Over 60 percent of American adults are overweight or obese. More than half of these are overweight, defined as a body mass index between 25 and 29.9. In Louisiana, stats are staggering, with obesity (BMI) prevalence of 30 percent or more.

For many obese patients (BMI of 30 or more), surgery is the ultimate solution. To qualify, the National Institutes of Health recommends that patients have a BMI of at least 40, or with BMI 35 and obesity-related comorbid conditions such as diabetes, hypertension or obstructive sleep apnea. But, most of the population – approximately 80 percent – is about 20 to 30 pounds overweight and does not qualify for the gold standards of laparoscopic gastric bypass, sleeve gastrectomy or lap band surgeries. These patients are usually the ones suffering through countless diet and endless exercise programs without achieving success.

Now, a new, non-surgical alternative, POSE (Primary Obesity Surgery, Endolumenal), is available to patients right here in Louisiana. “Basically, what that means is that through the mouth, endoscopically, we are able to decrease the size of the stomach so patients, number one, fill up on smaller amounts, and number two, have less hunger and cravings,” explained Dr. Tom Lavin, a general, laparoscopic and bariatric surgeon at Surgical Specialists of Louisiana. “So, they don’t want as much food.”

Surgical Specialists of Louisiana, a practice of eight bariatric surgeons in the New Orleans metro area, began performing POSE in February, 2009, as part of a registry with five other practices in the U.S. Out of 27 patients, SSL did nine of these procedures with the best results. Over the past year and a half, Lavin and his partners have done about 50 to 60 POSE weight loss operations. “I’ve done more than anybody in the world,” Lavin said. “I spoke on it at our international meeting in Hamburg, Germany, a few months ago. So, we right now, are the most experienced people in the world. And, we had the best results.”

The outpatient procedure, which is performed in the hospital, takes about one hour. “We sew the stomach closed from the inside,” Lavin explained. “That’s how you shrink it.” Patients can usually go home about three or four hours later.

POSE results are impressive. In Lavin’s practice, he has seen patients lose approximately 35 to 40 percent of their excess weight. Additionally, co-morbid conditions, such as diabetes and hypertension, have resolved. “We had good early results,” Lavin observed. “But, we feel they’ve been getting better, particularly over the last year, because we are doing much more this time. In our own practice, we’ve seen diabetes go away, and we’ve seen improvement in all the medical problems associated with obesity.”

Unlike surgical procedures like gastric bypass, banding and sleeve gastrectomy, where patients need to lose 75 to 100 pounds, POSE is indicated for those who want to lose anywhere from 20 to 70 pounds. “It’s a different subset of patients that we’re looking for to do POSE,” Lavin explained. “But then, it’s an endoscopic procedure that is outpatient as opposed to an actual surgical procedure.”

Side effects from POSE are minimal. Post-procedure, patients might expect a sore throat for a couple of days. “But, other than that, they shouldn’t have much pain,” Lavin said. “They should get back to work relatively quickly within in a day or two. “As with other endoscopic procedures, complications include bleeding and perforation of the GI tract. “This would be a very unlikely scenario. But, any time you do any endoscopic procedures, those are the types of things you have to worry about,” Lavin observed.

Although no long-term data is available, Lavin has seen good results with his POSE patients. He cautions that, as with most weight loss procedures, POSE is not a cure. “Everything we do needs to be seen as a tool, meaning there’s no magic,” he explained. “What we can do is decrease your capacity, and decrease your hunger drive and cravings. Those are the two things that no diet on the planet will ever do, and that’s why diets generally are always short-term solutions to a long-term problem.”

Patients also have no dietary limitations post-POSE. “There are no restrictions, because you don’t tighten (the stomach) so much that anything would ever get stuck or anything like that,” Lavin said. “But, of course, you want people to change their eating patterns and their habits. …after the procedure, they are going to fill up on smaller amounts and have fewer cravings of hunger.”

Patient feedback has been positive. “The patients are generally happy because, for the first time, they are filling up on a smaller amount, and they do have less hunger drive,” Lavin explained. “So, it helps get them over the hump to losing weight.”

Krystal Townsend of Hornbeck, La. had POSE this past June. She found out about Dr. Lavin while doing some Internet research, and thought that she would make a good candidate for POSE. For most of her life, she had struggled with her weight, which had a tendency to collect in her midsection. She had tried numerous commercial diets, including Weight Watchers, Adkins and Slimfast, only to lose weight then gain it back. “I could lose 15 or 20 pounds, but as soon as I messed up, the cycle would start all over again,” she recalled.

After having POSE, Townsend had a sore throat for a couple of days and some sore spots in her stomach for about two weeks. But, she never had any of the nausea, vomiting or “dumping syndrome” associated with surgical weight loss procedures. “Other than normal healing, I’ve had no side effects,” she reported. “It’s been an absolute breeze. I eat everything, anything that I want to eat.”

Townsend has found that her craving for sweets and between-meal snacks has decreased. “I think my appetite has decreased because I get full quicker,” she said. “I don’t have any doubt in my mind that I can reach my weight loss goal.”

Lavin finds that POSE is very effective for the right group of patients. “We see a lot of patients who will go through a liposuction and all these different procedures to help them lose weight or look better,” he said. “And, this procedure actually helps them get to the right weight and maintain it. So, we find this much more effective as opposed to just removing fat. It helps you fill up on a small amount and lose weight the natural way.”

To view the POSE procedure, check the website at POSEinfo.com.

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