The clinical management of obesity is, in its simplest terms, broken down by those treatments that use products or not. Behavioral modification and surgery (e.g., gastric bypass or roux en-y) comprise the "not" category.
In the area of products, the choices are pharmaceuticals or devices. The obesity pharma field has had plenty of attention lately, given the burgeoning demand for obesity treatment being met by a shifting set of standards by the FDA on obesity drug approvals. Several big, prospective drugs — Lorcaserin, Qnexa, Contrave — appeared to have hit the "safety" wall at the FDA, but actions by the agency in the past year have considerably backtracked toward a stance (at least suggested by panel recommendation) favoring approval.
Simultaneously, the obesity device market has been quietly getting the job done by aggressively gaining approvals and, to a fault, heavily marketing themselves as solutions.
Obesity devices (and drugs for that fact) accomplish treatment objectives by serving one (or more) of a number of functions:
- Restriction — limiting stomach capacity to reduce caloric intake
- Appetite suppression — limiting the driver behind caloric intake
- Satiety or "artificial fullness" — limiting caloric intake by signalling fullness earlier
- Malabsorption — limiting the impact of caloric intake by reducing its absorption in the GI tract
- Gastric emptying — slowing the rate of digestion, which leads to an earlier feeling of fulliness
The predominant mechanism of obesity devices is in restriction, for a variety of reasons. For one, it is in some ways the least challenging mechanism to accomplish (and emulates gastric bypass without being as invasive/traumatic).
Below is illustrated graphically the number of companies active by obesity device type.
Source: "Products, Technologies and Markets Worldwide for the Clinical Management of Obesity, 2011-2019", Report #S835, MedMarket Diligence, LLC.