healthmedicinet

NHS hospitals will soon start trials of a new procedure to treat obesity by turning off the ‘hunger hormone’. 

Kirsten Kerfoot, 32, a nurse and mother of one, from Baltimore in the U.S., was one of the first in the world to benefit from it. 

Here, Kirsten and the doctor who treated her, as well as the British surgeon who will perform the first such procedure in the UK within the next few months, talk to Rachel Ellis.  

The patient 

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’].

And there have been consequences for my health. My gallbladder had to be removed when I was just 24 because I had gallstones. Doctors said it was linked to years of yo-yo dieting.

At my heaviest, I weighed 23st 8lb; as I am 5ft 11in, my BMI was 46, ‘morbidly obese’ [below 25 is ‘healthy’]. And there have been consequences for my health

I developed type 2 diabetes and two years ago started taking insulin. I also had high blood pressure and sleep apnoea [where your airway temporarily collapses as you sleep], which left me feeling exhausted the next day.

While I was training to be a nurse practitioner in 2020, I realised my weight was going to make my job problematic, too. Part of my role would be asking people to lose weight — yet I was obese, so that made me feel uncomfortable.

As diets never worked for me long term, I knew I needed some kind of surgery to help me make the change. But weight-loss operations such as gastric bands and sleeves seemed like major operations and required you to stick to a strict diet afterwards.

I looked online for new options and found a trial which was investigating left gastric artery embolisation (LGAE), in which they cut off the blood supply in one of the arteries supplying the stomach, to reduce levels of the hunger hormone ghrelin that sends messages to your brain telling 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.

I was accepted on the trial in January 2021. I attended some appointments to help me make changes to my diet, and then had the procedure in March under sedation.

I had grumbly pain in my stomach for three days afterwards so took paracetamol, and stayed in hospital for two nights due to nausea (I am sensitive to pain medicine). I was eating normal food after by the end of the week.

Since the operation, a lot of the hunger pangs have gone. In fact, I don’t think about food until I sit down to eat.

I have cut out snacks and eat three meals a day. For breakfast I have yoghurt or porridge and fruit, then a turkey sandwich and fruit for lunch and dinner; I limit red meat to once a week.

I’ve lost 6st 7lb in the ten months since the operation, and am now 14st 12lb — my lowest ever. My sleep apnoea has disappeared and I am off all blood pressure and type 2 diabetes medication.

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.

My husband Aaron, a teacher, is proud of what I have accomplished and, best of all, I can run around with my son Quentin, who is two and never stops. I just hope the results last.

I’ve lost 6st 7lb in the ten months since the operation, and am now 14st 12lb — my lowest ever. My sleep apnoea has disappeared and I am off all blood pressure and type 2 diabetes medication

The specialists 

Dr Clifford Weiss is an interventional radiologist at Johns Hopkins University in Baltimore, U.S.

Left gastric artery embolisation has been used since the 1970s to treat bleeding stomach ulcers. Doctors noticed these patients reported losing weight afterwards, so they investigated using the procedure for obesity.

They also knew that levels of the hunger hormone ghrelin decreased rapidly after bariatric surgery (the hormone is produced mainly in the stomach), and advances in the understanding of the vascular anatomy of the stomach led us to think that blocking the left gastric artery would reduce production of the hormone.

LGAE takes just 40 minutes. Patients can be in and out of hospital in a matter of hours (unless they experience side-effects and need to be monitored for a bit longer, as Kirsten was).

First, we make a small cut in the groin or wrist and, guided by X?ray, pass a catheter [a long, thin tube] through to the left gastric artery supplying the stomach.

Microscopic plastic beads are then injected to block the blood supply to the area at the top of the stomach called the fundus. Reducing blood supply to the fundus is believed to reduce ghrelin production.

Small studies in the U.S. and in Eastern Europe have shown that LGAE leads to about a 10 per cent reduction in weight in obese patients within 12 months; some, including Kirsten, lose more. I have treated 25 patients with the LGAE and they have not had significant side-effects.

• Water pollution is threatening to wipe out UK’s life-saving… Britain gets back to normal as Omicron wanes: UK’s Covid…

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.

This is probably because the stomach is re-vascularised [i.e. new blood vessels form], so ghrelin production rises again. That’s why patients need to be on a weight-loss programme for long-term success. The goal is to help them become healthier in the least invasive way, and the procedure gives them a window to reset their eating habits. 

Ahmed R. Ahmed is a bariatric surgeon and lecturer at Imperial College London.

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.

Firstly, it is quicker and much less invasive than traditional bariatric surgery, which involves making permanent changes to the digestive system, takes about two hours under general anaesthetic and requires at least one night in hospital. With LGAE patients can eat what they want soon afterwards; with other bariatric operations they have to gradually wean themselves back on to normal food over many weeks.

Also, it is known to be safe. Other types of bariatric surgery carry risks of blood clots, wound infections and a blocked or leaky gut.

The weight loss associated with LGAE may not be as great as with bariatric surgery, but it is likely to be enough to reverse type 2 diabetes and reduce blood pressure in some patients.

Finally, LGAE costs £1,500 — four times less than other types of bariatric surgery. This could allow more patients to be treated. Current NHS waiting lists for bariatric surgery are two to three years.

A new NHS trial will provide the best possible evidence on how well the treatment really works.

Involving 76 patients, it will be carried out at St Mary’s Hospital and University College Hospital, both in London. Their weight and ghrelin levels will be monitored for a year, and they will be asked to fill in questionnaires about their hunger levels and quality of life. Results are expected in 2024. 

What are the risks? 

• Around 40 per cent of patients develop a stomach ulcer from the LGAE treatment which can be successfully treated with medication.

• It is not suitable for people taking medication that can drive hunger, such as that for depression and schizophrenia.

Commenting on the new research, Tam Fry, chair of the National Obesity Forum, says: ‘The results so far are very impressive and such innovation is desperately needed. However, protocol demands that this technique be evaluated in the UK before we can all rush out to buy into the procedure for the NHS.’

To find out about the trial, email: [email protected]