Current and cutting-edge interventions for the treatment of obese patients

Jenanan Vairavamurthy; Lawrence J Cheskin; Dara L Kraitchman; Aravind Arepally; Clifford R Weiss

doi:10.1016/j.ejrad.2017.05.019

Current and cutting-edge interventions for the treatment of obese patients

Eur J Radiol. 2017 Aug:93:134-142. doi: 10.1016/j.ejrad.2017.05.019. Epub 2017 May 19.

Authors

Jenanan Vairavamurthy¹, Lawrence J Cheskin², Dara L Kraitchman³, Aravind Arepally⁴, Clifford R Weiss⁵

Affiliations

¹ Vascular and Interventional Radiology Center, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins Hospital/The Johns Hopkins University, 1800 Orleans Street, Baltimore, MD 21287, United States. Electronic address: jvairav1@jhmi.edu.
² Department of Health, Behavior and Society, The Johns Hopkins Bloomberg School of Public Health, The Johns Hopkins University, 550 N. Broadway, Baltimore, MD 21205, United States. Electronic address: cheskin@jhu.edu.
³ Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins Hospital/The Johns Hopkins University, 600 N. Wolfe Street, Baltimore, MD 21287, United States. Electronic address: dkraitc1@jhmi.edu.
⁴ Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins Hospital/The Johns Hopkins University, 600 N. Wolfe Street, Baltimore, MD 21287, United States; Division of Interventional Radiology, Piedmont Radiology, 1984 Peachtree Road, Atlanta, GA 30309, United States. Electronic address: aarepal@jhmi.edu.
⁵ Vascular and Interventional Radiology Center, Russell H. Morgan Department of Radiology and Radiological Science, The Johns Hopkins Hospital/The Johns Hopkins University, 1800 Orleans Street, Baltimore, MD 21287, United States. Electronic address: cweiss@jhmi.edu.

Abstract

The number of people classified as obese, defined by the World Health Organization as having a body mass index ≥30, has been rising since the 1980s. Obesity is associated with comorbidities such as hypertension, diabetes mellitus, and nonalcoholic fatty liver disease. The current treatment paradigm emphasizes lifestyle modifications, including diet and exercise; however this approach produces only modest weight loss for many patients. When lifestyle modifications fail, the current "gold standard" therapy for obesity is bariatric surgery, including Roux-en-Y gastric bypass, sleeve gastrectomy, duodenal switch, and placement of an adjustable gastric band. Though effective, bariatric surgery can have severe short- and long-term complications. To fill the major gap in invasiveness between lifestyle modification and surgery, researchers have been developing pharmacotherapies and minimally invasive endoscopic techniques to treat obesity. Recently, interventional radiologists developed a percutaneous transarterial catheter-directed therapy targeting the hormonal function of the stomach. This review describes the current standard obesity treatments (including diet, exercise, and surgery), as well as newer endoscopic bariatric procedures and pharmacotherapies to help patients lose weight. We present data from two ongoing human trials of a new interventional radiology procedure for weight loss, bariatric embolization.

Keywords: BEAT Obesity; Bariatric surgery; Embolization; Obesity; Weight loss.

Publication types

Review

MeSH terms

Anastomosis, Surgical / methods*
Bariatric Surgery / methods*
Body Mass Index
Body Weight
Comorbidity
Embolization, Therapeutic / methods*
Gastrectomy / methods*
Humans
Hypertension / complications*
Obesity / complications*
Radiology, Interventional
Stomach
Weight Loss
World Health Organization

Abstract

Publication types

MeSH terms

Grants and funding