Monthly Archives: April 2016

Currently, the treatments for obesity consist of diet, exercise, drugs and invasive surgery. All methods demonstrate a measure of success, but all have their own issues. A new procedure – bariatric arterial embolization – could be a useful alternative.

Obesity, as no one can have failed to notice, is on the rise in the West. According to the US Department of Health and Human Services, 2 out of 3 Americans are overweight. An estimated 1 in 3 American adults are obese, and 1 in 20 are considered to have extreme obesity. In three states – Arkansas, Mississippi and West Virginia – obesity is over 35%. With these figures in mind, now is a prime time to welcome any new advances that could assist in this very modern epidemic. A new procedure, known as bariatric arterial embolization, has recently been trialed in a pilot study and shows real promise. One of the pilot study’s authors, Dr. Clifford Weiss, of the Johns Hopkins University School of Medicine in Maryland, recently presented the results at the Society for Interventional Radiology Annual Scientific Meeting in Vancouver, British Columbia, Canada.

What is bariatric arterial embolization?

Also known as left gastric artery embolization, the procedure has been used for many years as a method to stop bleeding in emergency situations. Bariatric arterial embolization involves blocking the main artery that supplies blood to the fundus – a section of the stomach. The blockage is produced by inserting microscopic beads into the blood supply through a catheter in the groin or wrist; the beads then make their way to the artery and block smaller vessels. How does blocking the blood supply to the fundus help? The answer to this question lies in the role of a hormone called ghrelin, which is produced in large quantities in the fundus.

The role of ghrelin

Ghrelin has been dubbed the “hunger hormone.” When the stomach is empty, ghrelin is produced; conversely, when the stomach is full and stretched, ghrelin production and release ceases. Ghrelin is a peptide hormone that works on the hypothalamus, inducing feelings of hunger and preparing the body for food, by, for instance, increasing gut motility. In total, more than 40 hormones have been discovered that limit the amount of food taken in; to date, ghrelin is the only hormone that has been found to stimulate food intake. Bariatric arterial embolization, by reducing blood flow to the fundus, reduces the release of ghrelin substantially and, therefore, reduces feelings of hunger. Dr. Weiss and his team recently conducted a pilot clinical trial, dubbed Bariatric Embolization of Arteries for the Treatment of Obesity (BEAT Obesity). The trial involved seven participants (six of whom were women), aged 31-59.

Bariatric arterial embolization pilot study

All participants had a BMI of between 40 and 50 (well over the obesity threshold of 30); the individuals were otherwise healthy. All seven people involved in the trial were coached before and after the procedure in essential weight-loss life changes. The researchers monitored the subjects’ weight loss, ghrelin levels, adverse events associated with the procedure and hunger levels at 1, 3 and 6 months. None of the trial group experienced adverse impacts of the minor intervention; all participants demonstrated weight loss and substantial reductions in feelings of hunger. One of the main parameters investigated by the researchers was the average excess weight loss; this measure gives the percentage of weight lost above the patient’s ideal body weight. The average excess weight loss of the group at the 1, 3 and 6 month follow-ups were 5.9%, 9.5% and 13.3%, respectively. Reduction in feelings of hunger was measured using a questionnaire that the participants completed throughout the day for 6 days prior to the procedure and 6 days prior to each follow-up assessment. At the 2-week, 1-month and 3-month measurements, the individuals reported decreases in sensations of hunger of 81%, 59% and 26%. At the 3-month mark, ghrelin levels were reduced by an average of 17.5%. Although the pilot study is small-scale, Dr. Weiss is enthusiastic about the results. He says:

“These early results demonstrate that bariatric arterial embolization is safe and appears to be effective in helping patients lose a significant amount of weight in the short and intermediate term. Compared to a surgical gastric bypass procedure, bariatric arterial embolization is significantly less invasive and has a much shorter recovery time.”

Dr. Weiss is quick to note the need for further investigation into the potential benefits of bariatric arterial embolization. To this end, the study is expanding and will be taking on more patients from both Johns Hopkins and the Mount Sinai Health System in New York. An intervention that is minimally invasive, relatively safe and, hopefully, effective, could play a vital role in the necessary slimming down of the industrialized world. Medical News Today recently covered research showing that obesity is now more prevalent worldwide than being underweight.