Devices for the Treatment of Obesity: Will Understanding the Physiology of Satiety Unravel New Targets for Intervention?

Weiss, Ram

doi:10.1177/193229680800200323

Cited by 8 publications

(4 citation statements)

References 54 publications

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“…However, the latter group showed substantial improvement in hypertension, hyperlipidemia, and insulin resistance. New non-invasive procedures trying to mimic hormonal effects of bariatric surgery may become available [43], but, need testing before proper assessment.…”

Section: Resultsmentioning

confidence: 99%

Bariatric surgery for obese children and adolescents: a review of the moral challenges

Hofmann

2013

BMC Med Ethics

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BackgroundBariatric surgery for children and adolescents is becoming widespread. However, the evidence is still scarce and of poor quality, and many of the patients are too young to consent. This poses a series of moral challenges, which have to be addressed both when considering bariatric surgery introduced as a health care service and when deciding for treatment for young individuals. A question based (Socratic) approach is applied to reveal underlying moral issues that can be relevant to an open and transparent decision making process.DiscussionA wide range of moral issues with bariatric surgery for children and adolescents is identified in the literature. There is a moral imperative to help obese minors avoiding serious health problems, but there is little high quality evidence on safety, outcomes, and cost-effectiveness for bariatric surgery in this group. Lack of maturity and family relations poses a series of challenges with autonomy, informed consent, assent, and assessing the best interest of children and adolescents. Social aspects of obesity, such as medicalization, prejudice, and discrimination, raise problems with justice and trust in health professionals. Conceptual issues, such as definition of obesity and treatment end-points, present moral problems. Hidden interests of patients, parents, professionals, industry, and society need to be revealed.SummaryPerforming bariatric surgery for obese children and adolescents in order to discipline their behavior warrants reflection and caution. More evidence on outcomes is needed to be able to balance benefits and risks, to provide information for a valid consent or assent, and to advise minors and parents.

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Section: Resultsmentioning

confidence: 99%

Bariatric surgery for obese children and adolescents: a review of the moral challenges

Hofmann

2013

BMC Med Ethics

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“…On the other hand, the computational approach makes it possible to evaluate stomach capacity depending on intragastric pressure and surgical procedure. Concerning gastric wall distension, reports in the scientific literature have investigated the influence of surgical procedures on mechanisms of satiety [ 10 , 11 , 45 ]. In vivo measurement of such elongation strains is quite complex.…”

Section: Discussionmentioning

confidence: 99%

Biomechanical Investigation of the Stomach Following Different Bariatric Surgery Approaches

et al. 2020

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Background: The stomach is a hollow organ of the gastrointestinal tract, on which bariatric surgery (BS) is performed for the treatment of obesity. Even though BS is the most effective treatment for severe obesity, drawbacks and complications are still present because the intervention design is largely based on the surgeon’s expertise and intraoperative decisions. Bioengineering methods can be exploited to develop computational tools for more rational presurgical design and planning of the intervention. Methods: A computational mechanical model of the stomach was developed, considering the actual complexity of the biological structure, as the nonhomogeneous and multilayered configuration of the gastric wall. Mechanical behavior was characterized by means of an anisotropic visco-hyperelastic constitutive formulation of fiber-reinforced conformation, nonlinear elastic response, and time-dependent behavior, which assume the typical features of gastric wall mechanics. Model applications allowed for an analysis of the influence of BS techniques on stomach mechanical functionality through different computational analyses. Results: Computational results showed that laparoscopic sleeve gastrectomy and endoscopic sleeve gastroplasty drastically alter stomach capacity and stiffness, while laparoscopic adjustable gastric banding modestly affects stomach stiffness and capacity. Moreover, the mean elongation strain values, which are correlated to the mechanical stimulation of gastric receptors, were elevated in laparoscopic adjustable gastric banding compared to other procedures. Conclusions: The investigation of stomach mechanical response through computational models provides information on different topics such as stomach capacity and stiffness and the mechanical stimulation of gastric receptors, which interact with the brain to control satiety. These data can provide reliable support to surgeons in the presurgical decision-making process.

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“…All these data suggest that reducing gastric emptying could be beneficial for weight loss in patients who follow a strict hypocaloric diet. Modulation of gastric motility could well be a potential target to treat obesity and can be achieved through several means such as volume-occupying devices, intraparietal botox injection and induction of stomach "stiffness" [46][47][48][49] . Gastric electrical stimulation (GES) or gastric pacing data from animal models and preliminary data from human trials suggest that the gut-brain axis plays a role in the GES mechanism.…”

Section: Discussionmentioning

confidence: 99%

Updates on gastric electrical stimulation to treat obesity: Systematic review and future perspectives

Cha

Marescaux

Diana

2014

WJGE

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AIM:To evaluate the current state-of-the-art of gastric electrical stimulation to treat obesity. METHODS:Systematic reviews of all studies have been conducted to evaluate the effect of different types of gastric electrical stimulation (GES) on obesity. RESULTS:Thirty-one studies consisting of a total of 33 different trials were included in the systematic review for data analysis. Weight loss was achieved in most studies, especially during the first 12 mo, but only very few studies had a follow-up period longer than 1 year. Among those that had a longer follow-up period, many were from the Transcend ® (Implantable Gastric Stimulation) device group and maintained significant weight loss. Other significant results included changes in appetite/satiety, gastric emptying rate, blood pressure and neurohormone levels or biochemical markers such as ghrelin or HbA1c respectively. CONCLUSION:GES holds great promises to be an effective obesity treatment. However, stronger evidence is required through more studies with a standardized way of carrying out trials and reporting outcomes, to determine the long-term effect of GES on obesity. Key words: Gastric electrical stimulation; TANTALUS ® system; Transcend ® implantable gastric stimulator; Retrograde gastric electrical stimulation; Gastric vagal nerve stimulation; Gastric pacing; EMPOWER trial; Dual-lead implantable gastric electrical stimulation trial; Laparoscopic obesity stimulation survey; Screened health assessment and pacer evaluation Core tip: Obesity is a major issue in many countries. Current medical treatments do not last long enough and while surgical interventions are more effective, they imply a higher risk of complications. This review contains the most up-to-date information on gastric electrical stimulation, which has shown to be a less invasive and potentially effective treatment option for the treatment of obesity.Cha R, Marescaux J, Diana M. Updates on gastric electrical stimulation to treat obesity: Systematic review and future perspectives. World J Gastrointest Endosc 2014; 6(9): 419-431 Available from:

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Devices for the Treatment of Obesity: Will Understanding the Physiology of Satiety Unravel New Targets for Intervention?

Cited by 8 publications

References 54 publications

Bariatric surgery for obese children and adolescents: a review of the moral challenges

Bariatric surgery for obese children and adolescents: a review of the moral challenges

Biomechanical Investigation of the Stomach Following Different Bariatric Surgery Approaches

Updates on gastric electrical stimulation to treat obesity: Systematic review and future perspectives

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