For most of her life, Cathy Shelley Newell considered herself about 15 to 20 pounds overweight. She tried programs such as Weight Watchers and Physicians Weight Loss Centers, took appetite control medications and experimented with low-carbohydrate diet plans.
She could lose the weight temporarily, but it would eventually come back.
“My mother always used to tell me — she’s deceased now — but she would always say, ‘Cathy, this is going to be a lifelong issue,’ and she was right,” Newell said.
Newell, 58, was a teacher for nearly 34 years at Conway Elementary School in Horry County before retiring in June. She recently went on antidepressants, following a divorce, which she said made her gain an additional 50 to 60 pounds. At her heaviest, the scale read 235.
This summer, Newell was prescribed a cholesterol-lowering medication and received a diagnosis of sleep apnea, which her doctor told her were both likely the result of her weight gain.
“I could see diabetes coming,” she said. “I was heading in that direction, and that was concerning enough for me to do something about it and get serious.”
In December, Newell became the first person in South Carolina to have a device similar to a pacemaker implanted under her skin that blocks hunger signals between her brain and stomach. The treatment, known as vBloc Therapy, helps patients feel fuller longer and crave less food, which should result in weight loss, according to Dr. Ken Mitchell, medical director of Roper St. Francis’ Bariatric and Metabolic Services Program.
He and his colleague Dr. Bryan Thomas are the only two surgeons in South Carolina trained to do the procedure, and Roper St. Francis is the only hospital system in the state that offers it.
How it works
The brain and stomach communicate with each other via the vagus nerve, which exits the brain and runs down the esophagus, through the chest and into the abdomen. The stomach tells the brain when it’s empty and when it’s full, and the brain tells the stomach when to push food to the small intestine, Mitchell said.
When a patient is obese, though, those signals from the stomach to overeat can intensify. The vBloc Therapy procedure intermittently blocks the vagus nerve from sending those signals between the brain and stomach. Hormones and other signals in the body should still tell the brain to eat, but the powerful hunger signals from the stomach are temporarily jammed.
Mitchell said two wire leads are attached to the vagus nerve in the esophagus. Those leads are then attached to a small device — called the Maestro Rechargeable System — that is about a third the size of an iPhone and includes a battery pack and computer.
The device is placed in a pocket under the skin below the patient’s left rib. The patient, who is under general anesthesia during the entire laparoscopic procedure, goes home the same day and can expect to be sore near the incisions for seven to 10 days, Mitchell said.
Once the device is implanted, the doctor can customize the device’s strength based on the patient’s eating habits and schedule from a computer. Newell’s, for instance, is on for 13 hours a day. She feels it turn on and then rarely notices it again throughout the day.
“When it first comes on in the morning, it’s sort of like a little flutter,” she said, adding that it can also feel like a few seconds of mild heartburn.
When the device is on, the system creates electrical charges that are more powerful than the charge that the vagus nerve can generate on its own, so signals are blocked, Mitchell said.
“There’s no communication at that point with the stomach and the brain when the vBloc is on,” he said.
It is programmed to turn off at night so that Newell’s brain and stomach can still communicate while she is sleeping and, presumably, is not tempted to overeat.
“We can increase the amplitude or decrease the amplitude and work with the patient to be able to fine-tune it to the point where patients are not feeling these needs to eat for no reason and their hunger is under control,” Mitchell said.
The device can be shut off if a patient becomes pregnant or an emergency occurs, and it is designed to stay inside the patient for the remainder of his or her life, with only a battery change every 10 to 12 years — even if the patient achieves a healthier weight.
“No matter how long you try to exercise or diet or do things, once your body fat percent gets to a certain point, your body will fight to stay there, which is why we have such a very difficult time with obesity in this country,” Mitchell said.
The number of bariatric surgeries performed in the United States is on the rise. About 158,000 people received gastric bypass, gastric sleeve, lap band and other kinds of weight loss surgeries in 2011. That number was up to 196,000 by 2015, according to the American Society for Metabolic and Bariatric Surgery.
Mitchell said vBloc Therapy is a way of treating obesity without having to make permanent changes to a person’s anatomy the way other procedures do. Gastric bypass surgery, for example, involves dividing a patient’s stomach and rearranging the small intestine so that less food can be eaten.
The vBloc surgical procedure is just one part of the therapy, though. To ensure patients have no underlying binge eating disorders or psychological problems, which could preclude them from the procedure, they see a clinical therapist, and they work with dietitians and behavioral therapists to come up with a weight-loss plan and realistic expectations, Mitchell said.
“Not everybody on dialysis gets a kidney. A kidney transplant is a tremendous undertaking, and we think and like to pattern our treatment for obesity very similar to the way you would treat somebody with a transplant,” Mitchell said. “It’s a lifelong follow-up. ... We think it’s paramount that patients understand and buy into the fact that this just isn’t surgery.”
Mitchell said devices can malfunction, wires can become disconnected internally and patients can experience pain at the incision sites, nausea and cramping. Newell said she only had some mild soreness in the days after the surgery.
About three weeks after having the device implanted, Newell had lost about five or six pounds, which is what she expected in that short amount of time.
“This is not supposed to be a drastic weight loss. It’s supposed to be slow and continuous,” she said. “I’m not expected to lose 25 pounds in a month or that kind of thing.”
Newell said she can already tell a major difference in her relationship with food, adding that she no longer feels the urge to overeat.
“I would crave, and I would eat just to eat, not because I was hungry,” she said. “I’ve noticed I don’t have so much of the cravings.”
Some of Mitchell’s other patients are interested in the therapy, but he said the $18,000 price tag — it’s not covered by insurance — holds back many who are eligible based on their weight.
This story originally appeared in the Jan. 23, 2017, print edition of the Charleston Regional Business Journal.