Thursday, January 15, 2015

FDA Approves VBLOC Treatment For Obesity

enteromedicslogowithtechlarge3x2We don’t have great treatments for obesity, so every new evidence-based tool in the obesity treatment tool box is something to look at closely.

The latest addition, just approved by the US FDA for the treatment of obesity  in adults with a BMI of 40 to 45 kg/m2 or a BMI of 35 to 39.9 kg/m2 with a related health condition, is something I’ve posted about before - VBLOC or the vagal “pacemaker” as it is sometimes referred to.

Indeed, Enteromedics‘ rechargeable Maestro system is very much like an implantable cardiac pacemaker, in that it delivers an electronic signal – in this case to block the action of the vagus nerve. The exact mode of action is not entirely clear but the weight-loss mediating effect (in the 10-15% average range) is largely a result of reduced appetite and increased satiety.

Here is how Enteromedics describes its system:

The Maestro® System consists of a subcutaneously implanted rechargeable neuroregulator and two electrodes that are laparoscopically implanted by a bariatric surgeon. It delivers VBLOC® vagal blocking therapy via these electrodes that are placed in contact with the trunks of the vagus nerves just above the junction between the esophagus and the stomach. The device intermittently blocks vagal nerve signals throughout the patient’s waking hours. The Maestro System is recharged using an external mobile charger and transmit coil worn by the patient. The device can be non-invasively programmed, and it can be adjusted, deactivated, reactivated or completely removed if desired.”

Obviously this is far from the be-all and end-all of obesity treatments – especially as it does not seem to work for everyone. Thus, the recently published results from the pivotal study (discussed here),  was certainly far less impressive than the company may have hoped for.

Just where VBLOC treatment will ultimately find its place in bariatric care remains to be seen – this is certainly a space to watch.

@Dr. Sharma
Edmonton, AB

 

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Thursday, September 18, 2014

Efficacy of Vagal Blockade For Obesity Treatment Remains Vague

VBLOC

VBLOC

Regular readers may recall past posts on the use of intermittent electrical blockade of the vagus nerves (VBLOC) as a means of reducing food intake to promote weight loss.

Now a large randomised controlled study of vagal blocakade, published by Sayeed Ikramuddin and colleagues, published in JAMA, reports on rather disappointing outcomes with this treatment.

In this study (ReCharge), conducted  at one of 10 sites in the United States and Australia between May and December 2011, 239 participants with a BMI greater than 40 (or greater than 35 with at least one comorbidity), were randomised to receiving an active vagal nerve block device (EnteroMedics’ Maestro® Rechargeable (RC) System, n=162) or a sham device (n=77).

Over the 12-month blinded portion of the 5-year study (completed in January 2013), the vagal nerve block group lost about 9% or their initial body weight compared to only 6% in the sham group.

In addition to this rather modest difference in weight loss between the groups (about 3%), participants in the active treatment group also experienced a number of clinically relevant adverse effects (heartburn or dyspepsia and abdominal pain).

Thus, overall these rather disappointing results are in line with the previously disappointing observations in the smaller MAESTRO trial.

Based on these findings, it seems that intermittent electrical blockade of the vagal nerve may not hold its promise of a safe and effective long-term treatment for severe obesity after all.

@DrSharma
Edmonton, AB

ResearchBlogging.orgIkramuddin S, Blackstone RP, Brancatisano A, Toouli J, Shah SN, Wolfe BM, Fujioka K, Maher JW, Swain J, Que FG, Morton JM, Leslie DB, Brancatisano R, Kow L, O’Rourke RW, Deveney C, Takata M, Miller CJ, Knudson MB, Tweden KS, Shikora SA, Sarr MG, & Billington CJ (2014). Effect of reversible intermittent intra-abdominal vagal nerve blockade on morbid obesity: the ReCharge randomized clinical trial. JAMA, 312 (9), 915-22 PMID: 25182100

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Tuesday, September 2, 2014

Can Weight Loss Supplements Promote Weight Gain?

sharma-obesity-weight-loss-supplementsApart from the fact that there are indeed no weight-loss supplements that will help you lose more than the weight of the money in your back pocket (a fact that even Dr. Oz had to admit to at a recent senate inquiry into the rubbish he promotes on his shows), there may be reason to suspect that the use of such supplements may in fact do the opposite.

Thus, a rather simple experiment by Yevvon Chang and Wen-Bin Chiou from Tunghai University, Taichung, Taiwan, published in Nutrition, suggests that taking a (supposed) weight-loss supplement may actually lead to greater caloric intake.

This field study was conducted in 70 volunteers, who were randomised to taking a either placebo or a weight-loss supplement (the same placebo) and were then exposed to a buffet meal.

On average, participants presumably taking weight loss supplements ate a greater number of food items than did control subjects (overall about 30% more food). They also tended to chose less healthy items than the control group.

This effect tended to be strongest in those subjects who had a more positive attitude towards taking supplements for weight loss (those with the most positive attitude eating almost 3 times more food items).

Or, as the authors summarise,

“…the results supported our hypothesis that taking weight loss supplements was associated with an inclination to eat more food. This link was driven by perceived progress toward the goal of weight reduction. The liberating effect of taking weight loss supplements on food consumption became more prominent as attitudes toward this kind of supplement became more positive.”

Obviously, it is hard to extrapolate from such a short-term experiment to what happens over time – especially when people do follow the lifestyle recommendations that come with most supplements (eat-less-move-more).

This study certainly is in line with the recent observation that people who take statins to lower their blood cholesterol levels tend to eat unhealthier diets and may in fact end up gaining more weight than people who don’t.

Thus, it may be time to study the “fattening” effect of weight-loss supplements. Perhaps the only reason that we have not yet observed this effect in larger studies is because very few people stay on these nonsensical agents for more than a few weeks.

@DrSharma
Gambach, Germany

ResearchBlogging.orgChang YY, & Chiou WB (2014). The liberating effect of weight loss supplements on dietary control: A field experiment. Nutrition (Burbank, Los Angeles County, Calif.), 30 (9), 1007-10 PMID: 24976417

 

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Thursday, August 28, 2014

Call For Abstracts: Canadian Obesity Summit, Toronto, April 28-May 2, 2015

COS2015 toronto callBuilding on the resounding success of Kananaskis, Montreal and Vancouver, the biennial Canadian Obesity Summit is now setting its sights on Toronto.

If you have a professional interest in obesity, it’s your #1 destination for learning, sharing and networking with experts from across Canada around the world.

In 2015, the Canadian Obesity Network (CON-RCO) and the Canadian Association of Bariatric Physicians and Surgeons (CABPS) are combining resources to hold their scientific meetings under one roof.

The 4th Canadian Obesity Summit (#COS2015) will provide the latest information on obesity research, prevention and management to scientists, health care practitioners, policy makers, partner organizations and industry stakeholders working to reduce the social, mental and physical burden of obesity on Canadians.

The COS 2015 program will include plenary presentations, original scientific oral and poster presentations, interactive workshops and a large exhibit hall. Most importantly, COS 2015 will provide ample opportunity for networking and knowledge exchange for anyone with a professional interest in this field.

Abstract submission is now open – click here

Key Dates

  • Notification of abstract review: January 8, 2015
  • Call for late breaking abstracts open: Jan 12-30, 2015
  • Notification of late breaking abstracts and handouts and slides due : Feb 27, 2015
  • Early registration deadline: March 3, 2015

For exhibitor and sponsorship information – click here

To join the Canadian Obesity Network – click here

I look forward to seeing you in Toronto next year!

@DrSharma
Montreal, QC

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Friday, August 22, 2014

Do Bite Counters Count Bites?

bite counterWith the current electronic self-montioring craze, it was only a matter of time before someone would try to come up with a device that counts the number of bites it takes you to finish a meal.

The device (Bite Counter), is worn no the wrist of the dominant hand and contains a tri-axial accelerometer that detects an upward, arcing motion from the table to the mouth.

Now a study by Jenna Desendorf and colleagues from the University of Tennessee, tested the accuracy and validity of this device in 15 adults (23–58 years old) while eating a meal consisting of foods/beverages, each consumed with different utensils: meat (knife and fork), side items (fork), soup (spoon), pizza (hands), can of soda (hands), and a smoothie (straw), while being observed them through a one-way mirror and counted the number of bites taken.

As the paper, published in Eating Behaviors reports, the overall accuracy of the device was around 80%. However, this varied substantially between foods: meat (127%), side items (82.6%), soup (60.2%), pizza (87.3%), soda (81.7%), and smoothie (57.7%).

So, while this device may well underestimate the number of bites taken during a mixed meal, the real question is what people will start monitoring next – number of chews? (I joke about this on my show) Saliva flow? Numbers of swallows per bite? Oesophageal transit time?

I can perhaps see some research applications but as a way to help improve your eating?

The company claims that limiting your number of daily bites to 100 will help you lose weight.

I am yet to be convinced.

@DrSharma
Edmonton, AB

ResearchBlogging.orgDesendorf J, Bassett DR Jr, Raynor HA, & Coe DP (2014). Validity of the Bite Counter device in a controlled laboratory setting. Eating behaviors, 15 (3), 502-4 PMID: 25064306

 

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In The News

Diabetics in most need of bariatric surgery, university study finds

Oct. 18, 2013 – Ottawa Citizen: "Encouraging more men to consider bariatric surgery is also important, since it's the best treatment and can stop diabetic patients from needing insulin, said Dr. Arya Sharma, chair in obesity research and management at the University of Alberta." Read article

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