However, this device must be implanted through minimally invasive outpatient surgery. Two wires are tied around the nerve at the spot where the stomach meets the esophagus. Those wires are connected to a rechargeable device under the skin that sends strong electrical impulses to shut down the brain-gut communication. When that happens, stomach contractions stop, digestive enzymes stall, and hunger stays at bay.
Patients recharge the device at home, and physicians tailor the strength of the electric signals to a patient's needs. But, you're only eligible for the surgery, if you have a BMI over 40, or a BMI over 35 and another obesity-related condition like heart-disease, hypertension, or type 2 diabetes.
Unfortunately, the device has underwhelmed experts. "The problem isn't that it's too powerful, it's too weak," says Lee Michael Kaplan, MD, director of Massachusetts General Hospital's Weight Center. In clinical trials, two groups of obese patients received the device, but researchers only turned it on in one group. They lost about 24 pounds over the next year, but the group with the dead devices lost 16 pounds. "That means that getting an implant alone was effective, and nearly as effective as having it turned on," says Angela Guarda, MD, director of the Eating Disorders Program at The Johns Hopkins Hospital. "Unfortunately, tha's not a ringing endorsement for a surgical procedure and 12-month follow up." And these results pale in comparison to those of gastric bypass surgery—another option for these patients.
A Solution For Binge-Eating?
The FDA also approved Vyvanse as the first and only drug to treat binge-eating disorder—a psychological diagnosis characterized by frequent episodes of overeating and associated feelings of shame. Binge-eating is the most common eating disorder in the United States, and two-thirds of binge-eaters are obese.
Vyvanse, which has been around since 2008 as a treatment for attention deficit hyperactivity disorder, offers a pharmacological solution to a mental issue that previously could only be managed with counseling and cognitive-behavioral therapy.
In at least one trial, a 50 mg and a 70 mg dose of Vyvanse significantly reduced the number of weekly binge-eating episodes. According to a 2013 study, an average dose of Vyvvanse leads to weight loss and an improved BMI for patients with bipolar disorder.
Not all the news is sunny with Vyvanse, warn experts. Similar to amphetamine—also used to treat weight at one time—it's potentially addictive. "Substance abuse is a concern and is often linked with binge-eating disorder," says Guarda. "Vyvanse is a controlled substance with abuse potential."
Despite some positive weight loss results, says Guarda, Vyvanse is neither a weight-loss drug nor cure for obesity. "There is some concern that the direct-to-consumer marketing of this drug that's underway will result in patients asking for this medicine from physicians," she says. "Without enough data to know how it will work, caution is warranted."
