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.
Weight-Loss Options
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.
Information about Gamma block bariatric arterial embolization treatment strategies. Treatment of obesity and saying goodbye to the extra inches shaking your confidence. Bariatrics is a field which studies therapies pertaining to weight loss and management. This includes surgical procedures and behavioral therapies. Gamma block bariatric arterial embolization treatment strategies (Dr Imtiaz Ahmad is the pioneer of this technique and named it as Gamma block bariatric arterial embolization in Nov 2017 after performing the first ever Gamma block bariatric arterial embolization procedure in Karachi Pakistan)also fall under the umbrella of this field and is a modern approach towards treatment of obesity. Approximately, 39% of the world’s adult population is suffering from either obesity or being overweight.
A person is regarded as obese if his/her body mass index (BMI) is greater than 30kg/m2 in which case, they can make good use of Gamma block bariatric arterial embolization treatment strategies. Obesity may occur due to metabolic dysregulation which could be genetic, lack of physical inactivity, diseases such as PCOS in women or simply because of overeating. Making balanced lifestyle choices is the way forward towards losing all that extra weight.
However, many men and women try to fight obesity by incorporating these lifestyle changes but are often demotivated by the weighing balance’s consistent reading. This may be due to a disease, medication, or psychological stress. Bariatric surgery for weight loss is often advised to people that are suffering from diseases that have either occurred due to obesity or are getting much worse because of it. These patients may have a BMI of 35–40 kg/m2 which is alarming and must be addressed in due time. Bariatric surgery has been around since a while and has proved beneficial. Average weight loss with bariatric surgery has been about 5 to 15 pounds in only the first 30 days. However, bariatric surgery is invasive and therefore, variations to the procedure have been introduced under interventional radiology.
What are the health risks following Obesity?
Obesity imposes several health risks and becomes the starting point of multiple chronic diseases. Ranging from metabolic dysfunctionality to cardiovascular and respiratory diseases, obesity is a defining factor in their progression. It is easy to understand why excess fat in the body would be so detrimental to health. Greater body mass affects almost every part of the body, from bones to muscles and from heart to brain, every organ faces the consequence. Risk of getting diabetes mellitus type 2, hypertension, osteoarthritis, coronary heart disease, respiratory problems, and some cancers, increase manifolds because of obesity. Moreover, in the recent age of social media, selfies, and fashion, being overweight or obese also contributes towards lower self-confidence, eventually leading a person into depression. Health risks following obesity and increasing mortalities have shifted attention towards studying ways in which weight could be reduced or the process of weight reduction could be hastened.
Treatment Of Obesity
The most obvious treatment plan for losing weight is to strike a balance between physical activity and healthy eating. It is no secret that losing weight is less about what you do to shed it and more about how consistently you are doing it. It is a lifestyle shift and being aware of the choices you make in your day-to-day routine. Special diets include intermittent fasting, calorie restricted diet and keto diet, to name a few. Most people require external help for their weight management where specialists plan a personalized routine for a person and conduct sessions to check up on the progress. Weight management programs under a specialist have proven more beneficial than being on your own and trying to lose weight since there is little accountability in the latter case.
Unfortunately, in some cases, a good diet and greater physical activity is also ineffective. Weight loss medicines and devices are advised to people who do not respond to management therapies, but it comes as no surprise that anti-obesity medications come with their fair share of side effects. Additionally, bariatric arterial embolization for weight loss has gained attention as being a minimally invasive procedure for obese people with comorbidities.
Gamma Block Bariatric Arterial Embolization
While the main cause of obesity remains ambiguous, hormones have been linked with controlling hunger, appetite, and weight gain by signaling the brain. Some of the hormones involved in the appetite regulation include oxyntomodulin, cholecystokinin, adiponectin, and ghrelin. Ghrelin is a hormone made from peptides and is released from the PD1 cells of the fundus, which is an important part of the stomach. Release of ghrelin is directly proportional to the food intake. Studies show that hunger increases on administration of ghrelin in subjects and during fasting or weight loss diets, levels of ghrelin rise, while once the hunger is quenched, ghrelin levels decrease. This variation points towards its role in hunger management.
The decrease in ghrelin level has been reported after bariatric surgery and believed to be associated with the weight loss process. Understanding the role of ghrelin is important to rationalize the bariatric embolization procedure which is an improved version of bariatric surgery. Fundus contributes to producing 90% of the ghrelin in the body. Blood supply to the fundus of the stomach is through the left gastric artery. right gastroepiploic artery and Short gastric arteries.
Dr Imtiaz Ahmad is the pioneer of Gamma block bariatric arterial embolization
procedure. This is a highly improved and precision guided procedure in which three blood vessels supplying the gastric funds are targeted as compared to rest of the world where only 1-2 blood vessels are targeted. The first ever “Gamma-Block” was performed in Pakistan in the month of Nov 2017. Patient was a 55 year male who lost approximately 67 pounds over a period of 3 months.
The procedure is a non-surgical alternative to bariatric surgery and does not involve the removal of any part of the digestive system. This aspect makes it minimally invasive yet achieves a similar goal to that of bariatric surgery. Gamma-block procedure is performed under image guidance. Catheter is introduced through the radial or the femoral artery to reach the left gastric artery,right gastro-epiploic artery followed by short gastric arteries supplying the Gastric fundus . Once image guidance confirms the correct position, embolization of the arteries is performed to disrupt the blood supply to the fundus. where “Hunger Center” The 90% ghrelin released from the” Hunger Center” located in gastric fundus causing hunger and overeating in already obese people is now “significantly”inhibited. Weight loss and management now yields much more promising results.
It is crucial to understand that while bariatric arterial embolization alone can prove quite effective, for an enhanced outlook, lifestyle changes and pharmacotherapy may become adjuvant to the treatment. It is helpful to remember that sometimes a loss is also a gain.
