In 2008, more than 1.6 billion adults were overweight (body mass index [BMI] ≥ 25), with more than 400 million considered obese (BMI ≥ 30). Currently, more than one-third of adults in the United States are obese, and by 2030, it is expected that more than 42% of Americans will be obese.
Being overweight and obese is associated with an increased risk of several diseases, including diabetes, cardiovascular disease (ie, heart disease and stroke), endometrial cancer, breast cancer, colon cancer, sleep apnea, and osteoarthritis. Of these obesity-related conditions, diabetes may be the most closely linked to obesity.
Diet, exercise, and behavioral modification have long been the mainstay of weight loss plans. 

Pharmacological interventions are rapidly being investigated. Drugs used to treat obesity include sibutramine and orlistat. Sibutramine was taken off the market due to adverse events. Orlistat works by inhibiting the action of gastric and pancreatic lipases. However, has side effects of flatulence and loose stools.

Bariatric surgery is indicated in patients with morbid obesity (BMI ≥ 40 or a BMI ≥ 35 with comorbid conditions).There are two general types of operations performed: those that restrict gastric volume (banded gastroplasty and sleeve gastrectomy) and those that alter digestion (Roux-en-Y gastric bypass)


Ghrelin-The hunger hormone is a hormone (protein) secreted in the cells in the fundus of the stomach. The hormone has been implicated in the regulation of eating behavior and weight balance. There are more ghrelin cells found in overweight patients. A small catheter is directed into the gastric artery and particles are deposited which cuts off the blood supply to this portion of the stomach. Bariatric surgery proposed for treatment of obesity is often associated with different complications and side effects. Ghrelin, a recently discovered neuropeptide that is predominantly produced in the gastric fundus is the only known hormone stimulating food intake. Patients reported decrease in appetite in 2-3 days after the procedure. Catheter-directed left Gastric Artery Chemical Embolization (GACE) in studies demonstrated decrease in ghrelin levels which lead to significant weight loss.

Ghrelin is a hormone produced by specialized cells that line the stomach and the pancreas.

Ghrelin is one of the main hormones to stimulate hunger. Ghrelin levels increase before meals and decrease after meals, a mechanism that has its roots in the hypothalamus. If the lateral hypothalamus is removed (as seen in animal studies), feeding becomes less frequent leading to severe weight loss and death.

A hormone that counteracts the effects of ghrelin is leptin, which is produced by the fat or adipose tissue in the body. Leptin induces satiation or a feeling of fullness after a meal. When the leptin level is high, hunger is decreased. Since ghrelin increases hunger, several weight loss procedures aim to reduce the ghrelin level in order to increase satiation, even with a small meal.

Catheter in the left gastric artery. The artery is outlined with contrast dye.

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