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Advances in the Treatment of Obesity

Dr. George R. Merriman II Answers Important Questions


What  is the biggest change in the treatment that you have seen over the life of your 30 year career?


Currently, the biggest change lies in our understanding that the basis of the obesity problem is not what we thought. When I started my training in the early 1980s, I was taught that a gastric bypass was curative of morbid obesity. We had a woefully inadequate understanding of the problem.

We understand today that obesity is a multi-factorial problem, based not only on genetics and behavioral issues, but also on environmental influences and psychological factors. We also now know that early intervention is very important. We don’t want to wait to treat and manage the problem until a patient is morbidly obese with significant comorbidities (associated health problems.) A truly modern program treats the obesity epidemic as a chronic, incurable problem that fortunately can be well managed and in many cases driven into remission. Because Obesity is such a widespread problem today, we are seeing significantly more research, funding and entrepreneurial efforts geared toward finding the best solutions to managing the problem.


We have been hearing about the newest non-surgical procedure for weight loss called the Gastric Balloon. Can you tell us how this works?


The device comes as a deflated silicon balloon that is placed through the esophagus into the stomach with an endoscope (the same tool used to look for ulcers, etc.) and is done with sedation rather than general anesthesia. Once placed, the balloon is inflated with saline solution and can remain in the stomach for up to six months. Following the balloon removal, the patient participates in a support program for an additional six months.


The main mechanism by which the intragastric balloon works is by profoundly delaying the speed at which food empties from the stomach. This maintains a prolonged sense of fullness and therefore inhibits hunger. Also, by occupying space in the stomach, the balloon reduces the amount of food a patient can eat at one sitting, significantly reducing daily calorie consumption. This new device is a powerful tool to jumpstart a patient’s weight loss and transition into a lifestyle and support system which can manage their problem long term.

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