Setting the pace against fat

Could gastric pacemakers be obesity's Waterloo?

By Maria Turner

It's not exactly breaking news that obesity is on the rise in Canada. But the statistics are still staggering -- between 1995 and 2001 the number of obese adults in this country rose by 24%, to almost 2.8 million. But the health community has known about this problem for years. As doctors, you have been advising your patients that excess weight and obesity can lead to serious health problems, including cardiovascular disease, type II diabetes, hypertension, stroke, and certain types of cancer. As the general population begins to understand the weight of this problem, more and more people are looking for a way to curb the obesity epidemic.

Gastric pacing -- where an electronic pacemaker is implanted under the skin and connected to the stomach -- is a novel therapy in the treatment of morbid obesity that is showing promising results, according to a study conducted in Italy published in the December 2003 issue of Obesity Research. Patients involved in the study experienced an average weight loss of 10.4kg after six months of treatment. The study included 11 obese patients with an average BMI of 46.0kg/m2 who had previously been unable to maintain weight loss through diet and lifestyle modifications. The aim of the study was to look at the possible mechanisms behind the change in eating behaviour of patients with gastric pacemakers. Previous studies have shown that gastric pacing increases satiety and the ability to reduce food intake, and leads to significant weight loss, but how the pacer works is still unknown. The study focused on the gastrointestinal hormones cholecystokinin (CCK), somatostatin, glucagon-like peptide-1 (GLP-1) and leptin, which are known to play a role in satiety and the regulation of food intake. Levels of these hormones were tested in patients one month before and after implantation of the pacemaker and then once a month for a period of six months. Blood samples were taken after 12 hours of fasting and again after ingestion of a standardized hypocaloric meal of 270kcal.

The authors of the study admit that they still don't fully understand the mechanisms involved in gastric pacing. "At present, we cannot tell whether decreased release of gastrointestinal peptides during gastric pacing is a consequence of altered neural input of secondary to changed gastrointestinal motor activity."

The authors of the study admitted that they still don't fully understand the mechanisms involved in gastric pacing. "At present, we cannot tell whether decreased release of gastrointestinal peptides during gastric pacing is a consequence of altered neural input to changed gastrointestinal motor activity. More studies are needed to elucidate these mechanisms."