NHS hospitals will soon start trials of a new procedure to treat obesity by turning off the ‘hunger hormone’.
Kirsten Kerfoot (32), a mother-of-one and nurse from Baltimore, the U.S.A, was among the first to receive it.
Rachel Ellis talks to Kirsten, the British surgeon who performed the procedure, and also the British doctor who helped her.
There’s not been a time in my life when I haven’t been overweight or obese. I ate a lot of cheese and loved sweets; and if I saw an advert for Chinese food on TV, I’d think: ‘I want it!’ The thought would stay in my mind for days.
Over the years I’ve tried all kinds of diets. I’d shed a few pounds, then I’d stop losing weight and get bored and put it all back on again.
At my heaviest, I weighed 23st 8lb; as I am 5ft 11in, my BMI was 46, ‘morbidly obese’ [below 25 is ‘healthy’].
There have been serious consequences to my health. When I was 24 years old, my gallbladder had had to be taken out because of gallstones. It was due to years of yo yo dieting, according to doctors.
At my heaviest, I weighed 23st 8lb; as I am 5ft 11in, my BMI was 46, ‘morbidly obese’ [below 25 is ‘healthy’]. These have had negative effects on my health.
Two years ago, I was diagnosed with type 2 diabetes. High blood pressure, sleep apnoea and high blood sugar were also issues. [where your airway temporarily collapses as you sleep]I felt exhausted and irritable the following day.
As I was preparing to become a nurse practitioner, in 2020, my weight started to affect my ability to do my job. Part of my role would be asking people to lose weight — yet I was obese, so that made me feel uncomfortable.
Since I had never been able to maintain a healthy weight, it was obvious that surgery would be necessary. Weight-loss surgery like gastric banding and sleeves were major and would require you to follow a strict diet.
After searching online, I came across a trial that investigated left gastric arter embolization (LGAE). They cut off blood supply to one of the stomach arteries to relieve hunger hormones ghrelin and send messages to your brain to tell you to eat.
The idea appealed to me as it was less invasive than traditional bariatric surgery and I’d be back to a normal diet within days.
The trial was opened to me in January 2021. After attending some sessions to make changes in my diet, I was sedated for the procedure.
After three days of grumbly stomach pain, I took paracetamol and was hospitalized for 2 nights. By the end of week, I was eating normally again.
A lot of hunger pangs disappeared since the operation. In fact, I don’t think about food until I sit down to eat.
My snack intake has been reduced to three meals per day. Breakfast is yoghurt, porridge or fruit with fruit. Lunch and dinner are a turkey sandwich and fruit. Red meat is only allowed once per week.
I’ve lost 6st 7lb in the ten months since the operation, and am now 14st 12lb — my lowest ever. The sleep apnoea is gone and all type 2 diabetes medications and blood pressure medication are off my desk.
I now can work a 12-hour shift and still have energy — and for the first time in my life I can cross my legs and be comfortable.
Aaron, my husband and teacher, is proud to see the accomplishments of me. And, most importantly, Quentin is two so I am able to go with him. It is my hope that the results will last.
I’ve lost 6st 7lb in the ten months since the operation, and am now 14st 12lb — my lowest ever. Sleep apnoea disappeared, and I’m now off blood pressure medications.
Dr Clifford Weiss, an interventional radioologist, is based at Johns Hopkins University Baltimore (U.S.).
Since the 1970s, left gastric artery embolisation is used to treat stomach ulcers. After these patients lost weight, doctors investigated the possibility of using this procedure to treat obesity.
It was also discovered that ghrelin levels dropped rapidly following bariatric surgery. The hormone is mainly produced in the stomach. Our understanding of the anatomy of the stomach has led to the conclusion that the production of this hormone would be reduced by blocking the left stomach artery.
LGAE takes just 40 minutes. The average time it takes for patients to leave the hospital is less than an hour, unless they have side-effects that require them to stay longer. Kirsten was one of these cases.
First, we make a small cut in the groin or wrist and, guided by X‑ray, pass a catheter [a long, thin tube]via the right gastric artery, which supplies the stomach.
To block blood supply to the Fundus at the top, microscopic plastic beads can be injected. The reduction of blood supply to this area is thought to decrease ghrelin levels.
Studies in Eastern Europe and the U.S. have found that LGAE results in a 10% weight loss in obese patients in 12 months. Some, like Kirsten, experience even greater weight reductions. The LGAE has not caused any side effects in 25 of my patients.
The procedure seems to reduce appetite but doesn’t suppress ghrelin production for ever — there is very significant weight loss in the first six to nine months and then it stabilises.
It is likely that the stomach has been revascularized. [i.e. new blood vessels form]As a result, ghrelin levels rise again. That’s why patients need to be on a weight-loss programme for long-term success. Patients are encouraged to lose weight and become more healthy in the most non-invasive manner possible.
Ahmed R. Ahmed, a surgeon in bariatrics and lecturer at Imperial College London is Ahmed R. Ahmed.
With 2.3 million people in the UK meeting the criteria for weight-loss surgery and only 6,000 a year getting it, there is an urgent need for more treatment options — and LGAE is potentially important for a number of reasons.
First, the procedure is much quicker than traditional bariatric surgical procedures. Traditional surgery involves permanent changes in the digestive system and takes around two hours. It also requires at most one night in hospital. LGAE allows patients to eat as much or less quickly after the operation. Patients who have undergone other bariatric procedures must gradually return to regular food for several weeks.
It is also safe. Bariatric surgery can also cause bleeding, infection and leaky or blocked stomachs.
While the weight loss with LGAE might not be as significant as that with bariatric surgical, it will likely be sufficient to reverse type II diabetes and decrease blood pressure in some cases.
Finally, LGAE costs £1,500 — four times less than other types of bariatric surgery. This will allow patients to receive treatment at a higher rate. The current waiting list for bariatric surgery on the NHS is two- to three years.
An NHS new trial will give the most reliable evidence about the effectiveness of the treatment.
Involving 76 patients, it will be carried out at St Mary’s Hospital and University College Hospital, both in London. For a year their weight, ghrelin and other factors will be tracked. Patients will then be asked questions about quality of life, hunger and other aspects. The results will be available in 2024.