Estimates suggest that 35% of the entire adult population in the United States is obese; this is more than 1 out of every 3 adults. To make things worse, many of these individuals struggle to fight food cravings and slowed metabolism as a result of psychiatric medications; approximately 1 out of every 5 adults is taking some sort of mind-altering pharmaceutical. There is often a symbiotic relationship between mental illness and obesity – having one can lead to development of the other.
A person may struggle with obesity, and in turn may develop severe depression. Another individual with severe depression may eat in excess as a coping mechanism to deal with extreme sadness and/or realize that a pharmaceutical taken to treat preexisting depression causes them to gain weight (there is clear evidence that many antidepressants cause weight gain). Regardless of the specific causes of a person’s obesity, treatment is essential to improve quality of life and maximize longevity.
While everyone is on the lookout for the latest weight loss pill, and others are already ingesting psychostimulants like Vyvanse for binge eating disorder – taking dopamine reuptake inhibitors (DRIs) is a short-sighted strategy. Temporary weight loss from pharmaceuticals may be appealing to many who are overweight, but over the long-term users tend to build up tolerance, experience diminishing returns, and eventually end up worse than their pre-medicated state. A new treatment for obesity called “VBLOC” alters signaling between the brain and digestive system to promote weight loss.
What is VBLOC therapy for weight loss? (How It Works)
VBLOC therapy is devised to modulate certain signals transmitted between the brain and digestive system. It is thought to specifically regulate the functionality of the vagus nerve, thereby promoting clinically significant weight loss. This is considered the first form of therapy to target the vagus nerve via “vagal blocking” for the management of obesity.
Should someone qualify for VBLOC therapy, a small laparoscopic surgical procedure (minimally invasive) is required; surgery takes approximately 60 to 90 minutes. The surgical procedure implants tiny electrodes next to the vagal trunks near the diaphragm (above the esophagus and stomach). These tiny electrodes use high-frequency electrical algorithms to intermittently downregulate vagal signaling.
The system itself is comprised of 3 specific hardware implants: a pulse generator (to send electrical signals) and two wires that are strategically positioned on the vagus nerve in the abdominal area. From outside the body, signals generated by the device can be manipulated with a remote controller that attaches to a transmitter coil and battery charger. The result is that those with obesity lose clinically significant amounts of weight as a result of “neuroregulation” stemming from the VBLOC electrodes.
To ensure that neuroregulation is occurring at optimal intervals, a physician will adjust the frequency (how often) the electrical stimulation is sent to the nerves. This is advantageous over other weight loss procedures in that the surgery is minimally-invasive and normal food can be consumed immediately.
VBLOC Therapy: Mechanism of Action
The precise mechanism of action associated with VBLOC therapy remains unclear. The vagal nerve has been associated with alterations in activation of “brown fat” – a healthy type of fat that promotes weight loss. Some speculate that activation of brown fat via signaling alterations could be part of the mechanism by which the device works.
It is known that the vagal nerve is highly complex, transmitting signals throughout the entire body. The mechanism of action may also be related to altering communication between the gastrointestinal tract (GI) and the brain. Since the vagal nerve also transmits signals to the heart, neck, and influences the autonomic nervous system – the specifics regarding the mechanism of action haven’t been clarified.
VBLOC Therapy for Weight Loss (The Research)
While there isn’t a lot of research involving vagal blocking with “VBLOC,” the available studies that have been conducted demonstrate statistically significant reductions in excess body weight among individuals with obesity. Evidence suggests that results from the device are noticeable within one week. Additionally, excess weight loss was documented to increase over a 6 month term and further after one year.
2013: A study was published in 2013 documenting the efficacy of VBLOC for weight loss, glycemic control, and blood pressure among those diagnosed with obesity and comorbid type-2 diabetes (DM2). The study was considered “open-label” and involved 28 participants that had been surgically implanted with a VBLOC device. Measures of weight loss, HbA1c, fasting blood glucose, and blood pressure were taken.
Of the 28 participants, 17 were female and 9 were male and all completed 12 months of follow-up. Just one individual experienced an adverse reaction (pain where the device was implanted), but this was rapidly corrected. After one week of using the device, the individuals had lost 9% of their excess weight, HbA1c reduced by 0.3, and blood pressure dropped by 7 mmHg. After 12 weeks of using the device, individuals had lost 25% of excess weight, HbA1c reduced by 1.0, and blood pressure dropped by 8 mmHg.
Based on the results after 12 weeks, VBLOC was considered both safe and effective among those with obesity and comorbid type-2 diabetes. The device triggered significant weight loss, improvements in HbA1c, and reduced blood pressure among those with hypertension.
- Source: http://www.ncbi.nlm.nih.gov/pubmed/23984050
2012: A large-scale study investigated the efficacy of vagal blocking with VBLOC therapy. This study recruited a total of 503 participants that had registered for the study at 15 locations. Following the informed consent portion of the study, a total of 294 individuals were surgically implanted with VBLOC devices. A total of 192 individuals were assigned to be in the “treated” group, while 102 served as controls.
Researchers determined the percentage of “excess weight loss” (% EWL) after one year, while noting any significant adverse reactions. The VBLOC therapy involved an external power source and customizable programmed algorithm delivering electrical signals to vagal nerves. The delivery of electrical signals altered transmission of the vagal nerve, which was hypothesized to cause weight loss.
Following one year of treatment, the percentage of excess weight loss was 17% of the treatment group, and 16% for the controls. There were some device-related adverse reactions in 3% of participants, but no deaths. Researchers noted that the amount of weight participants lost was associated with the number of hours they used the device.
Despite the fact that there was no significant difference in the excess weight loss between the treatment and control groups, researchers believe that built-in electrical safety checks may have triggered weight loss in both groups. In other words, both groups were getting vagal blocking as a result of charges being sent to the device. It was discovered that the amount of weight loss experienced was directly associated with number of hours the device was worn.
- Source: http://www.ncbi.nlm.nih.gov/pubmed/22956251
2008: Research published in 2008 analyzed the efficacy of vagal blocking (with VBLOC therapy) for weight loss and its effect on both dietary intake and vagal function. This study conducted was considered “open-label” and recruited obese individuals (as determined by BMI). A total of 31 participants would be surgically implanted with the VBLOC device and measures of body weight, electrocardiogram, dietary intake, satiation, satiety, and plasma pancreatic polypeptide (PP) were recorded.
Results indicated that excess weight loss at 4 weeks was over 7%. After 12 weeks of VBLOC therapy, individuals had lost excess weight of over 11%. Following 6 months of VBLOC therapy, weight loss had eclipsed 14%. Caloric intake had significantly been reduced among those receiving vagal blocking with the VBLOC device. Satiation, hunger reduction, and plasma pancreatic polypeptide (PP) measures also significantly improved.
This trial demonstrated significant efficacy of VBLOC therapy for excess weight loss (EWL) with minimal adverse reactions. It also significantly improved other secondary measures such as satiation and hunger.
- Source: http://www.ncbi.nlm.nih.gov/pubmed/18549888
How VBLOC Therapy May Influence the Brain
Researchers still don’t understand why altering signals sent from the vagus nerve to the brain might make people less hungry. Some suspect that the implanted electrodes from VBLOC therapy essentially “blind” the brain to the activity going on in the gastrointestinal (GI) tract. This blinding of signals from the gastrointestinal tract contribute to reductions in hunger or modulate some physiological response.
Most research investigating the effect of altering signals from the vagus nerve stems from animal studies. In animal studies, it was discovered that when the vagus nerve was stimulated near the stomach region, animals lost weight and ate less than non-stimulated counterparts. That said, the vagus nerve remains a therapeutic target for many conditions including: epilepsy, gasteroparesis, and major depressive disorder.
Advantages of VBLOC Therapy for Obesity
There are many advantages that could be derived from using VBLOC therapy over other modalities to stimulate excess weight loss among those with obesity. This is the very first vagal inhibitor to be approved by the FDA and yields significant results without ingestion of exogenous chemicals.
- Ability to adjust: Those that have been implanted with VBLOC devices can have them adjusted at any time. The adjustments made to the device’s algorithm can alter the rate by which high-frequency electrical pulses are delivered to the vagal nerve. It is thought that the more rapid the rate of pulsation delivery, the quicker the weight loss. To ensure steady weight loss progress, a doctor can tweak the device to ensure safe, sustained results.
- Autopilot: After the device has been implanted and electrodes properly positioned to target the vagal nerve, the person doesn’t really need to do much thinking. Assuming no adverse reactions are experienced, the device functions on autopilot, minimizing the need for constant monitoring. The fact that people don’t need to constantly check on their device to ensure that it’s working may be appealing.
- Clinically effective: Results from clinical trials suggest significant efficacy to the point of FDA approval. In order for any product or substance to get approved by the FDA, large-scale studies must show efficacy and safety over an extended term. Evidence of vagal blocking with VBLOC demonstrates that it’s an effective weight loss intervention.
- Eating less: Part of the mechanism by which VBLOC therapy works is via suppression of appetite. Clinical trials suggest a significant reduction in appetite and feelings of satiety when using the device. Thus, using VBLOC should help people reduce the amount of food they eat, while simultaneously making them feel full after smaller portions – both of which are effective for weight reduction.
- Minimally invasive: Although surgery is required for proper implantation of the device, the procedure is considered quick and minimally invasive. Unlike bariatric surgery, an individual is able to eat their normal diet right after implantation. Most people do not experience any significant complications associated with the surgery and the device is considered well-tolerated.
- Neuroscience-based: The device inhibits signaling from the vagal nerve with intermittent stimulation. This intermittent stimulation is thought to ultimately disrupt (potentially maladaptive) communication between the vagal nerve and the brain. The vagal nerve has long been investigated as a target of treatment for neurological disorders (e.g. major depression) and appears to be involved in a variety of functions, including weight management.
- No dietary changes required: Another aspect of VBLOC therapy that makes the device highly appealing is that no dietary changes are required when using the device. In other words, patients can gorge on the same unhealthy crap that they’ve been eating and still get results as a result of vagal signal inhibition. That said, it is still encouraged to eat an optimal diet for mental health and physical performance by cutting sugars, artificial sweeteners, refined carbohydrates, and processed foods.
- No pills required: The market for weight loss pills rakes in millions of dollars (maybe even billions) each year for people searching for a “quick fix” solution. Most of these weight loss pills are complete snake-oil, giving short-term results while carrying significant unwanted long-term consequences – including tolerance and a rebound effect. Realizing that there’s no biological free lunch from pills, there is significant appeal in using a device that regulates physiology via the vagal nerve.
- Removable device: An added benefit associated with using VBLOC therapy is that the implanted device is fully removable. You don’t need to have the hardware implanted inside your body for life, rather you can have it surgically removed at any time. The device can be removed with a minimally invasive surgical procedure. Theoretically, you could use the device for years and take it out with no permanent anatomical consequences.
- Safer than other surgeries: This device has a relatively favorable safety profile, with a minimal number of adverse reactions. Although people have experienced pain at the site of implantation, these cases were resolved quickly without further complications. Compared to other extreme interventions for obesity such as bariatric surgery, evidence suggests that VBLOC is safer.
- Sustained efficacy: Results from preliminary trials suggest that the device sustains efficacy over a long-term. One study found that individuals using the device for a year experienced greater excess weight loss than they did at 6 months. Though there may be diminishing returns over time in terms of excess weight loss, the device appears to elicit sustained results.
- Weight loss: The primary goal of using the VBLOC therapy is to decrease excess weight among those with obesity. Many studies have discovered that using the device for just 1 week produces noticeable weight loss, and after 6 months of usage, the excess weight loss is even more substantial.
Who can use VBLOC therapy for obesity and excess weight loss?
Not everyone can go out and get a VBLOC device implanted to promote vagal blocking. A majority of people who are looking to lose weight will not meet approved qualifications for VBLOC therapy. You must have a body mass index (BMI) of at least 35 and have a comorbid condition stemming from obesity such as Type-2 diabetes or hypertension (high blood pressure).
While this device may have significant appeal to those with obesity and no comorbidities (e.g. diabetes) and/or to those who are overweight, the cons may outweigh the pros. The device is not cheap and certainly warrants more research before it can be promoted on a larger-scale. In addition, the long-term effects of blocking vagal signaling are unknown; some hypothesize that they may be adverse.
Would you try VBLOC therapy for weight loss and obesity?
Assuming you met criteria to use a VBLOC device and could afford it, would you be willing to try it for weight loss? Feel free to share a comment below with reasoning supporting your answer. Do you think the potential benefits outweigh the potential drawbacks – why or why not?
My guess is that many people will want to try VBLOC therapy and that should the device be proven safe over longer periods, authorized FDA usage may expand to those with standalone obesity (rather than those with obesity and a comorbidity). Understand that at the end of the day, there’s still nothing better than eating a healthy diet, exercising, and avoiding all of the gimmicks.
Those that make an effort to work out will reap the psychological benefits of exercise such as neurogenesis and increasing BDNF levels. In addition, they may alter their genetics via epigenetics, alter brain activation of areas such as the dorsal medial habenula, and literally rewire their brain with self-directed neuroplasticity (assuming they make a sustained effort). For those in dire straits to get their health back on track, VBLOC therapy may have some appeal.