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The FDA Approved An Anti-Obesity Device…But Will It Work Long-Term?

When it comes to an FDA-approved treatment for obesity, there aren't a lot of options out there. Weight loss drugs such as Meridia have come and gone, since their risks have been found to outweigh their benefits. But here's some good news: Last week the FDA gave its seal of approval to a pacemaker-like device called the Maestro Rechargeable System (there are only two other FDA-approved weight loss devices on the market). Unlike diet pills of the past, this device is surgically implanted into the abdomen and sends intermittent electrical pulses to the abdominal vagus nerve—best known as the communicator between the brain and the stomach.

This nerve, which also is one of the longest nerves in our body, has been the target of anti-obesity research for years, since researchers have figured out that blocking its activity could aid in weight loss. "The vagus nerve is quite important in regulating communication along the gut-brain axis," says Christopher Ochner, PhD, an obesity and nutrition expert at The Mount Sinai Hospital in New York City. "We've come to realize just how vital the neurohormonal system is to the regulation of food intake and body weight. Therapies that alter signaling within this system are almost certainly the wave of the future."

Photo courtesy of EnteroMedics

Details about how the Maestro Rechargeable System actually works are unclear, but the FDA found the evidence to be favorable enough for approval. In a clinical trial that included 233 patients with a BMI of 35 or greater, of the 157 patients who received active Maestro devices, 52.5% lost at least 20% of their excess weight and 38% of them lost at least 25% of their excess weight. Overall, the experimental group lost 8.5% more of their excess weight than the control group after 12 months.

After evaluating the 18-month data, which showed sustained weight loss, the FDA Advisory Committee agreed that the benefits of the device outweighed the risks, which include nausea, pain at the site where the device is placed, vomiting, as well as surgical complications. 

But the FDA wants more information. Though the Maestro is approved for treatment in adults over the age of 18 who have not been successful in losing weight with a program, and who have a body mass index of 35 to 45 with at least one other obesity-related condition (like type 2 diabetes), the FDA is requiring the company that makes the device to conduct a five-year post-approval study. It will follow 100 patients to collect additional safety and effectiveness data including weight loss, adverse events, surgical revisions and explants and changes in obesity-related conditions. "How this system will fare in terms of long-term treatment effectiveness remains to be seen," Ochner says.

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