Gastric pacing is not enough: additional measures for an effective obesity treatment program.

Obesity has long been considered a behavioral disorder. Recent breakthroughs in our understanding of body weight regulation, however, have shown that once adipose tissue accumulates, a system of overlapping neuroendocrine systems actively resists weight loss. This counter-regulatory mechanism, which has evolved as protection against starvation, causes changes in appetite and metabolism that limit the amount of weight lost with every obesity intervention, including surgery. Future therapies for obesity will focus on neutralizing the counter-regulatory mechanisms in a coordinated manner, making greater weight losses possible. At this point, gastric stimulation appears to play a role in suppressing the compensatory mechanisms of the gut. Thus, gastric stimulation should work best when combined with other treatments such as diet, exercise, and behavioral change.