Review Article | Published:

Medical devices for the treatment of obesity

Nature Reviews Gastroenterology & Hepatology volume 14, pages 553564 (2017) | Download Citation

Abstract

Obesity is a major public health concern that leads to numerous metabolic, mechanical and psychological complications. Although lifestyle interventions are the cornerstone of obesity management, subsequent physiological neurohormonal adaptations limit weight loss, strongly favour weight regain and counteract sustained weight loss. A range of effective therapies are therefore needed to manage this chronic relapsing disease. Bariatric surgery delivers substantial, durable weight loss but limited access to care, perceived high risks and costs restrict uptake. Medical devices are uniquely positioned to bridge the gap between more conservative lifestyle intervention and weight-loss pharmacotherapy and more disruptive bariatric surgery. In this Review, we examine the range of gastrointestinal medical devices that are available in clinical practice to treat obesity, as well as those that are in advanced stages of development. We focus on the mechanisms of action as well as the efficacy and safety profiles of these devices. Many of these devices are placed endoscopically, which provides gastroenterologists with exciting opportunities for treatment.

Key points

  • Bariatric surgery provides substantial and durable weight loss, indicating that the gastrointestinal tract has key gut–brain signalling pathways that can alter control of central energy balance

  • Gastrointestinal devices assisting weight management can be placed endoscopically or laparoscopically, and aim at filling the safety and effectiveness therapeutic gap between lifestyle interventions and more invasive bariatric surgery

  • Laparoscopic adjustable gastric bands provide the largest amount of durable weight loss compared with other devices, and tailored, multidisciplinary aftercare programmes reduce explant rates and adverse outcomes

  • Intragastric balloon therapy is indicated in individuals with a BMI 30–40 kg/m2 for a maximum duration of 6 months; advances have enabled swallowable balloons not requiring endoscopic placement

  • Vagal blockade involves the surgical placement of a neuromodulator device with electrodes connected to the infradiaphragmatic vagal trunks, and achieves modest weight loss

  • A novel gastric emptying system that enables patients to aspirate gastric contents and ingested food via an endoscopically placed gastrostomy tube displays a promising benefit–risk profile

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Acknowledgements

J.D. acknowledges the support of the National Health and Medical Research Council through a senior research fellowship.

Author information

Affiliations

  1. Obesity and Metabolism Unit, Department of Endocrinology, Singapore General Hospital, 20 College Road, Singapore 169856.

    • Phong Ching Lee
  2. Clinical Obesity Research, Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, VIC 3004, Australia.

    • John Dixon

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Contributions

Both authors contributed equally to this manuscript

Competing interests

J.D. has provided consultancy services to Apollo Endosurgery, Bariatric Advantage, Covidien, Nestle Health Science, iNova Pharmaceuticals and Novo Nordisk. P.C.L. declares no competing interests.

Corresponding author

Correspondence to John Dixon.

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https://doi.org/10.1038/nrgastro.2017.80

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