A new obesity treatment method that does not require restriction in food intake and organ resection
Obesity treatment device without surgery
Keywords:Obesity, treatment, new, medical device, endoscopy, bariatric
Background/Aim: There are numerous treatment methods available for obesity, with bariatric surgery being the most effective. However, these techniques come with the risk of serious complications. This study presents a novel obesity treatment device that can shorten the length of the small intestine without the need for surgical intervention.
Methods: Our new device comprises three main components: a 25 cm long rope, with one end attached to a 1 cm diameter plastic ring and the other end attached to a 2 mm diameter, 5 g sphere. Twenty-one male Wistar albino rats (6 months old, mean weight 400 g, outbred) were divided into three equal groups. Laparotomy and gastrotomy were performed on the subjects in Group 1, and all three parts of the device were placed into the gastrointestinal tract. In Group 2, only the plastic ring was placed in the stomach, and in Group 3, only a gastrotomy was performed. All subjects were followed for 3 months, during which their body weight, serum ghrelin, leptin, and nesfatin-1 levels were recorded, and the amount of food they consumed was measured. After sacrificing the animals, the stomach, proximal, and distal intestines were resected for histopathological evaluation.
Results: The subjects in Group 1 experienced weight loss, whereas those in Groups 2 and 3 showed statistically significant weight gain (P<0.001 and P=0.022, respectively). Serum ghrelin levels were significantly increased in Groups 1 and 3 (P=0.015 and 0.031, respectively), while serum leptin levels were significantly decreased in Group 1 (P=0.015). Plasma nesfatin-1 levels were significantly higher in Group 1 compared to the other groups (P=0.014). There was no statistically significant difference in feed consumption between the groups. Histopathological examination revealed significantly higher fibrosis and inflammation scores in the proximal small intestine of Group 1 compared to the other groups (P=0.008 and P=0.005, respectively).
Conclusions: This new device facilitates rapid and effective weight loss without the need for restricting oral food intake or organ resection. Changes in serum ghrelin, leptin, and nesfatin-1 levels did not affect these results. We hypothesize that the effective weight loss is linked to the shortening of the small intestine length. Our future plans involve modifying the device for endoscopic application in humans.
Agha M, Agha R. The rising prevalence of obesity: part A: impact on public health. Int J Surg Oncol. 2017 Mar;2(5):17-22. DOI: https://doi.org/10.1097/IJ9.0000000000000017
Bluher M. Obesity: global epidemiology and pathogenesis. Nat Rev Endocrinol. 2019;15:288-98. DOI: https://doi.org/10.1038/s41574-019-0176-8
Simona IE, Alexandra C, Gabriela J. Obesity Treatment Strategies. Acta Medica Marisiensis. 2015;61:361-6. DOI: https://doi.org/10.1515/amma-2015-0076
Van Gaal LF, Wauters MA, De Leeuw IH. The beneficial effects of modest weight loss on cardiovascular risk factors. Int J Obes Relat Metab Disord. 1997;21:5-9.
Weinstock RS, Dai H, Wadden TA. Diet and exercise in the treatment of obesity: effects of 3 interventions on insulin resistance. Arch. Intern. Med. 1998;158:2477-83. DOI: https://doi.org/10.1001/archinte.158.22.2477
Vink RG, Roumans NJ, Mariman EC, van Baak MA. Dietary weight loss-induced changes in RBP4, FFA, and ACE predict weight regain in people with overweight and obesity. Physiol Rep. 2017;5:216-9. DOI: https://doi.org/10.14814/phy2.13450
Toh BC, Chan WH, Eng A, Lim E, Lim CH, Tham KW, et al. Five Years Long-term Clinical Outcome after Bariatric Surgery - A Multi-ethnic Asian Population in Singapore. J Diabetes Obes Metab 2018;20:1762-1765. DOI: https://doi.org/10.1111/dom.13263
Duboc H, Nguyen CC, Cavin JB, Ribeiro-Parenti L, Jarry AC, Rainteau D, et al. Roux-en-Y Gastric-Bypass and sleeve gastrectomy induces specific shifts of the gut microbiota without altering the metabolism of bile acids in the intestinal lumen. Int J Obes. 2018;43:428-31. DOI: https://doi.org/10.1038/s41366-018-0015-3
Sun D, Wang Y, Wei M, Zhang Z, Hu S. Combining Various Methods to Assess Insulin Sensitivity in Nonobese Rat after Sleeve Gastrectomy. Exp Clin Endocrinol Diabetes. 2019;127:477-84. DOI: https://doi.org/10.1055/s-0043-125315
Sinclair P, Docherty N, Roux CW. Metabolic Effects of Bariatric Surgery. Clin Chem. 2017;64:72-81. DOI: https://doi.org/10.1373/clinchem.2017.272336
Wing RR. Does Lifestyle Intervention Improve Health of Adults with Overweight/Obesity and Type 2 Diabetes? Findings from the Look AHEAD Randomized Trial. Obesity. 2021;29:1246-58. DOI: https://doi.org/10.1002/oby.23158
Sarlio-Lähteenkorva S, Rissanen A, Kaprio J. A descriptive study of weight loss maintenance: 6 and 15 year follow-up of initially overweight adults. Int J Obes Relat Metab Disord. 2000;24:116-25. DOI: https://doi.org/10.1038/sj.ijo.0801094
Weiss EC, Galuska DA, Kettel Khan L, Gillespie C, Serdula MK. Weight regain in U.S. adults who experienced substantial weight loss, 1999-2002. Am J Prev Med. 2007;33:34-40. DOI: https://doi.org/10.1016/j.amepre.2007.02.040
Purcell K, Sumithran P, Prendergast LA, Bouniu CJ, Delbridge E, Proietto J. The effect of rate of weight loss on long-term weight management: a randomised controlled trial. Lancet Diabetes Endocrinol. 2014;2:954-62. DOI: https://doi.org/10.1016/S2213-8587(14)70200-1
Patterson EJ, Urbach DR, Swanström LL. A comparison of diet and exercise therapy versus laparoscopic Roux-en-Y gastric bypass surgery for morbid obesity: a decision analysis model. J Am Coll Surg. 2003;196:379-85. DOI: https://doi.org/10.1016/S1072-7515(02)01754-4
Nguyen NT, Masoomi H, Magno CP, Nguyen XM, Laugenour K, Lane J. Trends in use of bariatric surgery, 2003-2008. J Am Coll Surg. 2011;213:261-7. DOI: https://doi.org/10.1016/j.jamcollsurg.2011.04.030
Greenstein AJ, Wahed AS, Adeniji A, Courcoulas AP, Dakin G, Flum DR, et al. Prevalence of adverse intraoperative events during obesity surgery and their sequelae. J Am Coll Surg. 2012;215:271-7. DOI: https://doi.org/10.1016/j.jamcollsurg.2012.03.008
Stenberg E, Szabo E, Agren G, Näslund E, Boman L, Bylund A, et al; Scandinavian Obesity Surgery Registry Study Group. Early complications after laparoscopic gastric bypass surgery: results from the Scandinavian Obesity Surgery Registry. Ann Surg. 2014;260:1040-7. DOI: https://doi.org/10.1097/SLA.0000000000000431
Nelson DW, Blair KS, Martin MJ. Analysis of obesity-related outcomes and bariatric failure rates with the duodenal switch vs gastric bypass for morbid obesity. Arch Surg. 2012;147:847-51. DOI: https://doi.org/10.1001/archsurg.2012.1654
Lim R, Beekley A, Johnson DC, Davis KA. Early and late complications of bariatric operation.Trauma Surg Acute Care Open. 2018;3:345-9. DOI: https://doi.org/10.1136/tsaco-2018-000219
Sundaram A, Koutkia P, Apovian CM. Nutritional management of short bowel syndrome in adults. J Clin Gastroenterol. 2002;34:207-20. DOI: https://doi.org/10.1097/00004836-200203000-00003
Billiauws L, Thomas M, Le Beyec-Le Bihan J, Joly F. Intestinal adaptation in short bowel syndrome. What is new? Nutr Hosp. 2018;35:731-7. DOI: https://doi.org/10.20960/nh.1952
Cui H, López M, Rahmouni K. The cellular and molecular bases of leptin and ghrelin resistance in obesity. Nat Rev Endocrinol. 2017;13:338-51. DOI: https://doi.org/10.1038/nrendo.2016.222
Morpurgo PS, Resnik M, Agosti F, Cappiello V, Sartorio A, Spada A. Ghrelin secretion in severely obese subjects before and after a 3-week integrated body mass reduction program. J Endocrinol Invest. 2003;26:723-7. DOI: https://doi.org/10.1007/BF03347353
Chao AM, Jastreboff AM, White MA, Grilo CM, Sinha R. Stress, cortisol, and other appetite- related hormones: prospective prediction of 6-month changes in food cravings and weight. Obesity. 2017;25:713-20. DOI: https://doi.org/10.1002/oby.21790
Zhou Y, Rui L. Leptin signaling and leptin resistance. Front Med. 2013;7:207-22. DOI: https://doi.org/10.1007/s11684-013-0263-5
Stock SM, Sande EM, Bremme KA. Leptin levels vary significantly during the menstrual cycle, pregnancy, and in vitro fertilization treatment: possible relation to estradiol. Fertil Steril. 1999;72:657-62. DOI: https://doi.org/10.1016/S0015-0282(99)00321-0
Va´zquez MJ, Romero-Ruiz A, Tena-Sempere M. Roles of leptin in reproduction, pregnancy and polycystic ovary syndrome: consensus knowledge and recent developments. Metabolism. 2015;64:79-91. DOI: https://doi.org/10.1016/j.metabol.2014.10.013
Oh-I S, Shimizu H, Satoh T, Okada S, Adachi S, Inoue K, et al. Identification of nesfatin-1 as a satiety molecule in the hypothalamus. Nature. 2006;12:709-12. DOI: https://doi.org/10.1038/nature05162
Chen X, Shu X, Cong ZK, Jiang ZY, Jiang H. Nesfatin-1 acts on the dopaminergic reward pathway to inhibit food intake. Neuropeptides. 2015;53:45-50. DOI: https://doi.org/10.1016/j.npep.2015.07.004
Shimizu H, Oh-I S, Hashimoto K, Yamamoto S, Yoshida N, Eguchi H, et al. Peripheral administration of nesfatin-1 reduces food intake in mice: the leptin-independent mechanism. Endocrinology. 2009;150:662-71. DOI: https://doi.org/10.1210/en.2008-0598
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