients (87.5%) had reported decrease in appetite and early satiety. About 53.6% of patients were satisfied. No complications resulting from the endoscopic procedure were observed in this series. Conclusions. Intragastric BTX-A injection can be beneficial in weight loss. It is a minimally invasive, cost-effective procedure, without serious side effects.

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Childhood Obesity: A New Menace

The Journal of Pediatric Pharmacology and Therapeutics ◽

10.5863/1551-6776-12.1.23 ◽

2007 ◽

Vol 12 (1) ◽

pp. 23-38

Author(s):

Maria L. Salazar ◽

Lea S. Eiland

Keyword(s):

Weight Loss ◽

Childhood Obesity ◽

Eating Behaviors ◽

Pediatric Population ◽

Cost Effective ◽

The United States ◽

Morbidly Obese ◽

Cost Effective Approach ◽

Treatment Of Obesity ◽

Weight Loss Medications

Childhood obesity is increasing in prevalence in the United States. Comorbid diseases once thought of as adult issues such as hypertension, diabetes, and dyslipidemia, are now being encountered in the pediatric population as a result of obesity. Primary prevention is still the most cost-effective approach to this growing problem. In terms of management, the treatment of obesity in children is not identical to that in adults. Thus far, the only accepted weight loss therapy for children are diet, exercise, modification of eating behaviors and family education. Further options for morbidly obese children include weight loss medications or surgery, regarding which long-term benefits are still under investigation.

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2084-P: Sustained Weight Loss in Men with Hypogonadism and Type 2 Diabetes (T2DM) Receiving Long-Term Treatment with Injectable Testosterone Undecanoate (TU): Ten-Year Data from a Urological Registry Study

Diabetes ◽

10.2337/db19-2084-p ◽

2019 ◽

Vol 68 (Supplement 1) ◽

pp. 2084-P

Author(s):

AHMAD HAIDER ◽

KARIM S. HAIDER ◽

FARID SAAD

Keyword(s):

Type 2 Diabetes ◽

Weight Loss ◽

Term Treatment ◽

Registry Study ◽

Testosterone Undecanoate ◽

Sustained Weight Loss ◽

Long Term Treatment

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Liraglutide for the Treatment of Obesity: Analyzing Published Reviews

Current Pharmaceutical Design ◽

10.2174/1381612825666190701155737 ◽

2019 ◽

Vol 25 (15) ◽

pp. 1783-1790 ◽

Cited By ~ 3

Author(s):

Rosario Pastor ◽

Josep A. Tur

Keyword(s):

Weight Loss ◽

Clinical Trials ◽

Systematic Reviews ◽

Randomized Clinical Trials ◽

Statistical Tests ◽

Overweight And Obesity ◽

Cochrane Library ◽

Medical Subject Headings ◽

Mesh Terms ◽

Treatment Of Obesity

Background: Several drugs have been currently approved for the treatment of obesity. The pharmacokinetic of liraglutide, as well as the treatment of type 2 diabetes mellitus, have been widely described. Objective: To analyze the published systematic reviews on the use of liraglutide for the treatment of obesity. Methods: Systematic reviews were found out through MEDLINE searches, through EBSCO host and the Cochrane Library based on the following terms: "liraglutide" as major term and using the following Medical Subject Headings (MesH) terms: "obesity", "overweight", "weight loss". A total of 3 systematic reviews were finally included to be analyzed. Results: From the three systematic reviews selected, only two included the randomized clinical trials, while the third study reviewed both randomized and non-randomized clinical trials. Only one review performed statistical tests of heterogeneity and a meta-analysis, combining the results of individual studies. Another review showed the results of individual studies with odds ratio and confidence interval, but a second one just showed the means and confidence intervals. In all studies, weight loss was registered in persons treated with liraglutide in a dose dependent form, reaching a plateau at 3.0 mg dose, which was reached just in men. Most usual adverse events were gastrointestinal. Conclusion: More powerful and prospective studies are needed to assess all aspects related to liraglutide in the overweight and obesity treatment.

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Pound Wise and Penny Foolish? Weight Loss and The Dynamics of Health Care Spending

Forum for Health Economics & Policy ◽

10.2202/1558-9544.1220 ◽

2011 ◽

Vol 14 (2) ◽

Author(s):

Thomas G Koch

Keyword(s):

Weight Loss ◽

Cost Savings ◽

Cost Effective ◽

Economic Consequences ◽

Health Care Spending ◽

Order Of Magnitude ◽

Dynamic Measures ◽

The Cost ◽

The Impact ◽

The Relationship

Current estimates of obesity costs ignore the impact of future weight loss and gain, and may either over or underestimate economic consequences of weight loss. In light of this, I construct static and dynamic measures of medical costs associated with body mass index (BMI), to be balanced against the cost of one-time interventions. This study finds that ignoring the implications of weight loss and gain over time overstates the medical-cost savings of such interventions by an order of magnitude. When the relationship between spending and age is allowed to vary, weight-loss attempts appear to be cost-effective starting and ending with middle age. Some interventions recently proven to decrease weight may also be cost-effective.

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Metabolic Surgery and Cancer Risk: An Opportunity for Mechanistic Research

Cancers ◽

10.3390/cancers13133183 ◽

2021 ◽

Vol 13 (13) ◽

pp. 3183

Author(s):

Edward R. Sauter ◽

Brandy Heckman-Stoddard

Keyword(s):

Weight Loss ◽

Cancer Risk ◽

Risk Reduction ◽

Dramatic Improvement ◽

Role Of Government ◽

Sustained Weight Loss ◽

Historical Role ◽

Cancer Risk Reduction

Metabolic (bariatric) surgery (MBS) is recommended for individuals with a BMI > 40 kg/m2 or those with a BMI 35–40 kg/m2 who have one or more obesity related comorbidities. MBS leads to greater initial and sustained weight loss than nonsurgical weight loss approaches. MBS provides dramatic improvement in metabolic function, associated with a reduction in type 2 diabetes mellitus and cardiovascular risk. While the number of MBS procedures performed in the U.S. and worldwide continues to increase, they are still only performed on one percent of the affected population. MBS also appears to reduce the risk of certain obesity related cancers, although which cancers are favorably impacted vary by study, who benefits most is uncertain, and the mechanism(s) driving this risk reduction are mostly speculative. The goal of this manuscript is to highlight 1) emerging evidence that MBS influences cancer risk, and that the potential benefit appears to vary based on cancer, gender, surgical procedure, and likely other variables; 2) the role of the NIH in MBS research in T2DM and CV risk for many years, and more recently in cancer; and 3) the opportunity for research to understand the mechanism(s) by which MBS influences cancer. There is evidence that women benefit more from MBS than men, that MBS may actually increase the risk of colorectal cancer in both women and men, and there is speculation that the benefit in cancer risk reduction may vary according to which MBS procedure an individual undergoes. Herein, we review what is currently known, the historical role of government, especially the National Institutes of Health (NIH), in driving this research, and provide suggestions that we believe could lead to a better understanding of whether and how MBS impacts cancer risk, which cancers are impacted either favorably or unfavorably, the role of the NIH and other research agencies, and key questions to address that will help us to move the science forward.

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Is One Anastomosis Gastric Bypass with a Biliopancreatic Limb of 150 cm Effective in the Treatment of People with Severe Obesity with BMI > 50?

Obesity Surgery ◽

10.1007/s11695-021-05499-3 ◽

2021 ◽

Author(s):

Arnaud Liagre ◽

Francesco Martini ◽

Radwan Kassir ◽

Gildas Juglard ◽

Celine Hamid ◽

...

Keyword(s):

Bariatric Surgery ◽

Weight Loss ◽

Gastric Bypass ◽

Severe Obesity ◽

Postoperative Mortality ◽

One Anastomosis Gastric Bypass ◽

Sustained Weight Loss ◽

Biliopancreatic Limb ◽

Percentage Excess Weight Loss

Abstract Purpose The treatment of people with severe obesity and BMI > 50 kg/m2 is challenging. The present study aims to evaluate the short and mid-term outcomes of one anastomosis gastric bypass (OAGB) with a biliopancreatic limb of 150 cm as a primary bariatric procedure to treat those people in a referral center for bariatric surgery. Material and Methods Data of patients who underwent OAGB for severe obesity with BMI > 50 kg/m2 between 2010 and 2017 were collected prospectively and analyzed retrospectively. Follow-up comprised clinical and biochemical assessment at 1, 3, 6, 12, 18, and 24 months postoperatively, and once a year thereafter. Results Overall, 245 patients underwent OAGB. Postoperative mortality was null, and early morbidity was observed in 14 (5.7%) patients. At 24 months, the percentage total weight loss (%TWL) was 43.2 ± 9, and percentage excess weight loss (%EWL) was 80 ± 15.7 (184 patients). At 60 months, %TWL was 41.9 ± 10.2, and %EWL was 78.1 ± 18.3 (79 patients). Conversion to Roux-en-Y gastric bypass was needed in three (1.2%) patients for reflux resistant to medical treatment. Six patients (2.4%) had reoperation for an internal hernia during follow-up. Anastomotic ulcers occurred in three (1.2%) patients. Only two patients (0.8%) underwent a second bariatric surgery for insufficient weight loss. Conclusion OAGB with a biliopancreatic limb of 150 cm is feasible and associated with sustained weight loss in the treatment of severe obesity with BMI > 50 kg/m2. Further randomized studies are needed to compare OAGB with other bariatric procedures in this setting. Graphical abstract

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