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Hunger hormone could be key to weight loss; procedure aims to block it

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Cheryl Denby (right), who lost 30 pounds so far after Bariatric Embolization of Arteries for the Treatment of Obesity at Johns Hopkins. She talks with Linda Bunyard, a registered dietitian at The Johns Hopkins Weight Management Center.

Cheryl Denby tried about every diet on the market over the years and always failed because of the same reason — she constantly felt hungry.

"I was just so hungry all the time that it would make it difficult to stick with anything," said the 48-year-old, who works in information technology. "I would feel so deprived and then want to eat everything."


All of that changed in December when the Oxon Hill resident underwent a new, minimally invasive procedure that helped her get her hunger under control and lose 30 pounds.

The procedure, known as bariatric arterial embolization, involves injecting small microscopic beads into the veins leading to the part of the stomach called the fundus that produces ghrelin, the body's most potent hunger-stimulating hormone. The blockage decreases the amount of ghrelin produced in the body and dulls the hunger signal so patients don't feel as much of an urge to eat.


Denby was one of seven patients who took part in a clinical trial led by Johns Hopkins Medicine researchers and aimed at morbidly obese people. The results will be released at the Society of Interventional Radiology's 2016 Annual Scientific Meeting today.

The study is still in the very early stages. Testing on the first seven patients proved the procedure was safe enough to expand to 20 patients, including those seeking care at Mount Sinai Health System in New York.

Lead researcher Dr. Clifford Weiss said the procedure could potentially offer another treatment option for the estimated 2 billion people worldwide who struggle with their weight.

Diets don't work for many people, but they might not necessarily want to get invasive and complicated bariatric surgery, which uses various techniques to significantly reduce the size of the stomach.

Obesity leads to a host of other health issues such as diabetes, heart diseases and cancer. In America and Canada, obesity-related health costs top $300 billion, the researchers said.

"If this pans out it looks like this is going to be a powerful tool for patients with weight problems," said Weiss, associate professor of radiology and radiological science and director of interventional radiology research at the Johns Hopkins University School of Medicine. "The patients lost a significant amount of weight."

People are considered obese if they have a body mass index above 30. The patients enrolled in the study had a BMI that ranged from 40 to 60, which means they were at least 100 pounds overweight and considered morbidly obese.

The procedure involved making small nicks in the wrist or groin and then using a catheter to gain access to the vessels where the beads were injected.


Before and after the procedure, patients were enrolled at the Johns Hopkins Weight Management Center, where they worked with a team of medical professionals, including nutritionists and behavioral specialists, who could teach them to eat healthfully, find out what emotional triggers might lead to overeating and develop an exercise plan.

Patients who underwent the procedure recorded a 5.9 percent average excess-weight loss, or the percentage loss of pounds above the patient's ideal body weight. That average increased to 13.3 percent after six months.

The patients also said they felt significantly less hungry after the procedure. Patients reported an average 81 percent decrease in appetite in the two weeks after the procedure and a 26 percent decrease three months after the procedure.

"The primary outcome of the study was there were not major adverse affects," Weiss said.

While Weiss kept patients overnight for observation for research purposes, he said the procedure could be done on an outpatient basis and patients could go home the same day. More research is needed to determine any cost savings.

Ghrelin was identified in 1999, and scientists like Weiss have been working to understand its role in hunger. Some studies have found that excess weight may increase sensitivity to the hormone. People who slim down may make more ghrelin, as if the body is trying to hold on to the extra weight.


"You can get people to lose weight, but while they are losing weight, their body is waiting to eat more," said Carole Sztalryd, associate professor of medicine in the division of endocrinology at the University of Maryland School of Medicine.

Sztalryd said learning more about ghrelin has promise for helping people struggling with weight gain.

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Denby was feeling down about her weight when she began scanning a website for clinical trials. She had tried Weight Watchers, the Atkins diet, Nutrisystem and Diet-To-Go, but the pounds barely budged. When she managed to lose a bit of weight, she would later regain it. She considered bariatric surgery but didn't want to have costly major surgery.

She opted to undergo bariatric arterial embolization. A month after the procedure, she felt better than she had in years. Gone was the constant feeling of hunger.

"I didn't feel miserable like I usually did when I was dieting," said Denby, who declined to share her current weight. "It was very encouraging."

Denby's goal is to lose 100 more pounds. The mother of a college-age son would like to one day stop worrying about being judged because of her size. She'd also like to sit in an airplane seat without "getting stuck" or having to ask for a seat belt extender.


"I haven't been on a plane yet, but I'm going to Jamaica in June," she said. "We'll see what happens."