Recently there was a report that the American company Gl Dynamics has developed a new method for the treatment of obesity, which can be a cheap and safe alternative to the currently existing surgical methods of weight loss. Created by Gl Dynamics, the EndoBarrier device is a hollow tube made of elastic polymer, which is attached to a base made of nitinol (an alloy of titanium and nickel). The base of the EndoBarrier is fixed in the stomach, and its polymer “sleeve” about 60 centimeters long unfolds in the small intestine, preventing the absorption of nutrients. Experiments on more than 150 volunteers have shown that the EndoBarrier installation is no less effective than surgical reduction of the stomach volume by banding. At the same time, the device is installed and removed through the mouth, using an endoscopic procedure that is simple and safe for the patient, if necessary, it is removed, and its cost is much lower than that of surgical treatment. Obesity is a condition where an excess of adipose tissue in the body poses a threat to human health. Body mass index (BMI) is used as an objective measure of being overweight or underweight. It is calculated by dividing body weight in kilograms by the square of height in meters; for example, a person weighing 70 kilograms and 1,75 meters tall has a BMI of 70/1,752 = 22,86 kg/m2. A BMI of 18,5 to 25 kg/m2 is considered normal. An index below 18,5 indicates a lack of mass, 25-30 indicates its excess, and above 30 indicates obesity. Currently, diet and exercise are primarily used to treat obesity. Only in the event that they are ineffective, resort to drug or surgical treatment. Weight loss diets fall into four categories: low-fat, low-carb, low-calorie, and very-low-calorie. Low-fat diets can reduce weight by about three kilograms within 2-12 months. Low-carb, as studies have shown, are effective only if the calorie content of food is reduced, that is, they do not lead to weight loss by themselves. Low-calorie diets imply a decrease in the energy value of food consumed by 500-1000 kilocalories per day, which makes it possible to lose up to 0,5 kilograms of weight per week and achieve an average weight loss of eight percent within 3-12 months. Very low-calorie diets contain only 200 to 800 kilocalories per day (at a rate of 2-2,5 thousand), that is, they actually starve the body. With their help, you can lose from 1,5 to 2,5 kilograms per week, but they are poorly tolerated and are fraught with various complications, such as muscle loss, gout or electrolyte imbalance. Diets allow you to quickly reduce weight, but their observance and subsequent maintenance of the achieved mass require efforts that not everyone who loses weight is capable of – by and large, we are talking about a change in lifestyle. In general, only twenty percent of people manage to successfully lose and maintain weight with their help. The effectiveness of diets increases when they are combined with exercise. An increased amount of adipose tissue significantly increases the risk of developing many diseases: type 2 diabetes mellitus, diseases of the cardiovascular system, obstructive sleep apnea (breathing disorders during sleep), deforming osteoarthritis, certain types of cancer and others. Therefore, obesity significantly reduces human life expectancy and is one of the main preventable causes of death and one of the most serious public health problems. By itself, exercise, available to most people, leads to only a small weight loss, but when combined with a low-calorie diet, the results are significantly increased. In addition, physical activity is necessary to maintain a normal weight. A high level of training loads ensures significant weight loss even without calorie restriction. One study in Singapore showed that over 20 weeks of military training, obese recruits lost an average of 12,5 kilograms of body weight, while consuming food of normal energy value. Diet and exercise, although they are the main and first-line treatments for obesity, may not help all patients. If they were not enough, drug or surgical treatment is prescribed.
Modern official medicine has three main drugs for weight loss with fundamentally different mechanisms of action. These are sibutramine, orlistat and rimonabant. Sibutramine (“Meridia”) acts on the centers of hunger and satiety like amphetamines, but at the same time does not have such a pronounced psychostimulating effect and does not cause drug dependence. Side effects with its use may include dry mouth, insomnia and constipation, and it is contraindicated in people with serious cardiovascular diseases. Orlistat (“Xenical”) disrupts the digestion and, as a result, the absorption of fats in the intestine. Deprived of the intake of fats, the body begins to use its own reserves, which leads to weight loss. However, undigested fats can cause flatulence, diarrhea and stool incontinence, which in many cases requires discontinuation of treatment. Rimonabant (Acomplia, currently only approved in the EU) is the newest weight loss drug. It regulates appetite by blocking cannabinoid receptors in the brain, which is the opposite of the active ingredient in cannabis. And if the use of marijuana increases appetite, then rimonabant, on the contrary, reduces it. Even after the introduction of the drug on the market, it was found that it also reduces cravings for tobacco in smokers. The disadvantage of rimonabant, as shown by post-marketing studies, is that its use increases the likelihood of developing depression, and in some patients it can provoke suicidal thoughts. The effectiveness of these drugs is very moderate: the average weight loss with long-term course administration of olistat is 2,9, sibutramine – 4,2, and rimonabant – 4,7 kilograms. Currently, many pharmaceutical companies are developing new drugs for the treatment of obesity, some of which act similarly to existing ones, and some with a different mechanism of action. For example, it seems promising to create a drug that acts on receptors for leptin, a hormone that regulates metabolism and energy. The most effective and radical methods of treating obesity are surgical. Many operations have been developed, but all of them are divided into two fundamentally different groups according to their approach: the removal of the adipose tissue itself and the modification of the gastrointestinal tract in order to reduce the intake or absorption of nutrients. The first group includes liposuction and abdominoplasty. Liposuction is the removal (“suction”) of excess fatty tissue through small incisions in the skin using a vacuum pump. No more than five kilograms of fat are removed at a time, since the severity of complications directly depends on the amount of tissue removed. An unsuccessfully performed liposuction is fraught with deformation of the corresponding part of the body and other undesirable effects. Abdominoplasty is the removal (excision) of excess skin and fatty tissue of the anterior abdominal wall in order to strengthen it. This surgery can only help people with excess belly fat. It also has a long recovery period – from three to six months. Gastrointestinal tract modification surgery may be aimed at reducing the volume of the stomach for an early onset of satiety. This approach can be combined with reduced nutrient absorption. There are several ways to reduce the volume of the stomach. In vertical Mason gastroplasty, part of the stomach is separated from its main volume with surgical staples, forming a small bag into which food enters. Unfortunately, this “mini-stomach” quickly stretches, and the intervention itself is associated with a high risk of complications. A newer method – gastric banding – involves reducing its volume with the help of a movable bandage encircling the stomach. The hollow bandage is connected to a reservoir fixed under the skin of the anterior abdominal wall, which makes it possible to regulate the degree of gastric constriction by filling and emptying the reservoir with physiological sodium chloride solution using a conventional hypodermic needle. It is believed that bandaging is advisable to use only when the patient is highly motivated to lose weight. In addition, it is possible to reduce the volume of the stomach by surgical removal of most of it (usually about 85 percent). This operation is called sleeve gastrectomy. It can be complicated by stretching of the remaining stomach, depressurization of the seams, etc. Two other methods combine gastric volume reduction with nutrient absorption suppression. When applying a gastric bypass anastomosis, a bag is created in the stomach, as in vertical gastroplasty. The jejunum is sewn into this bag, into which food goes. The duodenum, separated from the jejunum, is sutured into the lean “downstream”. Thus, most of the stomach and duodenum are switched off from the digestion process. In gastroplasty with duodenal exclusion, up to 85 percent of the stomach is removed. The rest connects directly to the lower section of the small intestine several meters long, which becomes the so-called. digestive loop. The large part of the small intestine, including the duodenum, turned off from digestion, is blindly sutured from above, and the lower part is sewn into this loop at a distance of about a meter before it flows into the large intestine. The processes of digestion and absorption after that will occur mainly in this meter segment, since digestive enzymes enter the lumen of the gastrointestinal tract from the pancreas through the duodenum. Such complex and irreversible modifications of the digestive system often lead to severe disturbances in its work, and, consequently, in the entire metabolism. However, these operations are incomparably more effective than other existing methods, and help people with even the most severe degrees of obesity. Developed in the USA, EndoBarrier, as follows from preliminary tests, is as effective as surgical treatment, and at the same time does not require surgery on the gastrointestinal tract and can be removed at any time. In this regard, it can become widespread and partially replace other methods of treatment.
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