The toolbox of bariatric therapy options continues to grow. A new approach called AspireAssist has just received FDA approval -- even as it appears to be eliciting mixed feelings from some patients and health advocates.
While most health practitioners will turn to lifestyle change and medications as the first options to treat obesity, recent studies have found surgical options helpful, especially if comorbidities like Type 2 diabetes are present. To be clear, all bariatric surgeries have some level of risk, and carry the possibility of negative outcomes. Additionally, without a modification in both diet and exercise habits, the surgery may have limited or no long-term success.
Qualifications for bariatric surgery include:
BMI of 40 or above or having more than 100 pounds of excess weight
BMI equal to or greater than 35 with two comorbid conditions, including Type 2 diabetes, hypertension, sleep apnea and some other respiratory conditions, etc.
An inability to achieve a healthy weight, for a sustained period of time, with many prior weight loss efforts
Surgery is usually performed on adults, but doctors are now also considering surgery for morbidly obese teens.
Some current bariatric surgery optionastric Bypass
Also called the Roux-en-Y Gastric Bypass, this is still considered the preeminent weight-loss surgery, during which a newly created, smaller stomach pouch forces the individual to eat smaller meal portions. Due to the re-routing of the small intestine, there is less absorption of calories and nutrients. Finally, geriatric bypass can result in a change in the balance of gut microbes, resulting in better or more efficient satiety. This surgery -- which has a higher risk of short-term and long-term post-operative complications -- has also been credited with reversing Type 2 diabetes.
Biliopancreatic Diversion with Duodenal Switch (BPD/DS) Gastric Bypass
Biliopancreatic Diversion with Duodenal Switch surgery has two components. First, a portion of the stomach is removed. Next, a significant portion of the small intestine is surgically bypassed. This surgery is associated with significant weight loss while still allowing individuals to eat normal-size meals. Because of the bypass, absorption of fat is reduced by up to 70 percent. The surgery also shifts the gut microbe population balance and has the greatest impact on Type 2 diabetes.
Also called “the sleeve” or Laparascopic Sleeve Gastrectomy, this non-reversible surgery removes 80 percent of the stomach, leaving a small, banana-shaped pouch. The surgery does appear to have similar benefits to gastric bypass with regard to Type 2 diabetes remission, due to changes in gut microbe populations. "The sleeve" also has the benefit of a relatively short post-op hospital stay.
Adjustable Gastric Band
This reversible surgery, also called “the band,” involves placing an inflatable band around the upper portion of the stomach, leaving a small pouch above the band and the rest of the stomach intact below. The person will feel full after eating much smaller portions of food.
And now, Aspire
The AspireAssist device just approved by the FDA allows patients to drain part of their stomach contents after each meal. About 30 percent of calories consumed can be discarded with the device.The procedure uses endoscopy to place a tube within the patient, with a disk-shaped port valve left outside the body. About 20 to 30 minutes after eating the patient can open the valve and drain stomach contents into the toilet. The process takes about five to 10 minutes.
The device is intended for patients 22 years of age or older with a BMI from 35 to 55 who have tried and failed repeatedly to lose weight. Patients need to be monitored closely and work on developing healthier eating and exercise habits while using the device. The valve requires replacement on a regular basis.
The FDA decision to approve the device was based on results from a study that followed 111 patients treated with both the device and with lifestyle counseling, and 60 patients who only received lifestyle counseling. After one year, the AspireAssist device group lost an average of 12.1 percent of their body weight, compared to a weight loss of 3.6 percent in the control group.
Side effects associated with the AspireAssist device include occasional indigestion, nausea, vomiting, constipation and diarrhea. There are also risks associated with placement of the device.
This particular treatment has met with some pushback from healthcare providers and patients who find the treatment methoduncomfortable and even distasteful. Nevertheless, it might be a good match for certain individuals.
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Amy Hendel, also known as The HealthGal, is a Physician Assistant, nutritionist and fitness expert.As a health media personality, she's been reporting and blogging on lifestyle issues and health news for over 20 years. Author of The 4 Habits of Healthy Families, her website offers daily health reports, links to her blogs, and a library of lifestyle video segments.