Devices Treat Obesity Patients without Options
This article was originally published in Start Up
Early intervention is the general rule for success in treating many diseases, but in obesity, patients have to be in bad shape before they're eligible for the most efficacious treatments, which are surgical interventions. Companies with minimally invasive--and anatomy sparing--devices hope to change that paradigm.
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Numerous physiologic pathways lead to obesity; those related to hunger, satiety, the breakdown and absorption of nutrients, and the regulation of energy. Given the complexity of obesity, it's not surprising that diet and exercise aren't currently effective and that drugs have had only modest success. Bariatric surgery, on the other hand, which reduces the size of the stomach (and, in some versions, also reroutes part of the small intestine so that food bypasses it) is extremely successful. Many patients that have undergone the Roux-en-Y gastric bypass procedure have sustained losses of 50% of their excess weight out to ten years and beyond. Now companies with minimally invasive devices for the treatment of obesity hope to fill the therapy gap between dieting and invasive surgery. It's too early to claim victory, but start-ups and scientists are benefiting from a better understanding of why gastric bypass surgery works.
Researchers have recently discovered that Roux-en-Y gastric bypass surgery is a very effective tool for improving-and sometimes completely reversing-type 2 diabetes. Medtech interviews Francesco Rubino, MD, chief of gastrointestinal metabolic surgery at Cornell University's Weill Cornell Medical College, who is at the forefront of a new subspecialty in bariatric surgery called diabetes surgery. He and his group are studying exactly how bariatric surgery succeeds in reversing type 2 diabetes.
It's not often that a company in the medical device industry, where most new products offer incremental innovation, has a chance to change the world. Start-up GI Dynamics does, though. Shooting for a non-invasive device that would replicate some of the benefits of the invasive Roux-en-Y gastric bypass surgery in obesity, it discovered that an endoscopically delivered implant appears to be extremely effective in type 2 diabetes, as is the predicate gastric bypass. Simple and non-invasive, the technology is potentially disruptive by reversing the disease, not just managing its symptoms. (See also the sidebar to this article: "A Mechanistic Look at Diabetes Surgery: An Interview with Francesco Rubino." )