In the 21st century, obesity is a leading public health issue and a burgeoning pandemic. It has staggering effects on human health and is a severe burden on health care. Obesity is a major cause of morbidity and mortality associated with a range of comorbid diseases such as cardiovascular disorders, liver diseases, diabetes mellitus, and cancer. Over a period of time, it can exacerbate numerous medical ailments. Besides just being a physical and cosmetic concern, it has psychological manifestations. Traditional treatments for obesity like bariatric surgery can be ineffective for some patients, carry side effects, and are very expensive. A relatively new treatment approach is the bariatric embolization procedure is patient-oriented and overcomes these limitations.
Obesity – What Does It Cost?
There was a time when obesity was seen as a health concern in high-income countries, but now the highest numbers of obesity cases are observed in middle and low-income countries. When it comes to obesity it gets more complex than what meets the eye. It is a multifactorial disease that is defined as the accumulation of excessive body fat. People who have a body mass index (BMI) equal to 25 kg/m2 are deemed overweight while those having a BMI equal to or greater than 30 kg/m2 are considered obese. The prevalence of obesity in adults rises up to 27.5%, with an overall mortality increase of 29%, for every five-unit increase in the BMI above 25 kg/m2. Moreover, it is estimated that by 2025, global obesity prevalence is expected to reach 18% in men and surpass 21% in women, with many countries experiencing much higher levels. Numerous polymorphic gene products, gut microbiome, and especially hormonal effects play a major role in the balance of food intake and weight gain by sending signals to multiple areas in the central nervous system that are responsible for appetite regulation. One of such hormones is ghrelin, which is an anabolic gastrointestinal hormone that increases body weight by stimulating appetite.
The first approach to weight loss that makes the most sense is to be mindful of eating habits and physical activity. However, for some individuals, obesity might have reached a point of no return. They might be at a high risk of developing comorbidities or life-threatening diseases. In order to expedite their weight loss process, several interventions can be done. Let’s go through the major treatment options. Obesity can be addressed through lifestyle modifications, medical interventions, and surgical procedures. However, surgical options are highly invasive and accompany several side effects. While lifestyle modification is almost always the initial approach towards weight loss by eating a controlled diet and exercising regularly, studies have shown that it helps only up to 5% to 10% in the case of either overweight or obese patients. The next option to avail is weight-loss through pharmacotherapy. For this, there is a very limited repertoire of anti-obesity agents that can be used which engender their own set of side effects.
Patients that are morbidly obese, and experience obesity-related comorbidities require more aggressive and rigorous management. For such patients, the last resort is bariatric surgery or more simply put, weight-loss surgery. There are several types of bariatric surgeries that result in weight loss which essentially works on the same principle, that is reduced food consumption or malabsorption. Gastric Banding and Sleeve Gastrectomy are some of them. Bariatric surgery, when combined with lifestyle modification, has proven to result in significant and sustained weight loss. Estimated weight loss among different surgical procedures accounts for up to 19% for gastric banding, 30% in sleeve gastrectomy, and approximately 36% in Roux-en-Y surgeries. However, don’t forget that because you’re going under the knife, these surgeries are associated with a relatively high morbidity rate that ranges from 2% to 17% generally.
In this regard, there is a real need to develop new treatments that are clinically effective, less invasive, and cost-effective for prospective patients. This is especially true for patients who don’t want to go down a surgical route. Considering that the principle that bariatric embolization employs works well to enhance weight loss. An intervention to supplant the surgical route with that of a non-invasive one makes the most sense. One such technique is the bariatric embolization procedure which bridges the gap between bariatric surgery and a non-invasive procedure for weight loss.
What Is Bariatric Arterial Embolization?
Bariatric arterial embolization (BAE) or simply bariatric embolization is a relatively new endovascular image-guided technique that provides a low-cost and minimally invasive alternative for obese patients. It is a trans-catheter procedure that aims to regulate endocrine functions of the gastric fundus by inducing metabolic changes similar to those induced by bariatric surgery.
This technique uses embolic microspheres for the trans-arterial embolization of the gastric fundus (the region which is mainly involved in the production of appetite-stimulating endocrine functions within the stomach) mainly through the left gastric artery (LGA) and, to a lesser extent, the gastroepiploic artery (GEA) with the final goal of inducing localized ischemia of the gastric fundus which is aimed to reduce ghrelin production, leading to appetite suppression and weight-loss.
The safety and efficacy of BAE have been demonstrated in many preliminary pre-clinical and clinical trials. Although the data is limited, there is a growing body of literature that verifies this procedure as feasible and well-tolerated by obese patients resulting in 7% to 17% weight loss. Clinical data has shown no serious adverse effects after the embolization procedure apart from nausea, vomiting, and superficial stomach ulceration or epigastric discomfort in the most severe of the cases.
Now it is your time to rejoice in your weight-loss journey since this procedure has been introduced and employed by Dr. Imtiaz Ahmed – an endovascular specialist, interventional radiologist, and non-surgical weight loss specialist in Pakistan who has been using an FDA-approved drug for the procedure since 2017. This facility can be availed in Karachi and Lahore with state-of-the-art technology and skilled team members. Although it is an outpatient procedure, the patient can expect a follow-up up to 6-12 months as a part of post-treatment practice.