New, Endoscopic Approaches to Weight Loss
December 1, 2016
Overweight and obesity continue to be chronic problems in the United States, affecting about two-thirds of adults. Even though bariatric surgery can be a very effective long-term weight loss solution, only a fraction of those who need to lose weight qualify for this intervention—and of those, about 1 to 2 percent choose bariatric surgery over other weight loss methods.
For many patients considering weight loss surgery, says Vivek Kumbhari, Johns Hopkins’ director of bariatric endoscopy, the invasive nature of Roux-en-Y gastric bypass and other traditional bariatric surgical techniques is undesirable. More conservative weight loss methods, such as medication, diet and exercise, typically aren’t effective for most who try them.
“Until recently,” Kumbhari says, “there hasn’t been anything in between medical therapies and traditional bariatric surgery. That’s where endoscopic weight loss surgery comes in.”
Kumbhari and registered nurse Margo Dunlap run the Johns Hopkins Concierge Weight Loss Program, a clinic that offers several endoscopic options for weight loss. These procedures, which aren’t yet covered by insurance, offer ways for patients to potentially lose between 5 and 20 percent of their total body weight. The program’s close partnership with the Johns Hopkins Weight Management Center helps ensure that patients’ results continue for the long term.
On a patient’s first visit to the clinic, Kumbhari and Dunlap take a detailed medical history, including past weight loss attempts and how successful they were. They then present all possible options, including several types of gastric balloons that are placed in the stomach and retained for six months. These devices occupy space, helping patients eat less at mealtimes. They also slow stomach emptying, so those who receive the procedure feel less hungry between meals. Weight loss from the technique averages between 12 and 15 percent of a patient’s total body weight.
Another option is endoscopic sleeve gastroplasty, in which sutures hold the walls of the stomach closer together, decreasing its volume by up to 70 percent. Like balloons, this technique helps patients eat less. Hormonal changes that aren’t yet well understood also contribute to decreasing appetite. Together, these effects lead to an average weight loss of 20 percent of total body weight.
Some patients choose another option in which botulinum toxin is injected into the stomach muscle, leading to a feeling of prolonged fullness. This method results in an average weight loss of 5 to 10 percent of total body weight. Although this method doesn’t have results as dramatic as other options, it’s also the least invasive, Kumbhari says.
Although each of these procedures can kick-start weight loss, Kumbhari explains, none are effective on their own. That’s why, before patients undergo any of them, they meet with experts at the Johns Hopkins Weight Management Center, directed by gastroenterologist Larry Cheskin. A team composed of dieticians, behavioral psychologists, exercise physiologists and Cheskin helps patients begin their journey and continue it over the next year.
“We’re used to seeing patients who have tried very hard to lose weight, sometimes for decades,” Kumbhari says. “Through our practices, we’re now able to offer patients a broader range of options than they’ve ever had before.”
Top row, medical images: Endoscopic sleeve gastroplasty can reduce stomach volume by up to 70 percent. Bottom row: Endoscopic balloons placed in the stomach for a period of six months can reduce hunger and lead to a loss of 5 to 20 percent of body weight.