The good, the bad and the outright bizarre | Timi Gustafson

Since the Food and Drug Administration (F.D.A.) has lowered the minimum weight requirements for gastric Lap-Band surgery, which made many more millions of Americans eligible for the procedure, a whole new industry of weight loss device makers has emerged, trying to cash in on this vastly expanding market.

Until now, people who wanted to have weight loss surgery (and qualified for it) had basically two choices: Gastric bypass, by which the size of the stomach is surgically reduced and parts of the small intestine are bypassed, or gastric banding, which applies an inflatable ring around the stomach to restrict food intake. Both procedures require invasive surgery, which carries a number of risks, including infections from incisions. And there is also the cost factor. Surgery involving general anesthesia is expensive, and insurance companies who cover gastric surgery are extremely interested in lowering these costs.

So, now there is a great rush to find surgery-free alternatives. A number of new techniques have already been developed and are being tested. For example, there is the so-called “sleeve gastrectomy” (still requiring invasive surgery), which narrows the stomach by stapling and permanently reducing it in size. Different variations of sleeve gastrectomy are still being tried out, such as gastric imbrication or plication, which does not cut off any parts of the stomach but simply folds it, like pleating.

The hope is that surgery can eventually become altogether obsolete in the fight against obesity. And there are already many innovative minds hard at work to achieve this. One company tried to develop a procedure that uses a stomach-stapler that can be inserted through the mouth, making incisions unnecessary. Another came up with a pill to be taken before each meal, which then swells up in the stomach and fills it to the point where there is less room left for actual food. There is also a “pacemaker” that sends jolts of electricity to the stomach wall with the intended effect of triggering fullness signals. Artificial stomach and intestine linings could some day prevent food absorption (it’s being worked on).

The idea of inserting devices in the stomach to reduce volume is not all that new. Balloons that can be swallowed and then inflated in the stomach have been around for a while. But they seem to lose their effectiveness over time and don’t always function as intended. The manufacturers of gastric banding are also trying to refine their line of products. One device that is currently being tested would allow “banding” from within the stomach, making it possible to insert the device through the mouth without the need for surgery.

Perhaps, one should marvel at the innovative ingenuity that goes into all of this, but I cannot help but feeling uncomfortable over the thought that all this effort seems to be necessary, simply to keep people from overeating and becoming obese. Cutting stomach sizes in half, inflating balloons and other items to take away room for food, tricking organs into false signals, and so forth. What has ever happened to self-restraint? Can we no longer count on a minimum of willpower to stop stuffing ourselves when we are clearly eating more than our bodies can handle?

All these clever devices will not change a dysfunctional relationship to food. These are band aids, not solutions. Having a plastic band around the stomach does nothing for the improvement of someone’s eating habits. It’s like mopping up the floor without turning off the faucet when your house is getting flooded. We would be better off by going to the roots of our flawed lifestyle choices instead of only treating the symptoms.

But, of course, the odds are that this will not happen any time soon. Weight loss technology is already big business and carries the promise of a financial blockbuster. Also, health insurance companies are much more inclined to pay for clearly defined procedures, such as surgery, rather than for open-ended, hard to measure approaches, like supervised dieting, exercise and counseling.

So, most likely we will be seeing more technology and less appeal to positive lifestyle changes in the fight against obesity, which is a shame.

Timi Gustafson R.D. is a clinical dietitian and author of the book “The Healthy Diner – How to Eat Right and Still Have Fun”.