Endoscopic bariatric and metabolic therapies: Another tool for the management of diabetes and obesity

Endoscopic bariatric and metabolic therapies (EBMTs) have sparked significant interest as minimally invasive therapeutic options for weight loss. Although bariatric surgery remains an effective option for sustained weight loss and improvement in the metabolic syndrome, access and utilization are limited. Various EBMTs have been designed to emulate the physiologic effects of established surgical interventions, including space‐occupying and non‐space‐occupying gastric therapies, gastric remodeling procedures, and small bowel therapies. This review discusses the safety and efficacy of available US Food and Drug Administration‐approved minimally invasive endoscopic bariatric interventions, as well as those currently under investigation. In addition, the role of endoscopic revision after failed surgical intervention is discussed.     

Stage of obesity epidemic model: Learning from tobacco control and advocacy for a framework convention on obesity control

The 2011 United Nations political declaration against non‐communicable diseases (NCDs) targeted four major risk factors: tobacco use, harmful use of alcohol, an unhealthy diet, and a lack of physical activity. The Framework Convention on Tobacco Control (FCTC), MPOWER strategies, and the four‐stage model of the tobacco epidemic are useful references for the prevention and control of other risk factors and NCDs. Obesity control is a more complex challenge. Herein we propose a stage of obesity epidemic model (SOEM). Obesity is in the early stages in most countries with increasing prevalence, but its effects on mortality will increase rapidly, even if its prevalence may have reached a peak and be declining. Based on current relative risk, obesity kills one in three obese people. Like tobacco, epidemiological studies of obesity in the early stages would underestimate the risks and disease burden. Further research will reveal more harm, especially from long‐term obesity since childhood. The prevalence of obesity will likely overtake smoking prevalence, but commitments to obesity control are too weak. The SOEM is needed and should be useful to forewarn against the expanding public health problems attributable to obesity, and challenges in epidemiology and interventions. Learning from tobacco control, we advocate for a framework convention on obesity control. Framing obesity control initiatives in the spirit of MPOWER strategies against tobacco should be considered to prevent and control obesity and obesity‐induced diseases. Healthcare professionals should take leading roles in these initiatives and obese individuals should reduce their weight and “quit” obesity.