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An Old Procedure With a New Purpose

Bariatric arterial embolization (BAE) is a less invasive procedure and a promising option.

BAE involves transarterial embolization of the left and/or right gastric artery.

Other Weight-Loss Treatment Options

Surgical Options

Sleeve Gastrectomy

A surgeon removes a portion of the stomach to induce weight loss by restricting food consumption. After approximately 75% of the stomach is removed laparoscopically, the stomach takes on the shape of a tube or “sleeve”.

Cost $15k to $23k
Weight Loss: An average of 70% of excess weight lost after one year
Cons: Risk for long-term nutrient deficiencies, stomach stretched back to its original size, staple line leaks (2% of patients), bleeding (1%), stenosis/ strictures (1%), and digestion issues (more common).

Gastric Band

A soft silicone ring with an expandable balloon at the center is placed around the top part of the stomach. The stomach is banded into two sections so that patients only eat enough to fill the top section of the stomach. Eventually, food passes through the opening of the band and digests normally.

Cost $12.5k to $23k
Weight Loss: An average of 40% of excess weight lost after one year
Cons: In the long term, between 15 and 60% of patients need re-operation for implant malposition, slippage, erosion, frequent vomiting, or weight loss failure; requires strict adherence to the postoperative diet and to postoperative follow-up visits; and can cause discomfort.

Gastric Bypass

A surgeon staples off a large section of the stomach, creating a small pouch, which the surgeon then connects to the small intestine. This procedure leads to weight loss because the patient can only accommodate small amounts of food at a time in the small pouch.

Cost $8k to $35k
Weight Loss: An average of 65% excess weight loss after 1 year
Cons: To prevent nutrient deficiencies, must keep a strict diet: an adequate intake of protein, taking vitamin and mineral supplements, including a multivitamin, B12, folate, iron, and calcium, and avoiding sweets and fatty foods; at risk for weight regain and ‘dumping syndrome,’ in which the consumption of sugar causes abdominal cramping and diarrhea, can occur. Operative complications include bleeding or intestinal leakage (occurring in less than 2%).

Non-Surgical Options

Endoscopic Balloon

A surgeon inserts a narrow tube through the mouth and into the stomach. A tiny instrument that carries the balloon device is placed through the tube. Once in the stomach, this balloon is delivered and then inflated with about 24-36 ounces of fluid. By taking up space in the stomach, the balloon helps to decrease appetite, which leads patients to eat less frequently and eat smaller portions.

Cost (without insurance): $8k
Weight Loss: On average, patients lost 30% of their excess weight in the first year
Cons: Immediate side effects included discomfort, nausea, and vomiting. 4.2% of patients had their gastric balloon removed early due to their discomfort. Rare side effects include migration and bowel obstruction (0.8%).

BAE

Exercise

Cost $800/yr
Exercise should be done to supplement any surgical or non-surgical weight loss procedure. However, for individuals who are not eligible for the more aggressive surgical and non-surgical options, exercise can be adopted as part of a comprehensive weight loss strategy that will only be successful when done in conjunction with a healthy diet. However, it can be difficult to achieve extreme weight loss with diet and exercise alone.

Medications

Cost 120-3k/month
The FDA has approved several medications that can be used to aid in weight loss. Some of these medications include Phentermine, Lorcaserin, and Benzphetamine, among others. Many of the weight loss medications are approved only for short-term use—generally less than 12 weeks. It is important to consult with a physician about possible interactions with other medications.

Focused diets

Cost $7k to lose 20 pounds
Focused diets, like exercise, should be done to supplement any surgical or non-surgical weight loss procedure. However, for individuals who are not eligible for the more aggressive surgical and non-surgical options, improvements in diet and nutrition can be adopted as part of a comprehensive weight loss strategy. However, it can be difficult to achieve extreme weight loss with diet and exercise alone.

Psychotherapy

Cost $75-150
The field of clinical psychology has much to offer patients who struggle with their weight. Specifically, Cognitive Behavioral Therapy (CBT) is a goal-oriented psychotherapy that works to change clients’ behavioral patterns and thinking. Even when people understand what they must do to lose weight (choose the salad over the french fries), implementing those changes can be extremely challenging. Psychotherapy gives clients the tools and cognitive skills to adhere to a healthier lifestyle plan.

Acupuncture

To lose 5 to 10 pounds, you have to attend every 3 days or twice a week.
Cost $50-120/session
Some studies suggest that Chinese acupuncture can help improve weight loss. Specifically, inserting needles into certain points on the ear has been shown to reduce food cravings. When done in conjunction with other weight loss methods, including diet and exercise, acupuncture may help people achieve their weight loss goals.